New monitoring strategies during shock
Kakihana, Y.; Yoshimura, N.
Nihon Geka Gakkai Zasshi 100(10): 648-651
1999
ISSN/ISBN: 0301-4894 PMID: 10570773 Document Number: 498580
Disturbances in tissue perfusion and oxygenation are known to occur during shock. To treat shock properly, it is necessary to have a good understanding of its pathophysiological characteristics. By monitoring cardiac output and oxygen delivery, we can assess the systemic oxygen transport to the tissues, while mixed venous oxygen saturation provides an index of the systemic oxygen balance between oxygen delivery and consumption. However, because a redistribution of blood volume and flow occurs in shock, the use of systemic monitoring alone does not allow an assessment of regional oxygenation in the various organs. Monitoring of hepatic and jugular venous oxygen saturation enables us to assess the adequacy of regional tissue oxygenation in the liver and brain, respectively, while monitoring intramucosal pH (pHi) is useful not only to assess regional oxygenation in the splanchnic organs, but also to predict complications and to evaluate the clinical outcome. The use of near-infrared spectroscopy may allow simultaneous, noninvasive monitoring of regional tissue oxygenation and energy levels. There exists a wide variety of viable options for the monitoring of shock, both systemically and regionally. This increases the chances of successful treatment.