Lightweight noninvasive trauma monitor for early indication of central hypovolemia and tissue acidosis: a review.
نویسندگان
چکیده
BACKGROUND Hemorrhage is a major cause of soldier death; it must be quickly identified and appropriately treated. We developed a prototype patient monitor that noninvasively and continuously determines muscle oxygen saturation (SmO₂), muscle pH (pHm), and a regional assessment of blood volume (HbT) using near-infrared spectroscopy. Previous demonstration in a model of progressive, central hypovolemia induced by lower body negative pressure (LBNP) showed that SmO₂ provided an early indication of impending hemodynamic instability in humans. In this review, we expand the number of subjects and provide an overview of the relationship between the muscle and sublingual microcirculation in this model of compensated shock. METHODS Healthy human volunteers (n = 30) underwent progressive LBNP in 5-minute intervals. Standard vital signs, along with stroke volume (SV), total peripheral resistance, functional capillary density, SmO₂, HbT, and pHm were measured continuously throughout the study. RESULTS AND DISCUSSION SmO₂ and SV significantly decreased during the first level of central hypovolemia (-15 mm Hg LBNP), whereas vital signs were later indicators of impending cardiovascular collapse. SmO₂ declined with SV and inversely with total peripheral resistance throughout LBNP. HbT was correlated with declining functional capillary density, suggesting vasoconstriction as a cause for decreased SmO₂ and subsequently decreased pHm. CLINICAL TRANSLATION: The monitor has been miniaturized to a 58-g solid-state sensor that is currently being evaluated on patients with dengue hemorrhagic fever. Early results demonstrate significant decreases in SmO₂ similar to those observed with progressive reductions in central blood volume. As such, this technology has the potential to (1) provide a monitoring capability for both nontraumatic and traumatic hemorrhage and (2) help combat medics triage casualties and monitor patients during lengthy transport from combat areas.
منابع مشابه
Lightweight Noninvasive Trauma Monitor for Early Indication of Central Hypovolemia and Tissue Acidosis
Hemorrhage is a major cause of soldier death, particularly in the first hour of injury. Seriously injured soldiers must be quickly identified and appropriate resuscitation techniques applied. Currently available vital sign measurements are inadequate for this task. In previous swine and human studies we have demonstrated that muscle oxygen measurements respond rapidly to internal bleeding and t...
متن کاملO18: In Hospital Management of Child with Road Trauma
Trauma is the most common cause of mortality and morbidity in pediatric population. Caring for the injured child requires special knowledge, precise management, and scrupulous attention to details. All clinicians who are responsible for the care of a pediatric trauma patient, including pediatricians, pediatric emergency room clinicians, and trauma surgeons, must be familiar with every tenet of ...
متن کاملDetecting change in left ventricular ejection time during head-up tilt-induced progressive central hypovolemia using a finger photoplethysmographic pulse oximetry wave form.
BACKGROUND Change in cardiac preload caused by mild hypovolemia can alter left ventricular ejection time (LVET) without noticeable change in blood pressure (BP). Previously our group has explored a novel method of LVET monitoring using a noninvasive finger photoplethysmographic pulse oximetry wave form. The current study investigated the ability of photoplethysmographic pulse oximetry wave form...
متن کاملComparison of Intra-abdominal Pressure Measurement and Physical Exam for Diagnosis of Surgery Indication in Patients with Abdominal Compartment Syndrome due to Blunt Trauma
Background & Aims: Increase in abdominal pressure can lead to the so-called intra–abdominal compartment syndrome (ACS) that is often observed during the first 24 hours after sever abdominal trauma and surgery. Measurement of the intra abdominal pressure through the bladder as a non-invasive measurement can provide a quick and accurate assessment of abdominal pressure changes. This study was per...
متن کاملPathogenesis of acute traumatic coagulopathy.
Acute traumatic coagulopathy (ATC) is an early endogenous process, driven by the combination of tissue injury and shock that is associated with increased mortality and worse outcomes in the polytrauma patient. This review summarizes our current understanding of the pathophysiology of ATC and the role of rapid diagnostics in the management of severe trauma hemorrhage. In particular we consider d...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
عنوان ژورنال:
- The journal of trauma and acute care surgery
دوره 73 2 Suppl 1 شماره
صفحات -
تاریخ انتشار 2012