Highlights
- ·Definitions for occult hypoperfusion in trauma (tOH) differ markedly in the literature.
- ·The described impact of tOH on outcome differs between studies, and it´s role in trauma remains unclear.
- ·A systematic review was performed to identify utilized criteria for tOH in recent literature.
- ·The following definition for tOH is proposed: Lactate > 2 mmol/l or BE 〈-3 mmol/l plus SBP 〉 90 mmHg and PR < 120 bpm.
Abstract
Introduction
Occult hypoperfusion (OH) entails inadequate tissue oxygenation in the presence of
normal vital signs. Numerous studies have demonstrated that this phenomenon is associated
with impaired outcome and increased mortality, however definitions of OH differ between
studies. The aim of the current study was to identify and evaluate the published definitions
of the term `occult hypoperfusion` in trauma (tOH).
Material & methods
A review of literature was performed using the Medline database. The following MeSH
terms have been used: occult hypoperfusion, severe trauma, polytrauma, resuscitation.
Clinical studies on OH were included and utilized definitions have been compared.
A predefined data-interpretation process was applied to create an integrative definition
for tOH.
Results
A total of 43 publications used the term OH. A definition of OH was provided in 16
manuscripts. A pooled mean number of participants of 729 (SD: 1158) was found per
study. The majority of manuscripts combine multiple parameters for inadequate tissue
oxygenation and normal vital signs to define OH in trauma. In 12 manuscripts, specific
cut-off values for hemodynamic parameters (SBP/PR/UP) and in 11/16 papers exact metabolic
thresholds (lactate/B.E) were defined. The following definition best integrates definitions
in current literature: Lactate > 2 mmol/l or BE <-3 mmol/l (to define inadequate oxygenation)
plus SBP > 90 mmHg and PR < 120 bpm (to define normal macroperfusion).
Conclusions
The current systematic review demonstrates that definitions of occult hypoperfusion
in trauma differ in the literature. The following comprehensive definition for (tOH)
is proposed: Lactate > 2 mmol/l or BE <-3 mmol/l plus SBP > 90 mmHg and PR < 120 bpm.
This recommendation appears to represent current literature on tOH and may improve
the identification of trauma patients at risk for OH and related complicated courses.
Further validation studies are required to demonstrate the clinical role of tOH and
the proposed definition.
Keywords
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Article info
Publication history
Published online: January 11, 2023
Accepted:
January 8,
2023
Identification
Copyright
© 2023 Elsevier Ltd. All rights reserved.
