Non-Calibrated Pulse-Contour Analysis for Monitoring Adequacy of Tissue Perfusion in Major Abdominal Surgeries in Perioperative Period

Abstract

During major abdominal surgeries, incidence of major blood loss as well as major fluid loss is an acute risk factor. If the fluid is not replenished in the perioperative period, can lead to increased risk of complications, including cardiac and respiratory failure, cognitive impairment and physiologic reaction to the infection due to lack of the oxygenation and organ perfusion. Underlying disease and co morbidities, anesthetic use and nature and duration of the surgery also associated with the development of these complications which often lead to poor patient outcome. To potentially improve outcomes and reduce complications, monitoring modalities that reflect the patient’s dynamic intra vascular physiology in real time should be employed. Increasingly, clinicians have turned to haemodynamic assessment to measure cardiac output to guide vasopressor support for oxygen delivery, organ perfusion, blood pressure, as well as the use of appropriate anesthetic. Data has shown that using haemodynamic assessment to guide fluid management leads to reduce hypovolemia and hypoperfusion. Using measurement of stroke volume, stroke volume variation and pulse pressure variation. Over other volume indicators like central venous pressure have been effective in reducing complications and improving outcomes via goal directed therapy protocols. Various devices are available to measure or estimate cardiac output using different methods. Some of these less invasive devices track stroke volume (SV) continuously and provide dynamic indices of fluid responsiveness, others allow assessment of volumetric preload variables, and some also provide continuous measurement of central venous saturation via the use of proprietary catheters that are attached to the same monitor. All these variables together with cardiac output – may result in an improved hemodynamic assessment of the critically ill patient. When selecting a cardiac output monitoring device for clinical use, different factors play a role. Institutional factors may largely limit the choice of the available devices. On the other hand important device-related factors, e.g., invasiveness (Figure 3), may restrict the area of application. Moreover, patient specific conditions may dictate the use of an invasive or a particular non-invasive device. The current study was a single center, prospective randomized controlled clinical trial that estimate the efficacy of using non calibrated pulse-contour analysis using Vigileo/FloTrac monitor for monitoring adequacy of tissue perfusion in major abdominal surgeries in perioperative period. Eighty patients was included in the study who are 18-70 years of age with an ASA score II or III, with one or more risk factors according to risk index of lee, underwent major abdominal surgeries, the patients meeting inclusion criteria were randomized preoperatively into conventional resuscitation group (conv-group) and cardiac output resuscitation group (CO-group). Randomization was performed using serially numbered opaque envelopes.