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Excerpt
Introduction: Low subcutaneous oxygen tension (PsqO2) increases the risk of impaired wound healing and infection in surgical patients. [1] A previous study in "well-resuscitated" trauma patients showed a high incidence (35-78%) of low PsqO2. [2] Hypovolemia, hypothermia and pain result in low PsqO2 due to autonomic vasoconstriction. We thus began a randomized interventional study to evaluate the effect of forced air warming, fluid administration, and pain control on increasing PsqO2 and improving wound outcome and overall outcome in trauma patients.
Methods: With informed consent, 1 female and 7 male adults with ISS 16-45 meeting resuscitation criteria within 24 hrs of injury (SBP >or=to 90mm Hg. IV fluid rate
Results: No significant differences were found between groups for (median; Mann Whitney): age, lowest intraoperative core temperature (C 34.7[degree sign]C. Rx 34.6[degree sign]C), ending intraoperative core temperature (C 36.4[degree sign]C, Rx 37[degree sign]C), OR IV fluids (C 3.3 Liters, Rx 33.5L) and ICU MSO4 equianalgesic dose (C 214 mg, Rx 173mg). Only 1 Rx subject failed to respond (at 1/5 time point): thus, data for both groups were combined. Inadequate response to increased FIO2 occurred in 28.6% of subjects at 0 hr, 12.5% at 12 hrs, 14.3% at 24 hrs, 25% at 36 hrs, 14.3% at 48 hrs, and 25% at 60 hrs.
Discussion: Contrary to the previous report, inadequate response of PsqO2 was uncommon in this sample. Potential reasons for this include: 1. routine use of intraoperative forced air warming resulting in less PO hypothermia, and 2. improved ICU pain management (pain Rx algorithm instituted during study period). This improvement in PsqO2 in these patients may translate to improved wound and other patient outcomes but the sample was too small to evaluate this effect.
Supported by NIH GM 27345 and Augustine Medical.
