Evaluation of the viability of a hemodynamic optimization protocol to high-risk surgical patients using less invasive monitoring tools

Introduction

Clinical, hemodynamics and perfusion variables are important tools to identify instable patients and guide therapy. There is a strong suggestion that shock-induced organ failure is attributable to peripheral tissue hypoperfusion and/or cellular hypoxia. The aim of this study was to evaluate the efficacy of a hemodynamic optimization protocol to correct tissue hypoxia during the initial postoperative period.

Patients and methods

Fifteen high-risk surgical patients according to Shoemaker's criteria were prospectively included when hyperlactatemia (arterial lactate ≥ 3 mmol/l) was present at ICU admission. Patients were monitored with Vigileo™ (Edwards Lifescience, Irvine, CA, USA) and resuscitated during the first 12 postoperative hours using the protocol shown in Fig. 1. The patients were considered as responders if at the end of resuscitation SvcO₂ ≥70% and arterial lactate ≥ 2 mmol/l.

Figure 1

(abstract P115)

Results

The mean age was 66 ± 13 years and 66% were male. The median APACHE II and MODS scores were 20.1 ± 6.4 and 5.6 ± 3.1, respectively. The main surgical procedure performed was resection of abdominal neoplasia (10/15). The mean amount of colloids administered during resuscitation period was 1715 ± 760 ml. Five out of 15 and 4/15 patients have used dobutamine and norepinephrine, respectively. Only two patients were transfused. Twelve patients were considered responders with 8.3% of the hospital mortality rate. Two of three nonresponders patients died before hospital discharge.

Conclusion

This hemodynamic optimization protocol based in less invasive technologies was efficient to correct tissue hypoxia in this sample of patients. These results warrant validation in a control trial.