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A Journal on Internal Medicine
Indexed/Abstracted in: Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,236
Minerva Medica 2004 October;95(5):461-8
Regional haemoglobin oxygen saturation during surgical haemorrhage
Torella F., McCollum C. N.
Aim. Experimental research and early clinical studies have shown that regional haemoglobin desaturation, measured by near infrared spectroscopy (NIRS), follows blood loss. To further assess NIRS as a blood loss monitor, we evaluated it on patients undergoing major surgery.
Methods. Regional haemoglobin oxygen saturation from the cerebral cortex (CsO2) and the left gastrocnemius muscle (PsO2) was continuously monitored with an INVOS 4100 NIRS oximeter in 10 patients during surgery. Haemoglobin, mean arterial pressure, arterial and central venous oxygen saturation and tension, temperature, pH and lactate concentration were also measured.
Results. The median (IQR) blood loss was 650 (400-1 800) ml, equivalent to 16% (11-35) of the patients' blood volume. During surgery, CsO2 fell by a mean (95% CI) of 8.4% (2-14.8) (p=0.016) and PsO2 fell by a mean (95% CI) of 3.3% (-1.5-8.1) (p=0.16). CsO2, but not PsO2, correlated with the volume of blood lost (R=0.44; p=0.004), central venous oxygen saturation (R=0.52; p=0.001), and venous oxygen tension (R=0.58; p<0.001). These correlations remained significant after calculations were adjusted for changes in arterial pressure, temperature and pH.
Conclusion. Cerebral, but not peripheral, haemoglobin oxygen saturation decreases proportionally to blood loss and correlates with measurements of systemic oxygen extraction. With further research, NIRS measurements of CsO2 may be developed into a useful tool to monitor blood loss.