Microcirculatory perfusion during different perioperative hemodynamic strategies

Abstract

Objective: We investigated whether hemodynamic optimization of systemic tissue perfusion based on PPV and CI improves microcirculatory perfusion when compared to a MAP-based strategy in patients undergoing elective abdominal surgery.

Methods: Patients were randomized into a PPV/CI guided group (n = 13, target PPV <12%, CI >2.5 L/min/m(2) , and MAP >70 mmHg) or MAP-guided group (n = 18, target MAP >70 mmHg). PPV, CI, and MAP were measured using noninvasive arterial blood pressure measurements. Sublingual microcirculatory perfusion was measured at one, two, and three hours following anesthesia induction, and quantified as TVD, PVD or the proportion of perfused vessels. Data were analyzed using ANOVA RM.

Results: Patients in the PPV/CI group required more fluid administration than control patients (1927 ± 747 mL versus 1283 ± 582 mL, respectively; p = 0.01). Despite this difference, we observed similar values for TVD (RM; F(1.28) = 0.01; p = 0.92), PVD (RM; F(1.28) = 0.09; p = 0.77) and the proportion of perfused vessels (RM; F(1.28) = 0.01; p = 0.76) in both groups.

Conclusion: Hemodynamic optimization of systemic tissue perfusion is not associated with improvement of microcirculatory perfusion compared to a MAP-guided protocol in patients undergoing abdominal surgery.

Keywords: goal-directed therapy; hemodynamic optimization; microcirculation; perioperative; pulse pressure variation.