Continuous measurement of cerebral oxygen saturation (rSO2) for assessment of cardiovascular status during hemorrhagic shock in a swine model
Continuous measurement of cerebral oxygen saturation (rSO2) for assessment of cardiovascular status during hemorrhagic shock in a swine model
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DOI：
10.1097/ta.0b013e3182606372
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发表时间：
2012-08-01
影响因子：
3.4
通讯作者：
Kramer, George C.
中科院分区：
文献类型：
--
作者：
Camacho Navarro, Lais Helena;Lima, Rodrigo M.;Kramer, George C.
背景：早期创伤护理依赖于主观评估和零星的生命体征评估。我们假设，近红外光谱测量的脑氧合（局部氧饱和度[rSO 2]）将提供一种工具来检测活动性出血期间的心血管损害。我们将rSO（2）与侵入性测量的混合静脉血氧饱和度（SvO（2））、平均动脉压（MAP）、心输出量、心率和计算的脉压进行比较。rSO（2）用无创性脑血氧测定法监测; SvO（2）用光纤肺动脉导管测量。作为对每个变量的时间反应性的评估，我们记录了每个变量从出血开始的分钟数，与基线相比，每个变量达到5%，10%，15%和20%的变化。结果：心血管崩溃的平均时间为35分钟+/- 11分钟（54 +/- 17%总血容量）。在平均MAP为78 mm Hg +/- 17 mm Hg时，脑rSO（2）开始稳定下降，远高于预期的脑血流量自动调节阈值。出血时rSO（2）下降5%、10%和15%的时间与SvO（2）相似，但rSO（2）比MAP下降的百分比滞后6分钟。rSO（2）与MAP（R-2 = 0.72）之间的相关性高于SvO（2）与MAP（R-2 = 0.55）之间的相关性。结论：近红外光谱测量的rSO（2）在出血过程中提供了可重复的降低，其时间过程与侵入性测量的心输出量和SvO（2）相似，但与MAP和脉压相比延迟5 - 9分钟。rSO（2）可以提供出血性休克恶化的早期警告，以便在无法进行连续动脉血压测量时对创伤患者进行及时干预。（J Trauma Acute Care Surg.2012; 73：S140-S146.版权所有（C）2012由LippincottWilliams & Wilkins）
BACKGROUND: Early trauma care is dependent on subjective assessments and sporadic vital sign assessments. We hypothesized that near-infrared spectroscopy-measured cerebral oxygenation (regional oxygen saturation [rSO2]) would provide a tool to detect cardiovascular compromise during active hemorrhage. We compared rSO(2) with invasively measured mixed venous oxygen saturation (SvO(2)), mean arterial pressure (MAP), cardiac output, heart rate, and calculated pulse pressure.METHODS: Six propofol-anesthetized instrumented swine were subjected to a fixed-rate hemorrhage until cardiovascular collapse. rSO(2) was monitored with noninvasively measured cerebral oximetry; SvO(2) was measured with a fiber optic pulmonary arterial catheter. As an assessment of the time responsiveness of each variable, we recorded minutes from start of the hemorrhage for each variable achieving a 5%, 10%, 15%, and 20% change compared with baseline.RESULTS: Mean time to cardiovascular collapse was 35 minutes +/- 11 minutes (54 +/- 17% total blood volume). Cerebral rSO(2) began a steady decline at an average MAP of 78 mm Hg +/- 17 mm Hg, well above the expected autoregulatory threshold of cerebral blood flow. The 5%, 10%, and 15% decreases in rSO(2) during hemorrhage occurred at a similar times to SvO(2), but rSO(2) lagged 6 minutes behind the equivalent percentage decreases in MAP. There was a higher correlation between rSO(2) versus MAP (R-2 = 0.72) than SvO(2) versus MAP (R-2 = 0.55).CONCLUSIONS: Near-infrared spectroscopy-measured rSO(2) provided reproducible decreases during hemorrhage that were similar in time course to invasively measured cardiac output and SvO(2) but delayed 5 to 9 minutes compared with MAP and pulse pressure. rSO(2) may provide an earlier warning of worsening hemorrhagic shock for prompt interventions in patients with trauma when continuous arterial BP measurements are unavailable. (J Trauma Acute Care Surg. 2012; 73: S140-S146. Copyright (C) 2012 by LippincottWilliams & Wilkins)