EVIDENCE FOR EARLY SUPPLY INDEPENDENT MITOCHONDRIAL DYSFUNCTION IN PATIENTS DEVELOPING MULTIPLE ORGAN FAILURE AFTER TRAUMA

Objective: To determine whether early supply independent mitochondrial oxidative dysfunction occurs in trauma patients who develop multiple organ failure (MOF), Design: Prospective focused observational trial, Methods: High-risk patients were aggressively resuscitated while being continuously monitored by near infrared spectroscopy, Near infrared s pectroscopy monitoring strips allow for a direct comparison of changes in tissue oxyhemoglobin levels (HbO(2)), which reflect local oxygen s upply, and cytochrome a,a(3) redox, which reflects mitochondrial oxyge n consumption, Under normal conditions, HbO(2) and a,a(3) redox are ti ghtly coupled, On the other hand, decoupled HbO(2) and a,a(3) redox is a sign of mitochondrial oxidative dysfunction, Outcomes included MOF, oxygen delivery, oxygen consumption, lactate, and the presence of dec oupled HbO(2) and a,a(3) redox, Results: Twenty-four high-risk patient s were studied; nine (38%) developed MOF, At 12 hours of resuscitation , MOF and non-MOF patients did not have statistically different oxygen delivery and oxygen consumption, but lactate levels were significantl y higher in MOF patients, Additionally, HBO2 and a,a(3) redox were dec oupled in eight (89%) MOF patients compared with two (13%) non-MOB pat ients (p < 0.05), Conclusion: Severely injured trauma patients who dev elop MOF preferentially display evidence of mitochondrial oxidative dy sfunction early in the course of their resuscitation despite early goa l-oriented maximization of oxygen delivery.