Please see Bibliography of References for a list of abstracts, manuscripts and posters.
Heyer L, Rezlan E, Madadaki K, Rabuel C, Schourando P, Payen D. Int Care Med. 2006;32(Supp 1):S168. Abstract 0643.
Introduction: We study the micro-oxygenation impairment of peripheral muscle in post-partum haemorrhagic shock.
Methods: Tissue oxygenation and perfusion of thenar muscle were assessed using near infrared spectrometry technique (NIRS) at ICU admission in 33 consecutive post-partum haemorrhagic shock women. Tissue O2 saturation was measured at baseline ( StO2) and following forearm arterial occlusion. The slope of the decrease in StO2 during occlusion (S-Occ), the slope of the increase in StO2 following occlusion release (S-Rel) and the deficit of post-ischemic oxygenation recruitment (Deficit) in response to transient ischemia were measured. The haemorrhagic shock group (HEMORRHAGE) was divided accordingly to myocardial ischemia defined by a Troponin I value above 0.08 ng/ml (TROPO+ and TROPO-). Values obtains in a control group of 11 post-partum women with normal delivery (CONTROL) were used for comparison.
Results: Tissue oxygenation and perfusion were significantly impaired in HAEMORRHGE group but an additional impairment was observed in TROPO+ sub-group only for S-Occ and S –Rel (p<0.004 et p<0.0001 respectively). In multivariable analysis, the increase in lactate acid and the decrease in S-Rel were the two independent factors associated to Troponin I elevation (p=0.04).
Table 1:
|
CONTROL (11) |
HAEMORRHAGE TROPO – (20) |
HAEMORRHAGE TROPO + (13) |
Anova p | |
|
StO2 (%) |
87 (4) |
81 (5) |
77 (15) |
0.03 |
|
Deficit (%) |
2 (1) |
5 (2) |
10 (11) |
0.008 |
|
S-Occ (%/mn) |
- 28 (7) |
- 20 (9) |
- 13 (6) |
< 0.0001 |
|
S-Rel (%/mn) |
453 (107) |
328 (92) |
156 (95) |
< 0.0001 |
Conclusion: Post-partum acute haemorrhage cause diffuse hypo perfusion with myocardial ischemia and dysfunction of micro-vascular pathway of the peripheral muscle. This disease of the tissue appears in spite of aggressive cares. Local monitoring of tissue oxygenation and perfusion with thenar NIRS highlights the interest of tissue perfusion optimization as a therapeutic resuscitation goal in heamorrhagic shock patients.
Grant acknowledgement: supported by HUTCHINSON Technology Inc