[Optimizing blood pressure in patients with sellar region tumors during complicated postoperative period]

Mechanism of arterial hypotension (AH) in patients with sellar region tumors (SRT) and complicated postoperative period consists in decrease of systemic vascular resistance and relative hypovolemia. Therapeutic directions for blood pressure (BP) stabilization are clear. However criteria of optimal BP in these patients are absent. Object of the study was defining such criteria. Prospective study was conducted from January, 2011 to January, 2012. Inclusion criteria were: adults; SRT; early postoperative period. Thirty patients were included into the study. Patients were divided into three groups. Group I (n=11) consisted of patients with uncomplicated postoperative period; group II (n=12) - patients with complicated postoperative and with stable hemodynamics; group III (n=7) - patients with complicated postoperative period and AH. Median of central venous saturation (ScvO2) was normal in all groups. ScvO2 was significantly higher than jugular vein saturation (SjvO2) in all measurement. In group I SjvO2 was normal, and it was higher, than in group II. In group SjvO2 did not achieve normal level during three days of the study. Mean BP did not change during these days. In group III SjvO2 was decreased if mean BP was between 70 and 90 mmHg. This level of SjvO2 did not differ from SjvO2 in group II. When mean BP increased up to 100-110 mmHg SjvO2 significantly increased too in the group III and achieved level of the group I (normal level). Outcomes were favorable in all patients of the group I (GOS=4, 5). Median of length of stay (LOS) in the ICU was 1 day. In group II outcomes were favorable in 10 (83.3%) patients, 2 (16.7%) patients died. Median LOS in ICU was 7 days. In group III outcomes were favorable in 6 (85.7%) patients, unfavorable outcome (GOS=3) was in 1 (24.3%) patient. Median LOS in ICU was 12 days. There were no significant differences in all groups in the lactate levels both in central vein and in jugular vein. ScvO2 can not be a criterion for BP optimization in patients with SRT. In patients with uncomplicated postoperative period SjvO2 is normal. In patients with complicated postoperative period and normal BP SjvO2 remains decreased. In patients with complicated postoperative period and arterial hypotension normal level of SjvO2 can be achieved if mean BP is increased up to 100-110 mmHg. SjvO2 normalization can improve outcomes in patients with SRT and complicated postoperative period.