Citation

Stewart CL, Mulligan J, Grudic GZ, Talley ME, Jurkovich GJ, Moulton SL. Shock 2016; 46(3 Suppl 1): 61-67.

Affiliation

*University of Colorado School of Medicine, Aurora, CO †Flashback Technologies Inc., Boulder, CO ‡Children's Hospital Colorado, Aurora, CO §Denver Health Medical Center, Denver, CO.

Copyright

(Copyright © 2016, The Shock Society, Publisher Lippincott Williams and Wilkins)

DOI

10.1097/SHK.0000000000000647

PMID

27172155

Abstract

INTRODUCTION: Humans are able to compensate for significant blood loss with little change in traditional vital signs. We hypothesized that an algorithm, which recognizes compensatory changes in photoplethysmogram (PPG) waveforms, could detect active bleeding and ongoing volume loss in injured patients.

METHODS: Injured adults were prospectively enrolled at a level I trauma center. PPG data collection was conducted using a custom-made pulse oximeter. Waveform data were post-processed by an algorithm to calculate the compensatory reserve index (CRI), measured on a scale of 1 to 0, with 1 indicating fully compensated and 0 indicating no reserve, or decompensation. CRI was compared to clinical findings.

RESULTS: 50 patients were enrolled in the study; 3 had incomplete data, 3 had indeterminate bleeding, 12 were actively bleeding, and 32 were not bleeding. The mean initial CRI of bleeding patients was significantly lower compared to the non-bleeding patients (CRI 0.17, 95% CI = 0.13-0.22 vs CRI 0.56, 95% CI = 0.49-0.62, p < 0.001). Using a cut-off of 0.21 had a sensitivity of 0.97 and specificity of 0.83 for identifying bleeding patients. CRI had a higher sensitivity than heart rate (75%), systolic blood pressure (63%), shock index (27%), base deficit (29%), lactate (80%), hemoglobin (50%), and hematocrit (50%). During ongoing bleeding, CRI decreased following fluid resuscitation, and conversely increased for patients that were not bleeding.

CONCLUSIONS: A novel computational algorithm that recognizes subtle changes in PPG waveforms can quickly and non-invasively discern which patients are actively bleeding and continuing to bleed with high sensitivity and specificity in acutely injured patients.

Language: en