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Hemodynamic and cardiac function parameters during heated intraoperative intraperitoneal chemotherapy using the open
J Esquivel1, F Angulo, R K Bland
1The Washington Cancer Institute, DC 20010, USA.
Annals of Surgical Oncology
|May 20, 2000
Summary
Heated intraoperative intraperitoneal chemotherapy (HIPEC) using the open abdomen technique can cause a hyperdynamic circulatory state. Liberal intravenous fluids, monitored by urinary output, are key to maintaining hemodynamic stability during HIPEC.
Area of Science:
- Oncology
- Surgical Oncology
- Critical Care Medicine
Background:
- Heated intraoperative intraperitoneal chemotherapy (HIPEC) is crucial for managing peritoneal carcinomatosis, offering high peritoneal drug concentrations with minimal systemic absorption.
- The closed abdomen technique in HIPEC is linked to perioperative toxicity due to hemodynamic and cardiac changes from elevated body temperature and intra-abdominal pressure.
- HIPEC is utilized for low-grade malignancies like pseudomyxoma peritonei and selected high-grade tumors such as colon adenocarcinoma.
Purpose of the Study:
- To evaluate hemodynamic and cardiac function during HIPEC using the open abdomen "coliseum technique."
- To assess the impact of the open abdomen technique on patient hemodynamics compared to the closed abdomen method.
Main Methods:
- Hemodynamic and cardiac function were monitored noninvasively using an esophageal Doppler monitor in 15 patients undergoing HIPEC.
- The study specifically employed the open abdomen "coliseum technique" for HIPEC administration.
Main Results:
- HIPEC with the open abdomen technique induced a hyperdynamic circulatory state, characterized by increased heart rate and cardiac output, and decreased systemic vascular resistance.
- A decrease in effective circulating volume was observed, with a trend towards reduced urinary output as therapy progressed.
- The open abdomen technique avoided the hemodynamic changes associated with increased intra-abdominal pressure seen in closed techniques.
Conclusions:
- The open abdomen coliseum technique for HIPEC creates a hyperdynamic circulatory state requiring increased intravenous fluid administration.
- Hemodynamic and cardiac stability, evidenced by normal blood pressure and adequate urinary output, can be maintained with liberal intravenous fluid management.
- Frequent urinary output monitoring is essential for titrating intravenous fluids to ensure stability during HIPEC with the open abdomen technique.