Document Detail


Massive transfusion in trauma patients: tissue hemoglobin oxygen saturation predicts poor outcome.
MedLine Citation:
PMID:  18404069     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Severely bleeding trauma patients requiring massive transfusion (MT) often experience poor outcomes. Our purpose was to determine the potential role of near infrared spectrometry derived tissue hemoglobin oxygen saturation (StO2) monitoring in early prediction of MT, and in the identification of those MT patients who will have poor outcomes. METHODS: Data from a prospective multi-institution StO2 monitoring study were analyzed to determine the current epidemiology of MT (defined as transfusion volume >/=10 units packed red blood cells in 24 hours of hospitalization). Multivariate logistic regression was used to develop prediction models. RESULTS: Seven US level I trauma centers (TC) enrolled 383 patients. 114 (30%) required MT. MT progressed rapidly (40% exceeded MT threshold 2 hours after TC arrival, 80% after 6 hours). One third of MT patients died. Two thirds of deaths were due to early exsanguination and two thirds of early exsanguination patients died within 6 hours. One third of the early MT survivors developed multiple organ dysfunction syndrome. MT could be predicted with standard, readily available clinical data within 30 minutes and 60 minutes of TC arrival (area under the receiver operating characteristic curve = 0.78 and 0.80). In patients who required MT, StO2 was the only consistent predictor of poor outcome (multiple organ dysfunction syndrome or death). CONCLUSION: MT progresses rapidly to significant morbidity and mortality despite level I TC care. Patients who require MT can be predicted early, and persistent low StO2 identifies those MT patients destined to have poor outcome. The ultimate goal is to identify these high risk patients as early as possible to test new strategies to improve outcome. Further validation studies are needed to analyze appropriate allocation and study appropriate use of damage control interventions.
Authors:
Frederick A Moore; Teresa Nelson; Bruce A McKinley; Ernest E Moore; Avery B Nathens; Peter Rhee; Juan Carlos Puyana; Gregory J Beilman; Stephen M Cohn;
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Journal of trauma     Volume:  64     ISSN:  1529-8809     ISO Abbreviation:  J Trauma     Publication Date:  2008 Apr 
Date Detail:
Created Date:  2008-04-11     Completed Date:  2008-04-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376373     Medline TA:  J Trauma     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1010-23     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, The Methodist Hospital, Houston Texas, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Blood Transfusion / methods*
Cohort Studies
Female
Hemoglobins / analysis*
Humans
Injury Severity Score
Male
Middle Aged
Multicenter Studies as Topic
Multiple Organ Failure / prevention & control*
Oximetry
Oxygen Consumption / physiology*
Predictive Value of Tests
Prognosis
Prospective Studies
Risk Assessment
Shock, Hemorrhagic / etiology,  mortality*,  therapy*
Survival Rate
Trauma Centers
Treatment Outcome
Wounds and Injuries / complications
Chemical
Reg. No./Substance:
0/Hemoglobins
Investigator
Investigator/Affiliation:
Janet McCarthy / ; Stephen M Cohn / ; Rachelle Babbitt Jonas / ; Joseph Johnston / ; Peter Lopez / ; Avery B Nathens / ; Dian Nuxoll / ; Frederick A Moore / ; Huawei Tang / ; Bruce A McKinley / ; Peter Rhee / ; Burapat Sangthong / ; Constantinos Constantinou / ; Juan Carlos Puyana / ; Patricio Polanco / ; Andrew B Peitzman / ; Ernest E Moore / ; Stephanie Huls / ; Jeffrey L Johnson / ; Catherine C Cothren / ; Gregory J Beilman / ; Melissa Thorson / ; Alan Beal / ; Teresa Nelson / ; Ronald G Pearl / ; Larry M Gentilello / ; Anthony A Meyer / ; LeAnn Anderson / ; Barbara Gallea / ; Diane Rupp / ; Becky Saar / ; Michelle McGraw / ; V A Diaz / ; Kristi Carlson / ; Greg Wheatley /

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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