Flick Moritz, Briesenick-Weskamm Luisa, Sierzputowski Pawel, Süykers Marie-Christin, Moll-Khosrawi Parisa, Krause Linda, Bergholz Alina, Thomsen Kristen K, Joosten Alexandre, Kouz Karim, Saugel Bernd
Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
J Clin Anesth. 2025 Sep;106:111905. doi: 10.1016/j.jclinane.2025.111905. Epub 2025 Jun 25.
Mechanistic effects of intraoperative blood flow-guided hemodynamic therapy remain poorly understood. Therefore, we aimed to determine the effects of a) maximizing stroke volume and b) maintaining preoperative resting cardiac index on oxygen delivery, oxygen consumption, and sublingual and abdominal microcirculatory tissue perfusion in major abdominal surgery patients.
We randomized 76 patients to maximizing stroke volume, maintaining preoperative resting cardiac index, or routine care during and for the first 6 h after surgery. We measured oxygen delivery index, oxygen consumption index, sublingual microvascular flow index, and urethral perfusion index.
At the end of surgery and 6 h after surgery, the median (25th percentile, 75th percentile) oxygen delivery index was higher in patients assigned to stroke volume maximization (460 (404, 556) ml/min/m and 503 (466, 595) ml/min/m) or to preoperative cardiac index maintenance (507 (460, 664) ml/min/m and 516 (403, 604) ml/min/m) than in patients assigned to routine care (403 (338, 517) ml/min/m and 390 (351, 510) ml/min/m). There were no important differences in oxygen consumption index and sublingual microvascular flow index among the three groups. The intraoperative average urethral perfusion index was slightly higher in patients assigned to stroke volume maximization or to preoperative cardiac index maintenance than in patients assigned to routine care.
In our trial, both maximizing stroke volume and maintaining preoperative resting cardiac index resulted in higher intraoperative and postoperative oxygen delivery index than routine care in major abdominal surgery patients. Large clinical trials are required to determine whether achieving higher perioperative oxygen delivery index translates into better outcomes.
术中血流导向的血流动力学治疗的机制性影响仍知之甚少。因此，我们旨在确定：a）使每搏量最大化；b）维持术前静息心脏指数，对腹部大手术患者的氧输送、氧消耗以及舌下和腹部微循环组织灌注的影响。
我们将76例患者随机分为三组，分别在手术期间及术后6小时进行每搏量最大化、维持术前静息心脏指数或常规护理。我们测量了氧输送指数、氧消耗指数、舌下微血管血流指数和尿道灌注指数。
在手术结束时和术后6小时，分配到每搏量最大化组（460（四分位数间距25%，75%）ml/分钟/米²和503（466，595）ml/分钟/米²）或术前心脏指数维持组（507（460，664）ml/分钟/米²和516（403，604）ml/分钟/米²）的患者的氧输送指数中位数高于分配到常规护理组的患者（403（338，517）ml/分钟/米²和390（351，510）ml/分钟/米²）。三组之间的氧消耗指数和舌下微血管血流指数没有显著差异。分配到每搏量最大化组或术前心脏指数维持组的患者术中平均尿道灌注指数略高于分配到常规护理组的患者。
在我们的试验中，对于腹部大手术患者，每搏量最大化和维持术前静息心脏指数均导致术中及术后氧输送指数高于常规护理。需要进行大型临床试验来确定实现更高的围手术期氧输送指数是否能转化为更好的预后。
