Intraoperative evaluation of tissue perfusion in high-risk patients by invasive and noninvasive hemodynamic monitoring

Abstract

The survivors had slightly higher mean arterial pressure, cardiac index, and mixed venous oxygen saturation, as well as significantly higher oxygen delivery, oxygen consumption, transcutaneous oxygen tension, and transcutaneous oxygen tension/FIO2 ratios, than did the nonsurvivors. The data suggest that blood flow, oxygen delivery, and tissue oxygenation of the nonsurvivors became inadequate toward the end of the operation. Noninvasive monitoring provides similar information to that of the PAC; both approaches revealed low-flow and poor tissue perfusion that were worse in the nonsurvivors. The continuous on-line real-time displays of hemodynamic trends facilitate early recognition of acute circulatory dysfunction.

Conservative vs Restrictive Individualized Goal-Directed Fluid Replacement Strategy in Major Abdominal Surgery

“…5,9,[16][17][18] Conversely, excessive fluid restriction, especially using unmonitored and fixed volumes, may expose a patient's tissue to hypovolemia and hypoperfusion, which are key triggers of organ dysfunction. 3,[19][20][21] Nevertheless, maintenance of the volume of intravascular fluid is essential to ensure adequate organ per-fusion. Surgical trauma is associated with endothelial damage arising from mechanical stress, endotoxin exposure, ischemia-reperfusion injury, or inflammation, 5,22 all of which can lead to increased endothelial permeability and unpredictable extravascular fluid shifts.…”

Randomised controlled trial assessing the impact of a nurse delivered, flow monitored protocol for optimisation of circulatory status after cardiac surgery

“…[8][9][10][11] One study found that the magnitude of the tissue organ debt perioperatively was related to the subsequent development of organ failure and death. 11 Tissue hypoxia is a potent stimulus for an inflammatory response.…”

Studies of Tissue Perfusion Failure at LAC+USCMC and the Incorporation of the Results into a National Trauma Database

“…These datasets have been used in several focused studies conducted in the past at LAC+USCMC [e.g., Refs. [6][7][8][9][10][11]. The percentage of patients covered by various physiological parameters is presented in Table 3 to help characterize the sensor coverage.…”