Please see Bibliography of References for a list of abstracts, manuscripts and posters.
Pottecher J, Mathe O, Laplace C, Mesnil M, Repesse X, Benhamou D, Duranteau J. Int Care Med. 2008;34(1):S257. Abstract 1007.
Introduction: The aim of this study was to assess microvascular dysfunction in trauma hemorrhagic shock (HS) patients by recording near-infrared spectroscopy (NIRS) signal during arterial occlusion tests.
Methods: After approval from our local IRB, trauma patients with HS were included in this prospective study. As soon as hemodynamic stabilization was obtained, NIRS-derived StO2 signals (InSpectra®, Hutchinson, USA) were recorded on the thenar eminence during 3 min brachial artery occlusion (Figure). The same trial was applied in ten healthy volunteers. Demographic, hemodynamic data, SAPSII and ISS scores were gathered. Data are median [IQR] are were analyzed with Mann-Whitney and Spearman tests.
Results: Nineteen HS patients aged 32 [23–56], SAPS II : 43 [32–63], ISS : 34 [24–44] were included after hemodynamic stabilization : MAP : 75 [62–78] mmHg. NIRS-derived values neither correlated with hemodynamic data nor with clinical scores. Occlusion and recovery slopes differed between HS patients and volunteers (Table 1).
Table 1: NIRS-Derived StO2 Values During Occlusion Tests in Hemorrhagic Shock and Volunteers
|
Hemorrhagic shock n = 19 |
Healthy volunteers n = 10 |
P value | |
|
Basal StO2, % |
80 [71–84] |
81 [77–85] |
NS |
|
Occlusion slope, %/min |
7 [7–10] |
11 [10–12] |
0.039 |
|
StO2 min, % |
45 [38–56] |
47 [38–50] |
NS |
|
Recovery slope, %/min |
79 [54–142] |
208 [204–219] |
0.0003 |
|
Hyperemic area, %.min |
15 [9–21] |
16 [11–21] |
NS |
Conclusion: Reduced occlusion and recovery slopes in trauma HS patients compared to healthy volunteers may reflect reduced oxygen consumption and impaired capillary recruitment respectively. Further patients are needed to confirm those results and study the time frame of this microvascular dysfunction.