Acil servise başvuran multitravma hastalarında doku satürasyon cihazı ölçümleriyle kan ürünü ihtiyacı ve mortalite öngörülebilir mi?
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Tarih
2022
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Dünya genelinde multitravma hastalarında hemorajik şok mortalitenin önde gelen
nedenidir. Sıvı resüsitasyonu ile doku oksijenizasyonun idame ettirilmesi, kanama kontrolü ve
koagülasyon desteği hemorajik şok hastalarında tedavinin temelini oluşturmaktadır. Hemorajik
şokun erken tanınması yaşam kurtarıcı müdahalelerin uygulanma zamanını azaltarak hastaların
sağkalımını arttırmaktadır. Ancak hemorajik şok varlığı kan basıncı ve kalp hızı gibi standart
vital bulguların monitörizasyonu ile her zaman tanınamamaktadır. Doku oksijen satürasyonu
(StO2) doku perfüzyonunu göstermektedir ve aktif kanama sırasında azalması beklenmektedir.
Travma merkezine hastaların gelişi sırasında ölçülen StO2 seviyesi hemorajik şok varlığını ve
kan transfüzyon ihtiyacının tahmininde kullanılabilir. Bu çalışmanın amacı yakın kızıl ötesi
spektroskopi ile değerlendirilen StO2 ölçümlerinin kan transfüzyonu ve mortalite tahminindeki
öneminin belirlenmesidir.
Gereç ve yöntem
Bir üniversite hastanesi acil servisine Ocak 2021-Ocak 2022 arasında getirilen 61 hasta
çalışmaya prospektif şekilde dahil edildi. Travma sonrası ilk 24 saatte acil servise getirilemeyen
hastalar çalışmadan dışlandı. Travma merkezine hastaların gelişi sırasında kan basıncını
ölçülmediği kolun tenar eminens bölgesine InSpectra StO2 cihazı yerleştirildi. Hastaların
demografik özellikleri, travma mekanizması, mortalite oranı, hastaların gelişi sırasındaki
sistolik (SKB) ve diyastolik kan basıncı (DKB), kalp hızı, hemoglobin ve laktat seviyesi
kaydedildi. ROC analizinde kan transfüzyonunda belirleyici olabilecek faktörler
değerlendirildi.
Bulgular
Hastaların yaş ortalaması 42,4 ± 19,1 yıl idi (18-88 yaş). Hastaların %82’si erkek, %18’i
kadındı. Erkek/kadın oranı 4,5/1 idi. En yaygın izlenen travma mekanizmaları sırasıyla araç içi
trafik kazası (%59), araç dışı trafik kazası (%34,4) ve yüksekten düşme (%18) idi. Hastaların
%37,7’sinde kan ürünü kullanıldı. Kan transfüzyonu yapılan tüm hastalara eritrosit
süspansiyonu verilmişti. Ek olarak hastaların %32,8’sine taze donmuş plazma, %3,3’üne
IV
trombosit süspansiyonu, %1,9’unda tam kan verildi. Acil servisteki mortalite oranı %9,8 (n=6),
hastane içi mortalite oranı %24,6 (n=15) idi. ROC analizinde, kan ürünü verilmesinde en
belirleyici faktörlerin başvuru StO2 (AUC=0,834), hemoglobin (AUC=0,813), kalp hızı
(AUC=0,783) ve SKB (AUC=0,757) olduğu görüldü. StO2 seviyesi %65’in altında olanlarda
acil servis (%30 & %0, p=0,001) ve hastane içi mortalite (%50, %12,2, p=0,003) oranı daha
yüksekti.
Sonuç
Multitravma hastalarında StO2 seviyesinin %65’in altında olması kan transfüzyon
ihtiyacı ve mortalite ile ilişkilidir. Bu nedenle, hemorajinin geleneksel belirteçlerinden daha
üstün olan StO2 seviyesi hemorajinin erken tanısında kullanılabilir.
Hemorrhagic shock is the main cause of mortality in multitrauma patients worldwide. Maintenance of tissue oxygenation with fluid resuscitation, bleeding control, coagulation support remain mainstays of therapy for patients with hemorrhagic shock. Earlier recognition of hemorrhagic shock decreases the time to implementation of life-saving interventions improves patient survival. However, the presence of hemorrhagic shock is not always apparent using standard vital signs monitoring, like blood pressure, heart rate. Tissue O2 saturation (StO2) is a measure of tissue perfusion and is expected to decrease during active bleeding. An initial StO2 value upon trauma center arrival, may predict hemorrhagic shock and requiring early blood product transfusion. The objective of this study was to determine whether nearinfrared spectroscopy -derived StO2 measurements could be used to predict the need for blood transfusions and mortality. Material and methods Sixty-one multitrauma patients admitted to an emergency department of an university hospital from January 2021- January 2022, were included in this prospective study. Patients who presented to the emergency department after 24 hours of trauma were excluded from the study. On arrival to the trauma center, the InSpectra StO2 device was placed on the thenar eminence of the patient’s hand on the arm not used for recording noninvasive blood pressure. Demographic features, mechanism of trauma, mortality rate, systolic (SBP) and diastolic blood pressures (DBP), heart rate, hemoglobin and lactate levels on admission were recorded. In the ROC analysis, the parameters that determine blood transfusion were evaluated. Results The mean age of the patients was 42.4 ± 19.1 years (18-88 years). 82% of the patients were male and 18% were female. The male/female ratio was 4.5/1. The most common trauma mechanisms were in-vehicle traffic accident (59%), pedestrian injuries (34.4%) and falling from height (18%), respectively. Blood product was used in 37.7%. Red blood cells (37.7%) was used in all transfused patients. In addition, fresh frozen plasma was used in 32.8%, platelet in 3.3%, and whole blood in 1.9% of patients. The mortality rate in the emergency department VI was 9.8% (n=6), and the in-hospital mortality rate was 24.6% (n=15). In the ROC analysis, the most powerful determinants in blood product transfusion were StO2 (AUC=0.834), hemoglobin (AUC=0.813), heart rate (AUC=0.783) and SBP (AUC=0.757) at admission. StO2 level below 65% had sensitivity of 65.2% and specificity of 86.8% in blood transfusion. Those with a StO2 level below 65% had higher emergency service (30% vs 0%, p=0.001) and hospital mortality (50% vs 12,2%, p=0.003). Conclusion An StO2 value <65% correlates with greater requirement for blood product transfusion and mortality in multitrauma patients. This suggests that StO2 can be used as an early marker of hemorrhage which may be superior to traditional markers of hemorrhage.
Hemorrhagic shock is the main cause of mortality in multitrauma patients worldwide. Maintenance of tissue oxygenation with fluid resuscitation, bleeding control, coagulation support remain mainstays of therapy for patients with hemorrhagic shock. Earlier recognition of hemorrhagic shock decreases the time to implementation of life-saving interventions improves patient survival. However, the presence of hemorrhagic shock is not always apparent using standard vital signs monitoring, like blood pressure, heart rate. Tissue O2 saturation (StO2) is a measure of tissue perfusion and is expected to decrease during active bleeding. An initial StO2 value upon trauma center arrival, may predict hemorrhagic shock and requiring early blood product transfusion. The objective of this study was to determine whether nearinfrared spectroscopy -derived StO2 measurements could be used to predict the need for blood transfusions and mortality. Material and methods Sixty-one multitrauma patients admitted to an emergency department of an university hospital from January 2021- January 2022, were included in this prospective study. Patients who presented to the emergency department after 24 hours of trauma were excluded from the study. On arrival to the trauma center, the InSpectra StO2 device was placed on the thenar eminence of the patient’s hand on the arm not used for recording noninvasive blood pressure. Demographic features, mechanism of trauma, mortality rate, systolic (SBP) and diastolic blood pressures (DBP), heart rate, hemoglobin and lactate levels on admission were recorded. In the ROC analysis, the parameters that determine blood transfusion were evaluated. Results The mean age of the patients was 42.4 ± 19.1 years (18-88 years). 82% of the patients were male and 18% were female. The male/female ratio was 4.5/1. The most common trauma mechanisms were in-vehicle traffic accident (59%), pedestrian injuries (34.4%) and falling from height (18%), respectively. Blood product was used in 37.7%. Red blood cells (37.7%) was used in all transfused patients. In addition, fresh frozen plasma was used in 32.8%, platelet in 3.3%, and whole blood in 1.9% of patients. The mortality rate in the emergency department VI was 9.8% (n=6), and the in-hospital mortality rate was 24.6% (n=15). In the ROC analysis, the most powerful determinants in blood product transfusion were StO2 (AUC=0.834), hemoglobin (AUC=0.813), heart rate (AUC=0.783) and SBP (AUC=0.757) at admission. StO2 level below 65% had sensitivity of 65.2% and specificity of 86.8% in blood transfusion. Those with a StO2 level below 65% had higher emergency service (30% vs 0%, p=0.001) and hospital mortality (50% vs 12,2%, p=0.003). Conclusion An StO2 value <65% correlates with greater requirement for blood product transfusion and mortality in multitrauma patients. This suggests that StO2 can be used as an early marker of hemorrhage which may be superior to traditional markers of hemorrhage.
Açıklama
Anahtar Kelimeler
Multitravma, Kan transfüzyonu, Doku oksijen satürasyonu, Acil servis, Multitravma, Blood transfusion, Tissue oxygen saturation, Emergency service
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Gökmen, M. (2022). Acil servise başvuran multitravma hastalarında doku satürasyon cihazı ölçümleriyle kan ürünü ihtiyacı ve mortalite öngörülebilir mi?. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Acil Tıp Anabilim Dalı, Konya.
