Regents of the University of Michigan Ann Arbor United States
Management of the polytrauma patient with or without TBI in the prolonged field care PFC setting especially when prolonged damage control resuscitation pDCR is required represents an extraordinary challenge. While there is a desire to develop new therapeutic agents to improve survival and mitigate tissue injury and organ failure, we have not yet developed tools which assist in helping providers maximize use of supportive treatments such blood transfusion, volume expansion, vasopressor use, etc. in a precision manner for goal directed therapy GDT. The use of goal GDT has been demonstrated to be life saving for both surgical and medical populations with severe hemodynamic compromise but is difficult to implement with current invasive and noninvasive tools because of their lack of precision or form factor and expense. This proposal will scale testing of two novel noninvasive measures that could allow for real-time use of GDT in the PFCpDCR setting. These include 1 Resonance Raman Spectroscopy RRS to measure tissue hemoglobin oxygen saturation StO2 of the buccal mucosa as a substitute for central or mixed venous hemoglobin oxygen saturation ScvO2and potentially lactate, and 2 Dynamic Respiratory Impedance Volume Evaluation DRIVE of the limb as a substitute for ultrasound of the inferiorsuperior vena cava and central venous pressure CVP. RRS-StO2 uses a special wavelength of light to determine how much oxygen a tissue is receiving.