Specificity of Compensatory Reserve vs SMO2, Lactate and ETCO2 as Early Predictors of Tolerance to Progressive Reductions in Central Blood Volume
Abstract
Circulatory shock resulting from acute uncontrolled hemorrhage remains a leading cause of death in both military and civilian trauma. Early, accurate and reliable prediction of decompensation is associated with effective intervention and improved clinical outcomes. Individual tolerance to reduced central blood volume can serve as a model to assess the sensitivity and specificity of vital sign measurements. The compensatory reserve (CR) is a measurement of this capacity. Measurements of muscle oxygen saturation (SmO2), lactate and end tidal CO2 (ETCO2) have recently gained attention as potentially superior prognostic tools for early assessment of the status of patients with progressive hemorrhage, but fail to identify individual tolerance. We hypothesized that CR would be able to better predict hemodynamic compensation and provide greater specificity and sensitivity than SmO2, lactate, or ETCO2. To test this hypothesis, we employed lower body negative pressure (LBNP) on healthy human subjects until symptoms of presyncope were evident. Receiver operating characteristic area under the curve (ROC AUC), sensitivity and specificity were used to evaluate the ability of CRI and SmO2, lactate and ETCO2 to predict hemodynamic decompensation. CR had the superior ability to predict decompensation compared to SM02, lactate and ETCO2 (ROC AUC: 0.91 vs. 0.68; 0.54; 0.70 p2.
Document Details
- Document Type
- Pub Defense Publication
- Publication Date
- Apr 01, 2017
- Source ID
- 10.1096/fasebj.31.1_supplement.1087.9
Entities
People
- Alicia M Schiller
- Jeff T Howard
- Victor A Convertino
Organizations
- United States Army Institute of Surgical Research