Near-infrared spectroscopy-guided closed-loop resuscitation of hemorrhage

Neal F. Chaisson, Robert A. Kirschner, Donald J. Deyo, J. Abraham Lopez, Donald Prough, George Kramer

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

Background: Endpoint resuscitation has been suggested as a better means to resuscitate penetrating injury. We performed computer-controlled closed-loop resuscitation using invasive cardiac output (CO) or noninvasive skeletal muscle oxygen saturation (SkMusSO2) via near infrared spectroscopy (NIRS). Methods: Conscious sheep received a 4.0-mm aortotomy and uncontrolled hemorrhage at t = 0 min (TO) while resuscitation started at T20 using lactated Ring. er's solution. Results: The aortotomy rapidly decreased the mean arterial pressure (MAP) to approximately 30 mm Hg and CO to 20% to 30% of baseline. The SkMusSO2 endpoint group required only half as much fluid through 4 hours of resuscitation as the CO endpoint group (34.9 ± 8.4 mL/kg vs. 63.1 ± 9.4 mL/kg). CO and MAP were lower in the SkMusSO2 group after T60. Mean infusion volumes were 180% and 100% of the bled volume collected at autopsy in the CO and SkMusSO2 groups. Brain and muscle oxygenation and base excess were as high or higher in the CO endpoint group. Conclusion: Closed-loop resuscitation with either CO or SkMusSO2 endpoints effectively performs fluid resuscitation of severe uncontrolled hemorrhagic shock. Limited resuscitation may achieve favorable clinical results with volumes less than recommended by Advanced Trauma Life Support guidelines.

Original languageEnglish (US)
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume54
Issue number5 SUPPL.
StatePublished - May 1 2003

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Near-Infrared Spectroscopy
Resuscitation
Cardiac Output
Hemorrhage
Arterial Pressure
Advanced Trauma Life Support Care
High Cardiac Output
Hemorrhagic Shock
Autopsy
Sheep
Skeletal Muscle
Guidelines
Oxygen
Muscles
Wounds and Injuries
Brain

Keywords

  • Circulatory shock
  • Closed-loop resuscitation
  • Computers in medicine
  • Fluid therapy
  • Near-infrared spectroscopy (NIRS)
  • Trauma

ASJC Scopus subject areas

  • Surgery

Cite this

Near-infrared spectroscopy-guided closed-loop resuscitation of hemorrhage. / Chaisson, Neal F.; Kirschner, Robert A.; Deyo, Donald J.; Lopez, J. Abraham; Prough, Donald; Kramer, George.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 54, No. 5 SUPPL., 01.05.2003.

Research output: Contribution to journalArticle

Chaisson, Neal F. ; Kirschner, Robert A. ; Deyo, Donald J. ; Lopez, J. Abraham ; Prough, Donald ; Kramer, George. / Near-infrared spectroscopy-guided closed-loop resuscitation of hemorrhage. In: Journal of Trauma - Injury, Infection and Critical Care. 2003 ; Vol. 54, No. 5 SUPPL.
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