Tissue oxygenation as a target for goal-directed therapy in high-risk surgery: a pilot study

BMC Anesthesiology

Thomas WL Scheeren¹  Alain F Kalmar¹  Marieke Poterman¹  Jaap Jan Vos¹  Paul A van Beest¹ 

[1]Department of Anesthesiology, University Medical Center Groningen, University of Groningen, PO Box 30001, 9700 RB Groningen, the Netherlands

关键词: Goal-directed therapy;    High-risk surgery;    Postoperative complications;    Near-infrared spectroscopy;    Tissue oxygenation;   

Others  :  1084202
DOI  :  10.1186/1471-2253-14-122

 received in 2014-07-27, accepted in 2014-12-08,  发布年份 2014

【 摘 要 】

Background

Tissue hypoperfusion occurs frequently during surgery and may contribute to postoperative organ dysfunction. There is a need for perioperative treatment protocols aiming at improving tissue oxygenation (StO₂). We hypothesised that intra-operative optimisation of StO₂ improves tissue perfusion and thus reduces postoperative complications. Furthermore, we evaluated the feasibility of the optimisation algorithm used.

Methods

We randomized 50 high-risk patients, all >65 years with ASA physical status III, who underwent major abdominal surgery under standardized balanced general anesthesia combined with epidural analgesia. Throughout surgery StO₂ was monitored at the thenar eminence using near-infrared spectroscopy. All patients were treated according to a standard care algorithm. In addition, patients in the intervention group were treated with dobutamine if necessary to keep or raise StO₂ ≥ 80%. Data were recorded continuously and complications were recorded during hospital stay with a maximum of 28 days.

Results

The number of complications was not significantly different between groups (11 vs 20; p = 0.23). Eleven patients in the intervention group had no complication, versus 7 in the control group. There was no significant difference between groups in length of stay in ICU or in hospital. Only ten patients in the intervention group received dobutamine. Administration of dobutamine resulted in a moderate 6 [-3 to 10] % increase of StO₂. The overall protocol adherence was 94%.

Conclusions

No statistically significant difference in outcome was realized through intraoperative optimization of StO₂ values in this pilot study. The protocol used may be considered feasible for clinical practice. Further research is obligatory to define both the optimal StO₂ threshold and intervention to treat tissue hypoperfusion.

Trial registration

ClinicalTrials.gov identifier: NCT01342900. Registered 21 April 2011.

【 授权许可】

   
2014 van Beest et al.; licensee BioMed Central.

【 图 表 】

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