Affiliations: [a] Department of Surgery, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| [b] Department of Anesthesiology, University Hospital Rio Hortega, Valladolid, Spain
| [c] Department of Intensive Care, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
Correspondence:
[*]
Corresponding author: Casper H.J. van Eijck, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, ’s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands. Tel.: +31 107033854; Fax: +31 107033555; E-mail: [email protected].
Note: [1] These authors contributed equally to this work.
Abstract: Background:An observational cohort study was conducted to identify potential sublingual microcirculation parameters as a target for goal-directed fluid therapy. Methods:Patients that were scheduled for an open elective pancreatico-biliary surgery in Erasmus Medical Center were included. All patients underwent sublingual microcirculatory measurement at three time points: one day before surgery (T0), within the first 24 hours after surgery (T1) and on the fourth day after surgery (T2). The following parameters were obtained: microvascular flow index (MFI (AU)), Total vessels density (TVD (mm/mm2/)), Perfused vessels density (PVD (mm/mm2)), and proportion of perfused vessels (PPV (%)). Results:Sixteen patients were included in the final analysis. The differences between the time points T1 and T0 in patients without clinical significant complication and in patients with these complications gave a significant difference for PVD small vessels (PVDs) (delta PVDs mean -0.1 vs -8.2, p=0.01) and PPV small vessels (PPVs) (delta PPVs median 7.0 % vs -15.5 %, p=0.01). Conclusion:The most significant microcirculatory parameter for a perioperative complicated course is the change of PVD and PPV. In the first 24 hours after surgery, if these parameters decrease there is a high chance of a complicated perioperative course.
