Anaerobic metabolism associated with traumatic hemorrhagic shock monitored by microdialysis
of muscle tissue is dependent on the levels of hemoglobin and central venous oxygen saturation: a
prospective, observational study
Engelsk titel: Anaerobic metabolism associated with traumatic hemorrhagic shock monitored by microdialysis
of muscle tissue is dependent on the levels of hemoglobin and central venous oxygen saturation: a
prospective, observational study
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Författare:
Bursa, Filip
;
Pleva, Leopold
Email: bursaf@seznam.cz
Språk: Eng
Antal referenser: 39
Dokumenttyp:
Artikel
UI-nummer: 14129114
Sammanfattning
BACKGROUND:
Traumatic hemorrhagic shock resulting in tissue hypoxia is a significant cause of morbidity and
mortality in polytraumatized patients. Early identification of tissue hypoxia is possible with
microdialysis. The aim of this study was to determine the correlation between a marker of tissue
hypoxia (L/P; lactate to pyruvate ratio) and selected parameters of systemic oxygen delivery (Hb;
hemoglobin) and oxygen extraction (ScvO2; central venous oxygen saturation). We also investigated
the severity of tissue hypoxia over the course of care.
METHODS:
Adult patients with traumatic hemorrhagic shock were enrolled in this prospective, observational
study. Microdialysis of the peripheral muscle tissue was performed. Demographic data and timeline
of care were collected. Tissue lactate, pyruvate, glycerol, glucose levels, hemoglobin, serum lactate
and oxygen saturation of the central venous blood (ScvO2) levels were also measured.
RESULTS:
The L/P ratio trend may react to changes in systemic hemoglobin levels with a delay of 7 to 10 hours,
particularly when systemic hemoglobin levels are increased by transfusion. Decrease in tissue L/P
ratio may react to increase in ScvO2 with a delay of up to 10 hours, and such a decrease may signify
elimination of tissue hypoxia after transfusion. We also observed changes in the L/P trend in the 13
hours preceding a change in the hemoglobin level. Fluid administration, which is routinely used as a
first-line treatment of hypovolemic shock, can cause hemodilution and decreased hemoglobin. When
ScvO2 decreases, increase in L/P ratio may precede the ScvO2 trend by 10 or 11 hours. An increase
in the L/P ratio is an early warning sign of insufficient tissue oxygenation and should lead to
intensive observation of hemoglobin levels, ScvO2 and other hemodynamic parameters. Patients
who were treated more rapidly had lower maximal L/P values and a lower degree of tissue ischemia.
CONCLUSION:
The L/P ratio is useful to identify tissue ischemia and can estimate the effectiveness of fluid
resuscitation. An increase in the L/P ratio is an early warning sign of inadequate tissue oxygenation
and should lead to more detailed hemodynamic and laboratory monitoring. This information cannot
usually be obtained from global markers.