What is. InSpectra StO 2?

Transcription

1 What is InSpectra StO 2?

2 What is InSpectra StO 2? Hemoglobin O 2 saturation is measured in three areas: 1) Arterial (SaO 2, SpO 2 ) Assesses how well oxygen is loading onto hemoglobin in the lungs is not an assessment of tissue oxygenation. 2) Venous (ScvO 2, SvO 2 ) ScvO 2 : Assesses upper body consumption, but cannot distinguish between protected brain and shunted peripheral muscle perfusion during shock. SvO 2 : Assesses whole body consumption, including coronary circulation, but cannot distinguish between protected organs and those at risk. 3) Microcirculation (StO 2 ) Assesses the adequacy of oxygen delivery to and oxygen extraction from the microcirculation. Warns of potential inadequate core organ (liver, kidney, gut) perfusion. artery vein 1 Microcirculation 2 SaO 2 SpO 2 Arteriole 3 Capillaries InSpectra StO 2 Tissue oxygen saturation Venule ScvO 2 SvO 2 Segment of Microcirculation O 2 Delivery (DO 2 ) StO 2 StO 2 StO 2 StO 2 Tissue O 2 Cell O 2 O 2 Consumption (VO 2 )

3 Why is it important? During shock, blood flow to peripheral muscles and core organs (liver, gut and kidneys) is reduced to preserve brain and heart oxygenation. Benefits of the InSpectra StO 2 System Brain, Heart, Lungs Liver, Kidneys Stomach, Intestines Peripheral muscle Circulation (InSpectra StO 2 measured) Early detection of hypoperfusion 1 Requires no invasive catheters, calibration, blood samples No time lag v. intermittent lactate and BD measurements 2 Responds to interventions 3 Tracks progress continuously Speeds identification of effective and ineffective interventions Cost effective May reduce unnecessary blood transfusions, IV fluids and catheter use 1. Cohn SM et al. J Trauma. 2007;62(1): Putnam B et al. Am Surg. 2007;73(10): Moore FA. Faist E, ed. Munich, Germany, March Bologna, Italy: Medimond; 2007: Normal Shock Beilman, Shock. 1999;12:196. Chalmers, J Physiol. 1967;192:561.

4 Assessing the Value; Tracking the Trend It is important to consider both the current StO 2 value and the trend when assessing a patient s status. 100% StO2 75% StO 2 adequate; assess need for further interventions; stop if indicated StO 2 high; usually seen in systemic vasodilation/ high CO 0% StO 2 low; assess for hypoperfusion; administer interventions if indicated StO 2 rising toward normal; assess continued interventions StO 2 falling; assess patient; resume interventions if indicated InSpectra StO 2 indicates hypoperfusion as well as base deficit or lactate in trauma patients 1 72% 95% InSpectra StO 2 range in 95% of 707 healthy volunteers 2 1. Cohn SM et al. J Trauma. 2007;62(1): Crookes BA et al. J Trauma. 2005; 58(4):

5 Hemoglobin Oxygen Saturation SaO 2 SpO 2 SvO 2 ScvO 2 InSpectra StO 2 Measure of Arterial O 2 Saturation Arterial O 2 Saturation Mixed Venous O 2 Saturation Central Venous O 2 Saturation Tissue O 2 Saturation Measure of % Hemoglobin O 2 Saturation Yes Yes Yes Yes Yes Place of Measurement Arteries Pulsing Arteries Pulmonary Artery Superior or Inferior Vena Cava, Right Atrium 1 Peripheral Microcirculation Method of Measure Arterial Blood Draw, Blood Gas Analyzer Pulse Oximeter Pulmonary Artery Catheter Central Venous Catheter InSpectra StO 2 Tissue Oxygenation Systems Use of Measure O 2 Loading in Lungs O 2 Loading in Lungs Indicator of Global Tissue Oxygenation Surrogate for SvO 2 Tissue Perfusion Status What it Indicates During Shock and Resuscitation Compromised Lung or Heart Function Changes in O 2 Delivery and/or Consumption Immediate Response to Early Peripheral Perfusion Status Changes Requires Pulsatile Flow No Yes No No No Notes: 1. The superior vena cava is the most common placement site for the catheter tip. If the tip is advanced into the right atrium, ScvO 2 readings will vary due to contributions from the inferior vena cava and/or coronary sinus.

6 Treatment Scenario InSpectra StO 2 Spot Check model 300 Assessing StO 2 in the emergency room Overview Male, 60s Primary complaint; hypotension ER Admitted 12:27 Lactate 2.4 2L NS Medical Floor Admitted 15:07 Additional fluids given 12:27 13:02 14:17 15:07 BP 103/50 121/57 101/70 117/93 HR RR SpO InSpectra StO Summary StO 2 could help identify hypoperfusion while other vital signs were nonalarming. Patient perfusion status did not respond despite fluid administration. Hypoperfusuion had not resolved before leaving ER.

7 Treatment Scenario InSpectra StO 2 Tissue Oxygenation Monitor model 650 Continuous StO 2 monitoring during resuscitation in the ICU Overview Intoxicated male, 30s Ejected, high speed MVC PRBC + referring hospital SBP 47 in-flight Patient discharged Day 27 InSpectra StO2, SpO2, SBP, DBP, HR, Temp C T.C. arrival by helicopter To CT To IR embolization To ICU 1u PRBC InSpectra StO 2 remained in 60s despite rewarming and embolization Active warming starts Bolus 2L LR 1u PRBC FFP Cryo Normothermia InSpectra StO 2 increased above 75% after additional PRBCs, FFP and cryo administered BD, HgB, Lactate Hypothermia 8:00 9:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 18:00 19:00 Time InSpectra StO 2 SpO 2 SBP HR HgB Lac Temp C Event Markers Summary A spot check, early in stay, could identify low StO 2 helping identify a possible at risk ICU patient. Though BP increased above 100, StO 2 stayed low until additional interventions were completed. At 13:00, standard vitals were no longer alarming; however StO 2 remained low until the patient received added interventions. Lactate, an intermittent measurement, was resolving. StO 2 also illustrated improved perfusion and the point at which perfusion increased above 75% in real time; helping indicate an end to perfusion resuscitation efforts.

8 Checklists for Low and High StO 2 InSpectra StO 2 values may indicate the need for further clinical assessment. Consider the following possibilities for LOW StO 2 values: Hemorrhage; new or ongoing Non-hemorrhagic hypovolemia Cardiac or pulmonary dysfunction Compensated shock with peripheral vasoconstriction Vasopressor administration Patient flexing/clenching hand with StO 2 sensor Pre-existing conditions that may limit peripheral perfusion High levels of PEEP (sufficient to reduce venous return and cardiac output) Consider the following possibilities for HIGH StO 2 values (mid to high 90 s): Systemic vasodilation accompanied by high cardiac output: Severe sepsis; Neurogenic shock; Portal hypertension Impaired cellular utilization of oxygen Vasodilator administration A persistently low or falling InSpectra StO 2 Measurement strongly suggests abnormal or deteriorating perfusion status that should be investigated. InSpectra StO 2 Tissue Oxygenation Systems noninvasively measure an approximated value of percent hemoglobin oxygen saturation in thenar skeletal muscle tissue (StO 2 ). Visit us online at for our full contact information and Instructions for Use. InSpectra is a registered trademark of Hutchinson Technology Inc. in the United States of America, the European Community, Australia, Canada, China and Japan Hutchinson Technology Inc F 3/11 All Rights Reserved. Printed in the USA. Rx Only. 0086