
==== Front
Trauma Surg Acute Care Open
Trauma Surg Acute Care Open
tsaco
tsaco
Trauma Surgery & Acute Care Open
2397-5776
BMJ Publishing Group BMA House, Tavistock Square, London, WC1H 9JR

10.1136/tsaco-2024-001600
tsaco-2024-001600
Commentary
1506
Lighting the way forward: using resonance Raman spectroscopy to non-invasively assess tissue perfusion
Rehani Chavi crehani@som.umaryland.edu
1
http://orcid.org/0000-0002-9582-8622
Kozar Rosemary rkozar@som.umaryland.edu
1
1 R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA
Dr; rkozar@som.umaryland.edu
None declared.

2024
12 9 2024
9 1 e00160001 9 2024
Copyright © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
2024
https://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

Shock, Hemorrhagic
oxyhemoglobin
==== Body
pmc Poor tissue perfusion is an important driver of shock in patients after surgery, trauma, and sepsis.1 Assessment of tissue oxygenation and volume status in these patients involves assimilating multiple endpoints of resuscitation.2 This commonly includes measuring surrogate markers such as serum lactate and central venous oxygenation (ScVO2) through blood sampling. These data points are helpful in guiding treatment, but they can only offer intermittent insights when limited by the frequency of blood draws. In the case of ScVO2, they can also require invasive procedures such as central line placement which carries risks of infection, pneumothorax, and thrombosis.

To overcome these challenges, Garcia Mancebo et al fabricated a novel device that uses resonance Raman spectroscopy (RRS) to quantify oxyhemoglobin saturation (ShbO2) using a small probe placed on the surface of various tissues. Using two different rodent models of hemorrhagic shock, the authors demonstrated that RRS-measured ShbO2 in the esophagus and tongue strongly correlated with both ScVO2 and serum lactate. Depending on the site, ShbO2 also detected near-term death with 72-83% sensitivity.3

It is interesting to note that over three decades ago, Scalea et al proposed the use of central venous blood oxygen saturation to detect acute blood loss in animals and in trauma patients.4 5 Although the idea of venous oxygenation monitoring may not be novel, the ability to non-invasively and continuously detect blood loss and hypoperfusion in real time may prove to be. The authors acknowledge limitations of their device, including the small size of the laser which only provides data over a small area of tissue. It can, therefore, be prone to sampling error and not reflect whole organ or systemic perfusion. Although this technology may prove useful in the battlefield or mass casualty setting to detect sequalae of massive hemorrhage and guide resuscitation, future studies should examine if RRS technology can detect subclinical hemorrhage which would have further application in both civilian and military trauma settings.

Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Patient consent for publication: Not applicable.

Ethics approval: Not applicable.

Provenance and peer review: Commissioned; internally peer reviewed.
==== Refs
References

1 Vincent JL De Backer D Circulatory Shock N Engl J Med 2013 369 1726 34 10.1056/NEJMra1208943 24171518
2 Martin ND Codner P Greene W Brasel K Michetti C Committee ACC Contemporary hemodynamic monitoring, fluid responsiveness, volume optimization, and endpoints of resuscitation: an AAST critical care committee clinical consensus Trauma Surg Acute Care Open 2020 5 e000411 10.1136/tsaco-2019-000411 32201737
3 Garcia Mancebo J Sack K Romfh P Peng Y Kheir J Esophageal oxyhemoglobin saturation as a resuscitative metric in hemorrhagic shock Trauma Surg Acute Care Open 2024 9 e001480 10.1136/tsaco-2024-001480
4 Scalea TM Holman M Fuortes M Baron BJ Phillips TF Goldstein AS Sclafani SJ Shaftan GW Central venous blood oxygen saturation: an early, accurate measurement of volume during hemorrhage J Trauma 1988 28 725 32 3385813
5 Scalea TM Hartnett RW Duncan AO Atweh NA Phillips TF Sclafani SJ Fuortes M Shaftan GW Central venous oxygen saturation: a useful clinical tool in trauma patients J Trauma 1990 30 1539 43 2258969
