A Noninvasive Stroke Volume Monitoring for Early Detection of Minimal Blood Loss: A Pilot Study.
Journal
Shock (Augusta, Ga.)
ISSN: 1540-0514
Titre abrégé: Shock
Pays: United States
ID NLM: 9421564
Informations de publication
Date de publication:
01 02 2021
01 02 2021
Historique:
pubmed:
10
8
2020
medline:
14
1
2022
entrez:
10
8
2020
Statut:
ppublish
Résumé
Alternation in traditional vital signs can only be observed during advanced stages of hypovolemia and shortly before the hemodynamic collapse. However, even minimal blood loss induces a decrease in the cardiac preload which translates to a decrease in stroke volume, but these indices are not readily monitored. We aimed to determine whether minor hemodynamic alternations induced by controlled and standardized hypovolemia can be detected by a whole-body bio-impedance technology. This was a non-randomized controlled trial that enrolled healthy blood donors. Vital signs, as well as shock index and stroke volume (SV), were recorded using noninvasive cardiac system, a noninvasive whole-body impedance-based hemodynamic analysis system, during phlebotomy. Sixty subjects were included in the study group and 20 in the control group. Blood loss of 450 mL resulted in a significant decrease in systolic blood pressure (5 mm Hg; 95% CI 3, 6) and SV (5.07 mL; 95% CI 3.21, 6.92), and increase in shock index (0.03 bpm/mm Hg; 95% CI 0.01, 0.05). Clinically detectable changes (≥10%) in blood pressure and shock index were detectable in 15% and 5%, respectively. SV decreased by more than 10% in 40% of blood donors. No significant changes occurred in the control group. Continuous noninvasive monitoring of SV may be superior to conventional indices (e.g., heart rate, blood pressure, or shock index) for early identification of acute blood loss. As an operator-independent and point-of-care technology, the SV whole body bio-impedance measurement may assist in accurate monitoring of potentially bleeding patients and early identification of hemorrhage.
Identifiants
pubmed: 32769818
pii: 00024382-202102000-00011
doi: 10.1097/SHK.0000000000001621
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
230-235Informations de copyright
Copyright © 2020 by the Shock Society.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest.
Références
Rhee P, Joseph B, Pandit V, Aziz H, Vercruysse G, Kulvatunyou N, Friese RS. Increasing trauma deaths in the United States. Ann Surg 260 (1):13–21, 2014.
Rossaint R, Bouillon B, Cerny V, Coats TJ, Duranteau J, Fernández-Mondéjar E, Filipescu D, Hunt BJ, Komadina R, Maegele M, et al. The STOP the bleeding campaign. Crit Care 17 (2):136, 2013.
Eastridge BJ, Mabry RL, Seguin P, Cantrell J, Tops T, Uribe P, Mallett O, Zubko T, Oetjen-Gerdes L, Rasmussen TE, et al. Death on the battlefield (2001–2011): implications for the future of combat casualty care. J Trauma Acute Care Surg 73: (6 suppl 5): S431–S437, 2012.
Parks JK, Elliott AC, Gentilello LM, Shafi S. Systemic hypotension is a late marker of shock after trauma: a validation study of Advanced Trauma Life Support principles in a large national sample. Am J Surg 192 (6):727–731, 2006.
Convertino VA, Ryan KL, Rickards CA, Salinas J, McManus JG, Cooke WH, Holcomb JB. Physiological and medical monitoring for en route care of combat casualties. J Trauma 64: (4 Suppl): S342–S353, 2008.
Cannon CM, Braxton CC, Kling-Smith M, Mahnken JD, Carlton E, Moncure M. Utility of the shock index in predicting mortality in traumatically injured patients. J Trauma 67 (6):1426–1430, 2009.
Joseph B, Haider A, Ibraheem K, Kulvatunyou N, Tang A, Azim A, O’Keeffe T, Gries L, Vercruysse G, Rhee P. Revitalizing vital signs: the role of delta shock index. Shock 46 (3S):50–54, 2016.
Foex BA. Systemic responses to trauma. Br Med Bull 55 (4):726–743, 1999.
Cotter G, Moshkovitz Y, Kaluski E, Cohen AJ, Miller H, Goor D, Vered Z. Accurate, noninvasive continuous monitoring of cardiac output by whole-body electrical bioimpedance. Chest 125 (4):1431–1440, 2004.
Germain MJ, Joubert J, O’Grady D, Nathanson BH, Chait Y, Levin NW. Comparison of stroke volume measurements during hemodialysis using bioimpedance cardiography and echocardiography. Hemodial Int 22 (2):201–208, 2018.
Ashwal E, Shinar S, Orbach-Zinger S, Lev S, Gat R, Kedar L, Pauzner Y, Aviram A, Yogev Y, Hiersch L. The hemodynamics of labor in women undergoing vaginal and cesarean deliveries as determined by whole body bioimpedance. Am J Perinatol 35 (02):177–183, 2018.
Myatchin I, Abraham P, Malbrain MLNG. Bio-electrical impedance analysis in critically ill patients: are we ready for prime time? J Clin Monit Comput 34:401–410, 2019.
Doenyas-Barak K, de Abreu MHFG, Borges LE, Tavares Filho HA, Yunlin F, Yurong Z, Levin NW, Kaufman AM, Efrati S, Pereg D, et al. Non-invasive hemodynamic profiling of patients undergoing hemodialysis—a multicenter observational cohort study. BMC Nephrol 20 (1):347, 2019.
Birkhahn RH, Gaeta TJ, Terry D, Bove JJ, Tloczkowski J. Shock index in diagnosing early acute hypovolemia. Am J Emerg Med 23 (3):323–326, 2005.
Wong DH, O’Connor D, Tremper KK, Zaccari J, Thompson P, Hill D. Changes in cardiac output after acute blood loss and position change in man. Crit Care Med 17 (10):979–983, 1989.
Tanino Y, Shite J, Paredes OL, Shinke T, Ogasawara D, Sawada T, Kawamori H, Miyoshi N, Kato H, Yoshino N, et al. Whole body bioimpedance monitoring for outpatient chronic heart failure follow up. Circ J 73 (6):1074–1079, 2009.
Cohen AJ, Arnaudov D, Zabeeda D, Schultheis L, Lashinger J, Schachner A. Non-invasive measurement of cardiac output during coronary artery bypass grafting. Eur J Cardiothorac Surg 14 (1):64–69, 1998.
Paredes OL, Shite J, Shinke T, Watanabe S, Otake H, Matsumoto D, Imuro Y, Ogasawara D, Sawada T, Yokoyama M. Impedance cardiography for cardiac output estimation: reliability of wrist-to-ankle electrode configuration. Circ J 70 (9):1164–1168, 2006.
Rozenman Y, Rotzak R, Patterson RP. Detection of left ventricular systolic dysfunction using a newly developed, laptop based, impedance cardiographic index. Int J Cardiol 149 (2):248–250, 2011.
Mutschler M, Nienaber U, Münzberg M, Wölfl C, Schoechl H, Paffrath T, Bouillon B, Maegele M. The Shock Index revisited—a fast guide to transfusion requirement? A retrospective analysis on 21,853 patients derived from the TraumaRegister DGU®. Crit Care 17 (4):R172, 2013.
Hanson JM, Van Hoeyweghen R, Kirktnan E, Thomas A, Horan MA. Use of stroke distance in the early detection of simulated blood loss. J Trauma 44:128–134, 1998.
Wu SC, Rau CS, Kuo SCH, Hsu SY, Hsieh HY, Hsieh CH. Shock index increase from the field to the emergency room is associated with higher odds of massive transfusion in trauma patients with stable blood pressure: a cross-sectional analysis. PLoS One 14 (4):e0216153, 2019.
Barcroft H, Edholm OG, Mcmichael J, Sharpey-Schafer EP. Posthæmorrhagic fainting. study by cardiac output and forearm flow. Lancet 243 (6294):489–491, 1944.
Kirkman E, Watts S. Haemodynamic changes in trauma. Br J Anaesth 113 (2):266–275, 2014.
Moulton SL, Mulligan J, Grudic GZ, Convertino VA. Running on empty? the compensatory reserve index. J Trauma Acute Care Surg 75:1053–1059, 2013.
Witting MD. Standing shock index: an alternative to orthostatic vital signs. Am J Emerg Med 35 (4):637–639, 2017.
Dittmar M. Reliability and variability of bioimpedance measures in normal adults: effects of age, gender, and body mass. Am J Phys Anthropol 122 (4):361–370, 2003.