Agerskov Marianne, Thusholdt Anna Nicoline Wolfhagen, Højlund Jakob, Meyhoff Christian Sahlholdt, Sørensen Henrik, Wiberg Sebastian, Secher Niels Henry, Bang Foss Nicolai
Department of Anaesthesia, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
Department of Anaesthesia, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark.
BMJ Open. 2019 Nov 21;9(11):e031249. doi: 10.1136/bmjopen-2019-031249.
Perioperative haemodynamic instability is associated with postoperative morbidity and mortality. Macrocirculatory parameters, such as arterial blood pressure and cardiac output are associated with poor outcome but may be uncoupled from the microcirculation during sepsis and hypovolaemia and may not be optimal resuscitation parameters. The peripheral perfusion index (PPI) is derived from the pulse oximetry signal. Reduced peripheral perfusion is associated with morbidity in critically ill patients and in patients following acute surgery. We hypothesise that a low intraoperative PPI is independently associated with postoperative complications and mortality.
We plan to conduct a retrospective cohort study in approximately 2300 patients, who underwent acute non-cardiac surgery (1 November 2017 to 31 October 2018) at two Danish University Hospitals. Data will be collected from patient records including patient demographics, comorbidity and intraoperative haemodynamic values with PPI as the primary exposure variable, and postoperative complications and mortality within 30 and 90 days as outcome variables. We primarily assess association between PPI and outcome in multivariate regression models. Second, the predictive value of PPI for outcome, using area under the receiver operating characteristics curve is assessed.
Data will be reported according to the Strengthening the Reporting of Observational Studies in Epidemiology and results published in a peer-reviewed journal. The study is approved by the regional research ethics committee, storage and management of data has been approved by the Regional Data Protection Agency, and access to medical records is approved by the hospital board of directors (ClinicalTrials.gov registration no: NCT03757442).
围手术期血流动力学不稳定与术后发病率和死亡率相关。诸如动脉血压和心输出量等大循环参数与不良预后相关，但在脓毒症和低血容量期间可能与微循环解耦，且可能不是最佳的复苏参数。外周灌注指数（PPI）源自脉搏血氧饱和度信号。外周灌注减少与重症患者及急性手术后患者的发病率相关。我们假设术中低PPI与术后并发症和死亡率独立相关。
我们计划对约2300例患者进行一项回顾性队列研究，这些患者于2017年11月1日至2018年10月31日在两家丹麦大学医院接受急性非心脏手术。将从患者记录中收集数据，包括患者人口统计学信息、合并症以及以PPI作为主要暴露变量的术中血流动力学值，以及术后30天和90天内的并发症和死亡率作为结局变量。我们主要在多变量回归模型中评估PPI与结局之间的关联。其次，使用受试者工作特征曲线下面积评估PPI对结局的预测价值。
数据将根据加强流行病学观察性研究报告标准进行报告，并在同行评审期刊上发表结果。该研究已获地区研究伦理委员会批准，数据的存储和管理已获地区数据保护机构批准，获取病历已获医院董事会批准（ClinicalTrials.gov注册号：NCT03757442）。
