TY - JOUR
T1 - Effect of pneumoperitoneum and steep reverse-Trendelenburg position on mean systemic filling pressure, venous return, and microcirculation during esophagectomy
AU - He, Huaiwu
AU - Gruartmoner, Guillem
AU - Ince, Yilmaz
AU - Henegouwen, Mark I. van Berge
AU - Gisbertz, Suzanne S.
AU - Geerts, Bart F.
AU - Ince, Can
AU - Hollmann, Markus W.
AU - Liu, Dawei
AU - Veelo, Denise P.
PY - 2018
Y1 - 2018
N2 - Background: Keeping adequate tissue perfusion during high-risk abdominal surgery is of utmost importance to decrease postoperative complications. The objective was to investigate the alteration in mean systemic filling pressure (MSFP), venous return (VR) and sublingual microcirculation during pneumoperitoneum and steep reverse-Trendelenburg position during thoracolaparoscopic esophagectomy. Methods: This is a single-center prospective observational study in operating room at a university hospital. Eleven consecutive patients undergoing minimally invasive esophagectomy. Intraoperative hemodynamic and sublingual microcirculatory variables were simultaneously measured within 5 minutes at the following time points: T1, baseline supine position before the start of surgery; T2, pneumoperitoneum in supine position; T3, steep reverse-Trendelenburg position after the pneumoperitoneum. The cardiac output (CO) was obtained with continuous pulse contour waveform-derived measurements, and the MSFP was estimated with the analogue method. Results: The pneumoperitoneum and reverse-Trendelenburg caused an increase in stroke volume variation (SVV), MSFP and central venous pressure (CVP), and a decrease in the microcirculatory perfusion index (MFI, < 0.05). However, changes in CO, pressure gradient of VR, resistance of VR and blood pressure were not consistent and did not differ significantly across timepoints. Moreover, MFI is significantly related to CVP and MSFP but not to CO and blood pressure (BP). Measurements with MFI ≤2 have a higher CVP and MSFP compared to those with MFI > 2. Using a CVP ≤23 mmHg to detect MFI ≤2 results in a sensitivity of 61.54% and a specificity of 100%. Conclusions: A high CVP is related to poor microcirculatory flow perfusion even if the macrocirculation has been maintained during pneumoperitoneum.
AB - Background: Keeping adequate tissue perfusion during high-risk abdominal surgery is of utmost importance to decrease postoperative complications. The objective was to investigate the alteration in mean systemic filling pressure (MSFP), venous return (VR) and sublingual microcirculation during pneumoperitoneum and steep reverse-Trendelenburg position during thoracolaparoscopic esophagectomy. Methods: This is a single-center prospective observational study in operating room at a university hospital. Eleven consecutive patients undergoing minimally invasive esophagectomy. Intraoperative hemodynamic and sublingual microcirculatory variables were simultaneously measured within 5 minutes at the following time points: T1, baseline supine position before the start of surgery; T2, pneumoperitoneum in supine position; T3, steep reverse-Trendelenburg position after the pneumoperitoneum. The cardiac output (CO) was obtained with continuous pulse contour waveform-derived measurements, and the MSFP was estimated with the analogue method. Results: The pneumoperitoneum and reverse-Trendelenburg caused an increase in stroke volume variation (SVV), MSFP and central venous pressure (CVP), and a decrease in the microcirculatory perfusion index (MFI, < 0.05). However, changes in CO, pressure gradient of VR, resistance of VR and blood pressure were not consistent and did not differ significantly across timepoints. Moreover, MFI is significantly related to CVP and MSFP but not to CO and blood pressure (BP). Measurements with MFI ≤2 have a higher CVP and MSFP compared to those with MFI > 2. Using a CVP ≤23 mmHg to detect MFI ≤2 results in a sensitivity of 61.54% and a specificity of 100%. Conclusions: A high CVP is related to poor microcirculatory flow perfusion even if the macrocirculation has been maintained during pneumoperitoneum.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85049241178&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/30069335
U2 - https://doi.org/10.21037/jtd.2018.05.169
DO - https://doi.org/10.21037/jtd.2018.05.169
M3 - Article
C2 - 30069335
SN - 2072-1439
VL - 10
SP - 3399
EP - 3408
JO - Journal of thoracic disease
JF - Journal of thoracic disease
IS - 6
ER -