Loss of Haemodynamic Coherence, Diagnosed Using a Continuous Monitoring of Oesophageal Photoplethysmography

We report the case of a 75-year-old man with appendicular peritonitis in whom we observed oesophageal tissue perfusion, using a new photoplethysmographic probe. As the patient suffered from lactic acidosis, we chose to increase the mean arterial pressure (MAP) using norepinephrine. Thanks to an oesophageal photoplethysmographic signal, we could observe a loss of haemodynamic coherence and a severe alteration of tissue perfusion triggered by the MAP increase. Considering new information regarding the tissue perfusion status, we were able to adjust our MAP targets accordingly and restore the initial perfusion index values. This case illustrates the loss of haemodynamic coherence and highlights the clinical relevance of continuous tissue perfusion monitoring to highlight potential adverse norepinephrine effects.