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Prehospital dynamic tissue oxygen saturation response predicts in-hospital lifesaving interventions in trauma patients

Kim, HK and Hostler, D and Puyana, JC and Pinsky, MR (2012) Prehospital dynamic tissue oxygen saturation response predicts in-hospital lifesaving interventions in trauma patients. Journal of Trauma and Acute Care Surgery, 72 (4). 930 - 935. ISSN 2163-0755

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Abstract

BACKGROUND: Tissue oximetry (StO2) plus a vascular occlusion test is a noninvasive technology that targets indices of oxygen uptake and delivery. We hypothesize that prehospital tissue oximetric values and vascular occlusion test response can predict the need for in-hospital lifesaving interventions (LSI). METHODS: We conducted a prospective, blinded observational study to evaluate StO2slopes to predict the need for LSI. We calculated the DeO2slope using Pearson's coefficients of regression (r2) for the first 25% of descent and the ReO2slope using the entire recovery interval. The primary outcome was LSI defined as the need for emergent operation or transfusion in the first 24 hours of hospitalization. We created multivariable logistic regression models using covariates of age, sex, vital signs, lactate, and mental status. RESULTS: We assessed StO2in a convenience sample of 150 trauma patients from April to November of 2009. In-hospital mortality was 3% (95% confidence interval [CI], 1.1-7.6); 31% (95% CI, 24-39) were admitted to the intensive care unit, 6% (95% CI, 2.8 -11.1) had an emergent operation, and 10% (95% CI, 5.7-15.9) required transfusion. Decreasing DeO2was associated with a higher proportion of patients requiring LSI. In the multivariate model, the association between the need for LSI and DeO2, Glasgow Coma Scale, and age persists. CONCLUSION: Prehospital DeO2is associated with need for LSI in our trauma population. Further study of DeO2is warranted to determine whether it can be used as an adjunct triage criterion or an endpoint for resuscitation. Copyright © 2012 by Lippincott Williams & Wilkins.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Kim, HKhyk11@pitt.eduHYK11
Hostler, D
Puyana, JC
Pinsky, MRpinsky@pitt.eduPINSKY
Centers: Other Centers, Institutes, or Units > McGowan Institute for Regenerative Medicine
Date: 1 April 2012
Date Type: Publication
Journal or Publication Title: Journal of Trauma and Acute Care Surgery
Volume: 72
Number: 4
Page Range: 930 - 935
DOI or Unique Handle: 10.1097/ta.0b013e31823d0677
Schools and Programs: School of Medicine > Critical Care Medicine
Refereed: Yes
ISSN: 2163-0755
MeSH Headings: Adolescent; Adult; Aged; Aged, 80 and over; Blood Circulation; Emergency Medical Services--statistics & numerical data; Emergency Service, Hospital--statistics & numerical data; Female; Humans; Male; Middle Aged; Oximetry--statistics & numerical data; Predictive Value of Tests; Prospective Studies; Resuscitation--statistics & numerical data; Shock, Traumatic--diagnosis; Shock, Traumatic--etiology; Shock, Traumatic--therapy; Wounds and Injuries--blood; Wounds and Injuries--mortality; Wounds and Injuries--therapy; Young Adult
PubMed ID: 22491607
Date Deposited: 18 Oct 2012 21:13
Last Modified: 10 Jan 2019 14:55
URI: http://d-scholarship.pitt.edu/id/eprint/16006

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