Wireless Sensor for Guiding Severe Trauma Resuscitation

 描述(申请人提供)：创伤是美国1-44岁人群的主要死因(S)。对受伤病人的护理标准是控制出血 和容量复苏。复苏的目标是恢复组织灌流，纠正氧供应和组织氧需求之间的失衡。为了解决休克期累积的组织氧“债务”，氧输送通常必须大大高于正常水平。目前，复苏是由血压、尿量和心率等全身指标指导的。在这些参数正常化后，高达85%的患者仍处于“代偿性休克”状态，仍有组织酸中毒。代偿性休克状态可导致多器官功能障碍综合征(MODS)，MODS是外科重症监护病房的主要死亡原因。组织灌注量或酸中毒和氧耗量是指导复苏充分性和预测MODS发展的较好指标。肠道已被证明是对失血性休克最敏感的器官，因此是理想的监测目标。这项工作的重点是开发和测试一种基于微型光子学的肠道血流和氧合监测系统，该系统专门针对肠道使用进行优化，以更准确地指导创伤和失血性休克的复苏。这样的系统将有助于向医生保证，患者从休克中完全复苏，但不会出现“过度复苏”的并发症。我们的团队将开发和测试一种新型的3波长植入式光子系统，该系统结合使用脉搏血氧仪和可见光(VIS)光谱来测量动脉血氧饱和度、静脉血氧饱和度和组织灌注量。植入式传感器单元将与电子设备集成，用于放大和处理信号，以将噪音降至最低，并与遥测系统集成，以将信号无线发送到床边单元。床边单元将能够处理收集的数据，并以医生可以用来做出临床决策的形式显示患者的血流和氧合信息。传感器的性能将在体外使用基于新型聚二甲基硅氧烷(PDMS)的模体进行测试，并在兔模型中进行测试。

 DESCRIPTION (provided by applicant): Trauma is the leading cause of death for people aged 1-44 year(s) in the United States. The standard of care for injured patients is to control bleeding and volume resuscitation. The goal of resuscitation is to restore tissue perfusion and to correct the imbalance between oxygen supply and tissue oxygen demand. Oxygen delivery must often be increased substantially above normal levels in order to resolve accrued tissue oxygen "debt" from the period of shock. Currently, resuscitation is guided by systemic indicators such as blood pressure, urine output, and heart rate. After these parameters are normalized up to 85% of patients are still in "compensated shock" and still have tissue acidosis. The compensated shock state can lead to multiple organ dysfunction syndrome (MODS) which is the leading cause of death in surgical intensive care units. Tissue perfusion or acidosis and oxygen consumption are better criteria to guide adequacy of resuscitation and to predict the development of MODS. The intestine has been demonstrated to be the organ most sensitive to hemorrhagic shock, and it is therefore the ideal target for monitoring. The focus of this work is to develop and test a miniatur photonics-based intestinal perfusion and oxygenation monitoring system specifically optimized for use on the intestine to more accurately guide resuscitation from trauma and hemorrhagic shock. Such a system would help assure the physician that patients are fully resuscitated from shock but without complications of "over-resuscitation". Our team will develop and test a novel 3-wavelength implantable photonic system that measures arterial oxygen saturation, venous oxygen saturation, and tissue perfusion using a combination of pulse oximetry and visible (VIS) spectroscopy. The implantable sensor unit will be integrated with electronics for amplifying and processing the signal to minimize noise and a telemetry system to send the signal wirelessly to the bed-side unit. The bed-side unit will be able to process the collected data and display the patient perfusion and oxygenation information in a form that the physician can use to make clinical decisions. The sensor performance will be tested in vitro using novel polydimethylsiloxane (PDMS) based phantoms and in vivo in a rabbit model.