A Feldheiser1, O Hunsicker1, L Kaufner1, J Köhler1, H Sieglitz1, R Casans Francés2, K-D Wernecke3, J Sehouli4, C Spies5. 1. Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-University Medicine Berlin, Berlín, Alemania. 2. Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España. 3. Charité-University Medicine Berlin and SOSTANA GmbH Berlin, Berlín, Alemania. 4. Department of Gynaecology, European Competence Center for Ovarian Cancer, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Berlín, Alemania. 5. Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-University Medicine Berlin, Berlín, Alemania. Electronic address: claudia.spies@charite.de.
Abstract
BACKGROUND:Near-infrared spectroscopy combined with a vascular occlusion test (VOT) could indicate an impairment of microvascular reactivity (MVR) in septic patients by detecting changes in dynamic variables of muscle O2 saturation (StO2). However, in the perioperative context the consequences of surgical trauma on dynamic variables of muscle StO2 as indicators of MVR are still unknown. METHODS: This study is a sub-analysis of a randomised controlled trial in patients with metastatic primary ovarian cancer undergoing debulking surgery, during which a goal-directed haemodynamic algorithm was applied using oesophageal Doppler. During a 3 min VOT, near-infrared spectroscopy was used to assess dynamic variables arising from changes in muscle StO2. RESULTS: At the beginning of surgery, values of desaturation and recovery slope were comparable to values obtained in healthy volunteers. During the course of surgery, both desaturation and recovery slope showed a gradual decrease. Concomitantly, the study population underwent a transition to a surgically induced systemic inflammatory response state shown by a gradual increase in norepinephrine administration, heart rate, and Interleukin-6, with a peak immediately after the end of surgery. Higher rates of norepinephrine and a higher heart rate were related to a faster decline in StO2 during vascular occlusion. CONCLUSIONS: Using near-infrared spectroscopy combined with a VOT during surgery showed a gradual deterioration of MVR in patients treated with optimal haemodynamic care. The deterioration of MVR was accompanied by the transition to a surgically induced systemic inflammatory response state.
RCT Entities:
BACKGROUND: Near-infrared spectroscopy combined with a vascular occlusion test (VOT) could indicate an impairment of microvascular reactivity (MVR) in septicpatients by detecting changes in dynamic variables of muscle O2 saturation (StO2). However, in the perioperative context the consequences of surgical trauma on dynamic variables of muscle StO2 as indicators of MVR are still unknown. METHODS: This study is a sub-analysis of a randomised controlled trial in patients with metastatic primary ovarian cancer undergoing debulking surgery, during which a goal-directed haemodynamic algorithm was applied using oesophageal Doppler. During a 3 min VOT, near-infrared spectroscopy was used to assess dynamic variables arising from changes in muscle StO2. RESULTS: At the beginning of surgery, values of desaturation and recovery slope were comparable to values obtained in healthy volunteers. During the course of surgery, both desaturation and recovery slope showed a gradual decrease. Concomitantly, the study population underwent a transition to a surgically induced systemic inflammatory response state shown by a gradual increase in norepinephrine administration, heart rate, and Interleukin-6, with a peak immediately after the end of surgery. Higher rates of norepinephrine and a higher heart rate were related to a faster decline in StO2 during vascular occlusion. CONCLUSIONS: Using near-infrared spectroscopy combined with a VOT during surgery showed a gradual deterioration of MVR in patients treated with optimal haemodynamic care. The deterioration of MVR was accompanied by the transition to a surgically induced systemic inflammatory response state.
Keywords:
Cirugía; Espectroscopia cercana a infrarrojos; Goal-directed therapy; Haemodynamic; Hemodinámica; Near-infrared spectroscopy; Surgery; Terapia dirigida por objetivos; Test de oclusión vascular; Vascular occlusion test
Authors: Jennifer Gehlen; Sven Klaschik; Claudia Neumann; Mignon-Denise Keyver-Paik; Alexander Mustea; Martin Soehle; Stilla Frede; Markus Velten; Andreas Hoeft; Tobias Hilbert Journal: J Transl Med Date: 2020-01-31 Impact factor: 5.531