{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T06:15:16Z","timestamp":1792131316691,"version":"4.4.0"},"reference-count":27,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2024,8,24]],"date-time":"2024-08-24T00:00:00Z","timestamp":1724457600000},"content-version":"unspecified","delay-in-days":23,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010210","name":"Defense Human Resources Activity","doi-asserted-by":"publisher","award":["W81XWH-19-1-0472"],"award-info":[{"award-number":["W81XWH-19-1-0472"]}],"id":[{"id":"10.13039\/100010210","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Trauma Surg Acute Care Open"],"accepted":{"date-parts":[[2024,8,9]]},"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Mixed venous saturation (SvO2) is considered the gold standard to assess the adequacy of tissue oxygen delivery (DO2) in shock states. However, SvO2 monitoring is challenging as it requires an invasive catheter and frequent blood sampling. Non-invasive methods, including near-infrared spectroscopy, have demonstrated low sensitivity to tissue dysoxia.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We fabricated a new device that uses resonance Raman spectroscopy (RRS) to quantify oxyhemoglobin saturation (ShbO2) in the esophagus (eShbO2), tongue (tShbO2), and liver (hShbO2). In two rat models of hemorrhagic shock, we quantified (1) The correlation of RRS-measured ShbO2 to SvO2 during progressive hemorrhage (n=20) and (2) The value of these metrics to predict near-term mortality in fixed, severe hemorrhage (mean blood pressure =25\u2009mm Hg; n=18).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In model 1, eShbO2 (r=0.705, p&lt;0.0001) and tShbO2 (r=0.724, p&lt;0.0001) correlated well with SvO2 and with serum lactic acid (eShbO2-lactate r=0.708, p&lt;0.0001; tShbO2-lactate r=0.830, p&lt;0.0001). hShbO2 correlated poorly with both SvO2 and lactic acid. Using time-matched ShbO2-SvO2 pairs, the performance of ShbO2 to detect severe tissue hypoxia (SvO2&lt;20%) was excellent (AUC 0.843 for eShbO2, 0.879 for tShbO2). In model 2, eShbO2 showed a maximized threshold of 40% with 83% of animals dying within 45 minutes of this cut-off, demonstrating accuracy as a monitoring device. This was similar for tShbO2, with a threshold of 50%, predicting death within 45 minutes in 76% of animals. ShbO2 showed superior sensitivity to invasive monitoring parameters, including MABP&lt;30\u2009mm Hg (sensitivity 59%), pulse pressure&lt;15\u2009mm Hg (sensitivity 50%), and heart rate&gt;220\u2009bpm (sensitivity 39%, p=0.004).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>eShbO2 represents a new paradigm to assess the adequacy of DO2 to a tissue. It constitutes a promising monitoring method to evaluate tissue oxygen saturation in real time and non-invasively, correlating with SvO2 and time to death.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Level of evidence<\/jats:title>\n                  <jats:p>Level III, therapeutic\/care management.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/tsaco-2024-001480","type":"journal-article","created":{"date-parts":[[2024,8,25]],"date-time":"2024-08-25T10:55:15Z","timestamp":1724583315000},"page":"e001480","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Esophageal oxyhemoglobin saturation as a resuscitative metric in hemorrhagic shock"],"prefix":"10.1136","volume":"9","author":[{"given":"Julia","family":"Garcia Mancebo","sequence":"first","affiliation":[{"name":"Department of Cardiology, Boston Children\u2019s Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristen","family":"Sack","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Boston Children\u2019s Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Padraic","family":"Romfh","sequence":"additional","affiliation":[{"name":"Pendar Technologies, Cambridge, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yifeng","family":"Peng","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Boston Children\u2019s Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6080-8739","authenticated-orcid":false,"given":"John","family":"Kheir","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Boston Children\u2019s Hospital, Boston, Massachusetts, USA"},{"name":"Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,8,25]]},"reference":[{"key":"2025081711033476000_9.1.e001480.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1208943"},{"key":"2025081711033476000_9.1.e001480.2","unstructured":"Chetana Shanmukhappa S , Lokeshwaran S . Venous oxygen saturation. In: StatPearls. StatPearls Publishing, Treasure Island (FL). 2023."},{"key":"2025081711033476000_9.1.e001480.3","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1016\/j.bpa.2014.09.006","article-title":"Venous oxygen saturation","volume":"28","author":"Hartog","year":"2014","journal-title":"Best Pract Res Clin Anaesthesiol"},{"key":"2025081711033476000_9.1.e001480.4","doi-asserted-by":"crossref","first-page":"2","DOI":"10.5152\/TJAR.2019.140","article-title":"Central and Mixed Venous O2 Saturation","volume":"48","author":"Gutierrez","year":"2020","journal-title":"Turk J Anaesthesiol Reanim"},{"key":"2025081711033476000_9.1.e001480.5","doi-asserted-by":"publisher","DOI":"10.1097\/00075198-200106000-00011"},{"key":"2025081711033476000_9.1.e001480.6","doi-asserted-by":"crossref","first-page":"3379","DOI":"10.4103\/jfmpc.jfmpc_205_19","article-title":"Comparison of central venous catheter in brachiocephalic vein and internal jugular vein for the incidence of complications in patients undergoing radiology","volume":"8","author":"Motamedfar","year":"2019","journal-title":"J Family Med Prim Care"},{"key":"2025081711033476000_9.1.e001480.7","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1111\/pan.14600","article-title":"Ultrasound-guided supraclavicular cannulation of left brachiocephalic versus right internal jugular vein: Comparative analysis of central venous catheter-associated complications","volume":"33","author":"Falay","year":"2023","journal-title":"Paediatr Anaesth"},{"key":"2025081711033476000_9.1.e001480.8","doi-asserted-by":"crossref","DOI":"10.1186\/s13756-020-00851-1","article-title":"Central venous catheter-related bloodstream infection and colonization: the impact of insertion site and distribution of multidrug-resistant pathogens","volume":"9","author":"Pitiriga","year":"2020","journal-title":"Antimicrob Resist Infect Control"},{"key":"2025081711033476000_9.1.e001480.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.tmrv.2020.03.003"},{"key":"2025081711033476000_9.1.e001480.10","doi-asserted-by":"crossref","first-page":"191","DOI":"10.17219\/acem\/32065","article-title":"Prevention of Iatrogenic Anemia in Critical and Neonatal Care","volume":"25","author":"Jakacka","year":"2016","journal-title":"Adv Clin Exp Med"},{"key":"2025081711033476000_9.1.e001480.11","doi-asserted-by":"publisher","DOI":"10.1007\/s10877-008-9123-2"},{"key":"2025081711033476000_9.1.e001480.12","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1111\/j.1460-9592.2006.02026.x","article-title":"Continuous SvO2measurement in infants undergoing congenital heart surgery \u2013 first clinical experiences with a new fiberoptic probe","volume":"17","author":"M\u00fcller","year":"2007","journal-title":"Pediatr Anesth"},{"key":"2025081711033476000_9.1.e001480.13","doi-asserted-by":"crossref","first-page":"e138","DOI":"10.1213\/ANE.0000000000004580","article-title":"Sensitivity of a Next-Generation NIRS Device to Detect Low Mixed Venous Oxyhemoglobin Saturations in the Single Ventricle Population","volume":"131","author":"Gagnon","year":"2020","journal-title":"Anesth Analg"},{"key":"2025081711033476000_9.1.e001480.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2017.03.154"},{"key":"2025081711033476000_9.1.e001480.15","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1097\/EJA.0000000000000855","article-title":"Near-infrared spectroscopy in vegetables and humans: An observational study","volume":"35","author":"Kahn","year":"2018","journal-title":"Eur J Anaesthesiol"},{"key":"2025081711033476000_9.1.e001480.16","unstructured":"Monet C . Survey of light-scattering phenomena. the raman effect. John Wiley Publishers,"},{"key":"2025081711033476000_9.1.e001480.17","doi-asserted-by":"publisher","DOI":"10.1016\/S0065-3233(08)60064-9"},{"key":"2025081711033476000_9.1.e001480.18","doi-asserted-by":"crossref","unstructured":"Spiro TG . Biological applications of resonance raman spectroscopy: haem proteins. Proceedings of the Royal Society of London. Series A, mathematical and physical sciences, Vol. 345, pp. 89\u2013105; 1975, JSTOR, Available: http:\/\/www.jstor.org\/stable\/78801 [accessed 12 Jun 2023].","DOI":"10.1098\/rspa.1975.0127"},{"key":"2025081711033476000_9.1.e001480.19","doi-asserted-by":"crossref","DOI":"10.3390\/bios8040107","article-title":"Raman Spectroscopy and Microscopy Applications in Cardiovascular Diseases: From Molecules to Organs","volume":"8","author":"Chaichi","year":"2018","journal-title":"Biosensors (Basel)"},{"key":"2025081711033476000_9.1.e001480.20","doi-asserted-by":"crossref","DOI":"10.1126\/scitranslmed.aan0117","article-title":"Responsive monitoring of mitochondrial redox states in heart muscle predicts impending cardiac arrest","volume":"9","author":"Perry","year":"2017","journal-title":"Sci Transl Med"},{"key":"2025081711033476000_9.1.e001480.21","doi-asserted-by":"publisher","DOI":"10.1016\/j.addr.2015.03.009"},{"key":"2025081711033476000_9.1.e001480.22","first-page":"113","article-title":"Organ blood flow and the cause of death following massive hemorrhage","volume":"14","author":"Bellamy","year":"1984","journal-title":"Circ Shock"},{"key":"2025081711033476000_9.1.e001480.23","first-page":"485","article-title":"Rat hepatic and splanchnic vascular responses to anaphylactic shock, compared with hemorrhagic or vasodilator-induced shock","volume":"27","author":"Zhang","year":"2013","journal-title":"In Vivo"},{"key":"2025081711033476000_9.1.e001480.24","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1007\/s11684-012-0217-3","article-title":"Esophageal pulse oximetry is more accurate and detects hypoxemia earlier than conventional pulse oximetry during general anesthesia","volume":"6","author":"Chen","year":"2012","journal-title":"Front Med"},{"key":"2025081711033476000_9.1.e001480.25","doi-asserted-by":"crossref","DOI":"10.21037\/atm.2017.03.109","article-title":"Helping prometheus: liver protection in acute hemorrhagic shock","volume":"5","author":"Veith","year":"2017","journal-title":"Ann Transl Med"},{"key":"2025081711033476000_9.1.e001480.26","doi-asserted-by":"publisher","DOI":"10.1097\/01.shk.0000140660.78744.bf"},{"key":"2025081711033476000_9.1.e001480.27","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1007\/s10877-015-9660-4","article-title":"Continuous and noninvasive hemoglobin monitoring reduces red blood cell transfusion during neurosurgery: a prospective cohort study","volume":"29","author":"Awada","year":"2015","journal-title":"J Clin Monit Comput"}],"container-title":["Trauma Surgery &amp; Acute Care Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/tsaco-2024-001480","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,17]],"date-time":"2025-08-17T18:03:45Z","timestamp":1755453825000},"score":1,"resource":{"primary":{"URL":"https:\/\/tsaco.bmj.com\/lookup\/doi\/10.1136\/tsaco-2024-001480"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8]]},"references-count":27,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,8,25]]},"published-print":{"date-parts":[[2024,8]]}},"alternative-id":["10.1136\/tsaco-2024-001480"],"URL":"https:\/\/doi.org\/10.1136\/tsaco-2024-001480","relation":{},"ISSN":["2397-5776"],"issn-type":[{"value":"2397-5776","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8]]}}}