The online version of this article (doi:10.1186/1471-2253-14-122) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
PB drafted the manuscript, participated in its design and coordination, and performed statistical analysis. JV responsible for data logging system and acquisition of continuous patient data and helped to draft the manuscript. MP responsible for processing continuous data, performed statistical analysis and helped to draft the manuscript. AK participated in the design of the study and helped to draft the manuscript. TS conceived of the study and participated in its design and coordination and helped to draft the manuscript. All authors read and approved the final manuscript.
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.
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.
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%.
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.
ClinicalTrials.gov identifier: NCT01342900. Registered 21 April 2011.
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- Tissue oxygenation as a target for goal-directed therapy in high-risk surgery: a pilot study
Paul A van Beest
Jaap Jan Vos
Alain F Kalmar
Thomas WL Scheeren
- BioMed Central
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