• Andrea Campos-Serra, Jaume Mesquida, Sandra Montmany-Vioque, Pere Rebasa-Cladera, Marta Barquero-Lopez, Ariadna Cidoncha-Secilla, Núria Llorach-Perucho, Marc Morales-Codina, Juan Carlos Puyana, and Salvador Navarro-Soto.
• Department of Surgery, Universitat Autònoma de Barcelona, Parc Taulí Hospital Universitari, Parc del Taulí 1, 08208, Sabadell (Barcelona), Spain. acampos@tauli.cat.
• Eur J Trauma Emerg Surg. 2023 Feb 1; 49 (1): 307315307-315.

PurposePersistent occult hypoperfusion after initial resuscitation is strongly associated with increased morbidity and mortality after severe trauma. The objective of this study was to analyze regional tissue oxygenation, along with other global markers, as potential detectors of occult shock in otherwise hemodynamically stable trauma patients.MethodsTrauma patients undergoing active resuscitation were evaluated 8 h after hospital admission with the measurement of several global and local hemodynamic/metabolic parameters. Apparently hemodynamically stable (AHD) patients, defined as having SBP ≥ 90 mmHg, HR < 100 bpm and no vasopressor support, were followed for 48 h, and finally classified according to the need for further treatment for persistent bleeding (defined as requiring additional red blood cell transfusion), initiation of vasopressors and/or bleeding control with surgery and/or angioembolization. Patients were labeled as "Occult shock" (OS) if they required any intervention or "Truly hemodynamically stable" (THD) if they did not. Regional tissue oxygenation (rSO2) was measured non-invasively by near-infrared spectroscopy (NIRS) on the forearm. A vascular occlusion test was performed, allowing a 3-min deoxygenation period and a reoxygenation period following occlusion release. Minimal rSO2 (rSO2min), Delta-down (rSO2-rSO2min), maximal rSO2 following cuff-release (rSO2max), and Delta-up (rSO2max-rSO2min) were computed. The NIRS response to the occlusion test was also measured in a control group of healthy volunteers.ResultsSixty-six consecutive trauma patients were included. After 8 h, 17 patients were classified as AHD, of whom five were finally considered to have OS and 12 THD. No hemodynamic, metabolic or coagulopathic differences were observed between the two groups, while NIRS-derived parameters showed statistically significant differences in Delta-down, rSO2min, and Delta-up.ConclusionsAfter 8 h of care, NIRS evaluation with an occlusion test is helpful for identifying occult shock in apparently hemodynamically stable patients.Level Of EvidenceIV, descriptive observational study.Trial RegistrationClinicalTrials.gov Registration Number: NCT02772653.© 2022. The Author(s).

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