Development and Testing of New Noninvasive Monitoring Tools for Prolonged Field Care Goal-Directed Therapy
Abstract
Care of the trauma patient with or without traumatic brain injury (TBI) in the prolonged field care (PFC) setting especially when prolonged damage control resuscitation (pDCR) is required is very difficult. While new therapeutic agents to improve survival are needed, we have not developed tools that help healthcare providers maximize use of supportive treatments such as blood transfusion, fluid administration, medication use, etc. in a precision manner for goal directed therapy (GDT). The use of goal GDT has been demonstrated to be lifesaving for both critically ill and injured patients who are very unstable, but it is difficult to carry out with current invasive and noninvasive devices because their performance is not sensitive or specific enough for the condition, they may be too large, or they may be too expensive. This proposal will increase testing of two new noninvasive measures that could allow healthcare providers to use of GDT in the PFC/pDCR setting. These include: (1) Resonance Raman Spectroscopy (RRS) to measure the level of oxygenation in tissue (StO2) of the inner cheek as a replacement for blood oxygenation coming from the inside of the right atrium of the heart called central venous oxygen saturation (ScvO2) and potentially lactate (a biochemical produced by the body’s cells when they are starving for oxygen), and (2) Dynamic Respiratory Impedance Volume Evaluation (DRIVE) of the arm as a substitute for ultrasound of the inferior vena cava (IVC) or the pressure insight the right atrium of the heart called central venous pressure (CVP). The combination of these new measures could optimize the resuscitation of casualties requiring PFC and pDCR. RRS-StO2 uses a special wavelength of light to determine how much oxygen a tissue is receiving. DRIVE uses a small amount of electricity passed through tissue to measure how much blood is moving in and out of the tissue during breathing. Hypothesis: The use of RRS-StO2 and DRIVE will provide information of sufficient value in complex surgical patients regarding tissue oxygenation and blood volume to allow their future use for GDT in PFC and pDCR. Specific Aims/Objectives: (1) Test and compare RRS-StO2 with other measures of tissue oxygenation including lactate and ScvO2 in multiple trauma and other very complicated and ill surgical patients. (2) Test and compare DRIVE to other measures of intravascular blood volume monitoring including ultrasound of the IVC and CVP in multiple trauma and other complicated surgical patients. (3) Compare multiple measurements of RRS-StO2 and DRIVE over time to patient outcomes including mortality and organ failure in order to support future clinical intervention trials. This is a clinical research study examining two new noninvasive devices (RRS-StO2 and DRIVE) to compare their performance to a range of standard invasive and noninvasive monitoring that may not be practical for PFC and pDCR. Trauma and surgical critical care patients undergoing invasive monitoring and noninvasive or minimally invasive monitoring will have these measures compared to RRS-StO2 and DRIVE over time. Responses to treatment such as blood transfusion, fluid administration, blood pressure medication administration, mechanical ventilation, etc. will be tracked and compared. Additional data such as lactate levels, injury information, surgical interventions, organ failure, and finally outcome will be compared to understand how DRIVE and RRS-StO2 perform compared to other traditional measures. An attempt will be made to enroll 200-300 patients. Since the study does not replace the current standard of care and the new devices are noninvasive, there are minimal risks to patients. Complex combat injuries are very difficult to take care of in settings outside of the hospital where resources are very limited and treatment with therapies like simple blood transfusions are very hard to carry out. These challenges could be eased if there were easy way
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Oct 29, 2018
- Source ID
- W81XWH1810078
Entities
People
- Kevin Ward
Organizations
- United States Army
- University of Michigan