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Superiority of compensatory reserve measurement compared with the Shock index for early and accurate detection of reduced central blood volume status

Journal Article · · Journal of Trauma and Acute Care Surgery
 [1];  [2];  [3];  [3];  [3];  [3]
  1. US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX (United States); Uniformed Services University, Bethesda, MD (United States)
  2. University of Texas Health, San Antonio, TX (United States); ATEM Ltd. (United Kingdom)
  3. US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX (United States)
+ Show Author Affiliations
Shock index (SI) equals the ratio of heart rate (HR) to systolic blood pressure (SBP) with clinical evidence that it is more sensitive for trauma patient status assessment and prediction of outcome compared with either HR or SBP alone. We used lower body negative pressure (LBNP) as a human model of central hypovolemia and compensatory reserve measurement (CRM) validated for accurate tracking of reduced central blood volume to test the hypotheses that SI: (1) presents a late signal of central blood volume status; (2) displays poor sensitivity and specificity for predicting the onset of hemodynamic decompensation; and (3) cannot identify individuals at greatest risk for the onset of circulatory shock. We measured HR, SBP, and CRM in 172 human subjects (19–55 years) during progressive LBNP designed to determine tolerance to central hypovolemia as a model of hemorrhage. Subjects were subsequently divided into those with high tolerance (HT) (n = 118) and low tolerance (LT) (n = 54) based on completion of 60 mm Hg LBNP. The time course relationship between SI and CRM was determined and receiver operating characteristic (ROC) area under the curve (AUC) was calculated for sensitivity and specificity of CRM and SI to predict hemodynamic decompensation using clinically defined thresholds of 40% for CRM and 0.9 for SI. The time and level of LBNP required to reach a SI = 0.9 (~60 mm Hg LBNP) was significantly greater (p < 0.001) compared with CRM that reached 40% at ~40 mm Hg LBNP. Shock index did not differ between HT and LT subjects at 45 mm Hg LBNP levels. ROC AUC for CRM was 0.95 (95% CI = 0.94–0.97) compared with 0.91 (0.89–0.94) for SI (p = 0.0002). Despite high sensitivity and specificity, SI delays time to detect reductions in central blood volume with failure to distinguish individuals with varying tolerances to central hypovolemia.
Research Organization:
Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN (United States)
Sponsoring Organization:
USDOE Office of Science (SC)
Grant/Contract Number:
SC0014664
OSTI ID:
2425812
Journal Information:
Journal of Trauma and Acute Care Surgery, Journal Name: Journal of Trauma and Acute Care Surgery Journal Issue: 2S Vol. 95; ISSN 2163-0755
Publisher:
American Association for the Surgery of Trauma (AAST)Copyright Statement
Country of Publication:
United States
Language:
English

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Related Subjects

60 APPLIED LIFE SCIENCES
Central hypovolemia
Compensatory reserve
General &amp; Internal Medicine
Hemorrhage
Shock index
Surgery