Systemic central venous oxygen saturation is associated with clot strength during traumatic hemorrhagic shock: A preclinical observational modelReportar como inadecuado




Systemic central venous oxygen saturation is associated with clot strength during traumatic hemorrhagic shock: A preclinical observational model - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

, 18:64

First Online: 07 December 2010Received: 19 August 2010Accepted: 07 December 2010

Abstract

BackgroundClot strength by Thrombelastography TEG is associated with mortality during trauma and has been linked to severity of tissue hypoperfusion. However, the optimal method for monitoring this important relationship remains undefined. We hypothesize that oxygen transport measurements will be associated with clot strength during traumatic shock, and test this hypothesis using a swine model of controlled traumatic shock.

MethodsN = 33 swine were subjected to femur fracture and hemorrhagic shock by controlled arterial bleeding to a predetermined level of oxygen debt measured by continuous indirect calorimetry. Hemodynamics, oxygen consumption, systemic central venous oxygenation ScvO2, base excess, lactate, and clot maximal amplitude by TEG TEG-MA as clot strength were measured at baseline and again when oxygen debt = 80 ml-kg during shock. Oxygen transport and metabolic markers of tissue perfusion were then evaluated for significant associations with TEG-MA. Forward stepwise selection was then used to create regression models identifying the strongest associations between oxygen transport and TEG-MA independent of other known determinants of clot strength.

ResultsMultiple markers of tissue perfusion, oxygen transport, and TEG-MA were all significantly altered during shock compared to baseline measurements p < 0.05. However, only ScvO2 demonstrated a strong bivariate association with TEG-MA measured during shock R = 0.7, p < 0.001. ScvO2 measured during shock was also selected by forward stepwise selection as an important covariate in linear regression models of TEG-MA after adjusting for the covariates fibrinogen, pH, platelet count, and hematocrit Whole model R = 0.99, p ≤ 0.032.

ConclusionsAmong multiple measurements of oxygen transport, only ScvO2 was found to retain a significant association with TEG-MA during shock after adjusting for multiple covariates. ScvO2 should be further studied for its utility as a clinical marker of both tissue hypoxia and clot formation during traumatic shock.

AbbreviationsAISAbbreviated Injury Scale

aPTTActivated Partial Thromboplastin Time

BEBase Excess

DeltaDifference

HgbHemoglobin

ISSInjury Severity Score

MAMaximal Amplitude

MAPMean Arterial Pressure

ODOxygen Debt

PCO2Partial Pressure of Carbon Dioxide

PltPlatelet Count

PTProthrombin Time

ROTEMRotational Thrombelastometry

TEGThrombelastography

TICTrauma Induced Coagulopathy

VO2Total Body Oxygen Consumption

WBCWhite Blood Cell Count

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Autor: Nathan J White - Erika J Martin - Yongyun Shin - Donald F Brophy - Robert F Diegelmann - Kevin R Ward

Fuente: https://link.springer.com/







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