Retinal large vessel oxygen saturations correlate with early blood loss and hypoxia in anesthetized swine.

BACKGROUND Noninvasive monitoring would likely improve trauma care. Using laser technology, we monitored the oxygen saturation in retinal vessels during exsanguination and hypoxia. METHODS Seven anesthetized swine were bled at 0.4 mL/kg/min for 40 minutes. During exsanguination, retinal venous saturation (SrvO2) was measured using an eye oximeter, and central venous saturation (SvO2) was measured using a fiber-optic catheter. After the shed blood was reinfused, the FiO2 was progressively decreased from 0.97 to 0.07. Femoral artery oxygen saturation (SaO2) and retinal artery oxygen saturation (SraO2) were measured at each increment. RESULTS During exsanguination, SrvO2 correlated with blood loss (r = -0.93) and SvO2 (r = 0.94). SraO2 correlated with SaO2 during incremental hypoxia (R2 = 0.93 +/- 0.15). CONCLUSIONS In this model of exsanguination, retinal venous oxygen saturation correlates with blood volume and with central venous oxygen saturation. The SraO2 correlates with SaO2 during graded hypoxia. Use of an eye oximeter to noninvasively monitor trauma patients appears promising and warrants further study.

[1]  D. Sobel Burning of a neonate due to a pulse oximeter: arterial saturation monitoring. , 1992, Pediatrics.

[2]  T. Scalea,et al.  Geriatric blunt multiple trauma: improved survival with early invasive monitoring. , 1988, The Journal of trauma.

[3]  M. Copass,et al.  The sensitivity of vital signs in identifying major thoracoabdominal hemorrhage. , 1989, American journal of surgery.

[4]  A. Trouwborst,et al.  Blood Gas Analysis of Mixed Venous Blood During Normoxic Acute Isovolemic Hemodilution in Pigs , 1990, Anesthesia and analgesia.

[5]  J. Hickam,et al.  Studies of the Retinal Circulation in Man: Observations on Vessel Diameter, Arteriovenous Oxygen Difference, and Mean Circulation Time , 1966, Circulation.

[6]  J. Kelleher,et al.  The penumbra effect: vasomotion-dependent pulse oximeter artifact due to probe malposition. , 1989, Anesthesiology.

[7]  M. Rockoff,et al.  Severe burns from a pulse oximeter. , 1990, Anesthesiology.

[8]  C. Poets,et al.  Noninvasive monitoring of oxygenation in infants and children: practical considerations and areas of concern. , 1994, Pediatrics.

[9]  D. Southall,et al.  Inappropriate sensor application in pulse oximetry , 1992, The Lancet.

[10]  M. Sanchez,et al.  Quality control of perfusion: monitoring venous blood oxygen tension to prevent hypoxic acidosis. , 1990, The Journal of thoracic and cardiovascular surgery.

[11]  D. Dries,et al.  Adequate resuscitation of burn patients may not be measured by urine output and vital signs , 1991, Critical care medicine.

[12]  F. Delori Noninvasive technique for oximetry of blood in retinal vessels. , 1988, Applied optics.

[13]  L. Goldman,et al.  The effectiveness of right heart catheterization in the initial care of critically ill patients. SUPPORT Investigators. , 1996, JAMA.

[14]  R C Pruett,et al.  Monochromatic ophthalmoscopy and fundus photography. The normal fundus. , 1977, Archives of ophthalmology.

[15]  J. Severinghaus,et al.  Pulse oximeter failure thresholds in hypotension and vasoconstriction. , 1990, Anesthesiology.

[16]  F. Delori,et al.  Spectral reflectance of the human ocular fundus. , 1989, Applied optics.

[17]  J. Räsänen Supply-dependent oxygen consumption and mixed venous oxyhemoglobin saturation during isovolemic hemodilution in pigs. , 1991, Chest.

[18]  L. Goldman,et al.  The effectiveness of right heart catheterization in the initial care of critically ill patients. SUPPORT Investigators. , 1996, JAMA.

[19]  T. Sloan Finger injury by an oxygen saturation monitor probe. , 1988, Anesthesiology.

[20]  W. Shoemaker,et al.  Unreliability of blood pressure and heart rate to evaluate cardiac output in emergency resuscitation and critical illness , 1993, Critical care medicine.

[21]  P. Simoens,et al.  Morphologic and clinical study of the retinal circulation in the miniature pig. B: Fluorescein angiography of the retina. , 1992, Experimental eye research.

[22]  H. Smithline,et al.  Continuous central venous oximetry and shock index in the emergency department: use in the evaluation of clinical shock. , 1992, The American journal of emergency medicine.

[23]  T. Scalea,et al.  Central venous blood oxygen saturation: an early, accurate measurement of volume during hemorrhage. , 1986, The Journal of trauma.

[24]  G. Jay,et al.  Pulse oximetry is accurate in acute anemia from hemorrhage. , 1994, Annals of emergency medicine.