ABSTRACT
Traumatic injuries are the third leading cause of death among all age groups and the leading cause of death among Americans aged 44 years and younger. To improve outcomes, life-threatening injuries must be diagnosed and treated expeditiously. The trauma surgeon must decide what type of monitoring will ensure an accurate diagnosis of shock, adequate and timely resuscitation, and early identification of potential complications. HR and BP are not adequate indicators of shock. Trauma patients with significant blood loss may present in compensated shock with normal vital signs. Other data in addition to HR and BP must be determined to detect occult hypoperfusion. Current local perfusion measures such as NIRS, gastric intramucosal pH, and sublingual capnography may help identify occult hypoperfusion; however, their lack of sensitivity limits their ability to guide resuscitation. Evidence suggesting they improve outcomes is lacking.
