Near-infrared spectroscopy during resuscitation of trauma patients predicts development of multiple organ dysfunction: a prospective cohort study

Introduction

Near-infrared spectroscopy (NIRS) noninvasively monitors muscle tissue oxygen saturation (StO₂). It may provide a continuous measurement to identify occult hypoperfusion, guide resuscitation, and predict the development of multiple organ dysfunction (MOD) after severe trauma. We evaluated the correlation between initial StO₂ and the development of MOD in multitrauma patients.

Methods

Patients presenting to our urban, academic, Level I Trauma Center/Emergency Department (TC/ED) and meeting standardized trauma-team activation criteria were enrolled. NIRS monitoring with collection of StO₂ at the thenar eminence was initiated immediately on arrival at the ED and continued up to 24 hours for those admitted to the trauma ICU. Standardized resuscitation assessment laboratory measures and clinical evaluation tools were collected. The primary outcome in this prospective study was the association between StO₂ and the development of MOD within the first 24 hours based on a MOD score of 6 or greater. Clinicians were blinded from the StO₂ values.

Results

Over a 14-month period, 78 patients were enrolled. Of the 78 patients, 26 (33.3%) developed MOD within the first 24 hours. The MOD patients had mean (SD) initial StO₂ values of 53.3 (± 10.3), significantly lower than those of non-MOD patients (61.1 (± 10.0); P = 0.002). The MOD patient mean shock index of 0.92 (± 0.28) was also significantly higher than those of non-MODS patients (0.73 (± 0.19); P = 0.0007). Lactate values were not significantly different.

Conclusion

Noninvasive, continuous StO₂ NIRS on initial arrival in the TC/ED correlates with the shock index and with the development of MOD.