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Surgical Endoscopy
Erschienen in: Surgical Endoscopy 12/2021

30.11.2020

Quantitative fluorescence angiography detects dynamic changes in gastric perfusion

verfasst von: Jens Osterkamp, Rune Strandby, Nikolaj Nerup, Morten Svendsen, Lars Svendsen, Michael Achiam

Erschienen in: Surgical Endoscopy | Ausgabe 12/2021

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Abstract

Introduction

The use of Indocyanine green (ICG) fluorescence angiography (ICG-FA) is an applied method to assess visceral perfusion during surgical procedures worldwide. Further development has entailed quantification of the fluorescence signal; however, whether quantified ICG-FA can detect intraoperative changes in perfusion after hemorrhage has not been investigated previously. In this study, we investigated whether a quantification method, developed and validated in our department (q-ICG), could detect changes in gastric perfusion induced by hemorrhage and resuscitation.

Methods

Ten pigs were included in the study. Specific regions of interest of the stomach were chosen, and three q-ICG measurements of gastric perfusion obtained: 20 min after completion of the laparoscopic setup (baseline), after reducing the circulating blood volume by 30%, and after reinfusion of the withdrawn blood volume. Hemodynamic variables were recorded, and blood samples were collected every 10 min during the procedure.

Results

The reduction in blood volume generated decreased gastric perfusion (q-ICG) from baseline (p = 0.023), and gastric perfusion subsequently increased (p < 0.001) after the reintroduction of the withdrawn blood volume. Cardiac output (CO) and mean arterial blood pressure (MAP) shifted correspondingly and the gastric perfusion correlated to CO (r = 0.575, p = 0.001) and MAP (r = 0.436, p = 0.018).

Conclusion

We present a novel study showing that the q-ICG method can detect dynamic changes in local tissue perfusion induced by hemorrhage and resuscitation. As regional gastrointestinal perfusion may be significantly reduced, while hemodynamic variables such as MAP or heart rate remain stable, q-ICG may provide an objective, non-invasive method for detecting regional early ischemia, strengthening surgical decision making.
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Metadaten
Titel
Quantitative fluorescence angiography detects dynamic changes in gastric perfusion
verfasst von
Jens Osterkamp
Rune Strandby
Nikolaj Nerup
Morten Svendsen
Lars Svendsen
Michael Achiam
Publikationsdatum
30.11.2020
Verlag
Springer US
Erschienen in
Surgical Endoscopy / Ausgabe 12/2021
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-020-08183-2

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