Haemodynamic optimisation improves tissue microvascular flow and oxygenation after major surgery: a randomised
Shaman Jhanji1, Amanda Vivian-Smith, Susana Lucena-Amaro
1Barts and The London School of Medicine and Dentistry, Queen Mary's University of London, Turner Street, London E1 2AD, UK. shaman.jhanji@bartsandthelondon.nhs.uk
Critical Care (London, England)
|August 12, 2010
Summary
Stroke volume-guided fluid therapy with dopexamine improved microvascular flow and oxygenation in surgical patients. This approach enhances tissue oxygen delivery, potentially improving clinical outcomes.
Area of Science:
- Critical Care Medicine
- Surgical Outcomes
- Hemodynamics
Background:
- Optimizing post-operative outcomes may involve flow-related endpoints for intravenous fluid and low-dose inotropic therapy.
- The precise mechanisms behind these benefits are not fully understood.
- This study investigates the impact of specific therapeutic strategies on tissue perfusion and inflammation.
Purpose of the Study:
- To assess the effects of stroke volume-guided intravenous fluid therapy combined with low-dose dopexamine.
- To evaluate the impact on tissue microvascular flow and oxygenation in patients undergoing major gastrointestinal surgery.
- To analyze changes in inflammatory markers post-operatively.
Main Methods:
- A randomized, controlled, single-blind study involving 135 patients in a university hospital critical care unit post-major gastrointestinal surgery.
- Three groups: central venous pressure (CVP) guided fluids, stroke volume (SV) guided fluids, and SV guided fluids with dopexamine (SV & DPX).
- Therapy was administered for eight hours post-surgery, with microvascular flow, oxygenation, and inflammatory markers assessed.
Main Results:
- The SV & DPX group showed improved sublingual and cutaneous microvascular flow and increased global oxygen delivery.
- Cutaneous tissue oxygen partial pressure (PtO2) improved significantly only in the SV & DPX group.
- No significant differences in serum inflammatory markers were observed; however, acute kidney injury was less frequent in the SV and SV & DPX groups compared to the CVP group.
Conclusions:
- Stroke volume-guided fluid therapy, particularly when combined with low-dose dopexamine, enhances global oxygen delivery, microvascular flow, and tissue oxygenation.
- These hemodynamic improvements did not correlate with changes in the inflammatory response.
- The observed improvements in microcirculation and oxygenation may explain previously reported better clinical outcomes with this therapeutic approach.
