Subcutaneous oxygen tension: A useful adjunct in assessment of perfusion status

• Published in: Critical care medicine Vol. 23; no. 5; pp. 867 - 873
• Main Authors: Powell, Craig C, Schultz, Scot C, Burris, David G, Drucker, William R, Malcolm, Diana S
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Williams & Wilkins 01-05-1995; Lippincott
• Subjects: Analysis of Variance; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Animals; Aspirin - analogs & derivatives; Aspirin - therapeutic use; Biological and medical sciences; Blood Gas Monitoring, Transcutaneous - instrumentation; Blood Gas Monitoring, Transcutaneous - methods; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Evaluation Studies as Topic; Hemoglobins - therapeutic use; Hemorrhage - physiopathology; Hemorrhage - therapy; Intensive care medicine; Male; Medical sciences; Prospective Studies; Random Allocation; Rats; Rats, Sprague-Dawley; Resuscitation - methods; Human; Blood gas; Oxymetry; Oxygen; Intensive care; Partial pressure; Surveillance; Perfusion; Hemodynamics; Subcutaneous tissue
• ISSN: 0090-3493; 1530-0293
• DOI: 10.1097/00003246-199505000-00015

OBJECTIVESUsing a new fluorescence-quenching optode which, unlike earlier oximeters, neither consumes oxygen nor generates heat, we sought to determine the effects of hemorrhage and resuscitation on subcutaneous PO2. Additionally, we compared the effects of resuscitation with diaspirin crosslinked hemoglobin, an oxygen-carrying solution, on subcutaneous PO2 to that of traditional resuscitative fluids. We also compared mean arterial pressure and central venous oxygen saturation, indirect indices of perfusion, to subcutaneous PO2, a direct index of perfusion.
DESIGNProspective trial, randomized for selection of treatment regimen.
SETTINGShock-trauma laboratory of a medical university.
SUBJECTSMale Sprague-Dawley rats, weighing 260 to 380 g.
INTERVENTIONSRats were bled 22 mL/kg and resuscitated, 1 min later, with either 66 mL/kg of lactated Ringer's solution, 22 mL/kg of human serum albumin, 22 mL/kg of blood, or 22 mL/kg of diaspirin crosslinked hemoglobin. A fifth group of animals was not resuscitated after hemorrhage. Subcutaneous PO2 and mean arterial pressure were monitored continuously throughout the experiment, while central venous oxygen saturation was measured intermittently.
MEASUREMENTS AND MAIN RESULTSSubcutaneous PO2 decreased in response to hemorrhage and, although it did increase after resuscitation with each fluid, no treatment was able to restore subcutaneous PO2 to baseline within 2 hrs postresuscitation. Subcutaneous PO2 continued to decrease after hemorrhage in the unresuscitated animals. In contrast, mean arterial pressure was restored to baseline values in only blood- and diaspirin crosslinked hemoglobin-treated animals, although this effect was lost within 30 mins in the blood-treated group. Only blood restored the central venous oxygen saturation to baseline values in the early postresuscitation period.
CONCLUSIONSThe fluorescence-quenching optode consistently followed changes in subcutaneous PO2 during hemorrhage and after resuscitation. Diaspirin crosslinked hemoglobin performed as well as blood in restoring peripheral perfusion, as measured by subcutaneous PO2, while both of these fluids were superior to either lactated Ringer's solution or albumin. Both whole blood and diaspirin crosslinked hemoglobin restored mean arterial pressure to baseline, although the effect of the latter was of a longer duration. The pressor effect of the crosslinked hemoglobin did not affect peripheral perfusion, as reflected by the values for subcutaneous PO2. Subcutaneous PO2 is a useful adjunct in assessment of the adequacy of peripheral perfusion and may help redefine targets for resuscitation.(Crit Care Med 1995; 23:867-873)