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Cardiac output and oxygen delivery are affected by intraoperative hyperthermic intrathoracic chemotherapy

Introduction

Pleural space hyperthermic perfusion with cisplatin (hyperthermic intrathoracic chemotherapy (HIC)) in the multimodality treatment of malignant mesothelioma is a relative modern procedure [1]. Published data are related to postoperative lung function and medium–long-term outcome. To our knowledge, no study describes the effects of HIC on cardiovascular and metabolic parameters. We aimed to evaluate the influence of the HIC on cardiac output (CO) and oxygen delivery (DO2) in thoracic surgery patients.

Methods

Ten patients (mean age 67 years) undergoing thoracic surgery for malignant mesothelioma were studied. HIC was applied with 3 l of 0.9% saline solution warmed at 42.5°C, containing cisplatin (100 mg/m2), and infused in 60 minutes. CO, DO2 and systemic vascular resistance (SVR) were calculated with a pulse contour system called the pressure recording analytical method (PRAM) [2]. PRAM parameters were blinded to the anaesthesiologists who based their management (for example, fluids and/or vasoactive drugs) on standard protocols. Data were retrieved before, during and after the HIC.

Results

When the HIC started, the mean arterial pressure (MAP) and SVR decreased from 81 to 51 mmHg, and from 1,500 to 1,050 dyne*s/cm5, respectively (P < 0.05). The MAP quickly went up to pre-HIC values before the end of HIC (within 10 min). Conversely, SVR achieved pre-HIC values after 3 hours. CO and DO2 decreased from 4.6 to 2.6 l/min, and from 610 to 370 ml/min, respectively (P < 0.05). They increased after the end of HIC and reached the pre-HIC values after 2 hours. Serum lactates peaked during the HIC from 0.9 to 2.8 mmol/l (basal vs on-HIC values, P < 0.01) and slowly decreased to reach pre-HIC values after 3 hours.

Conclusion

The hemodynamic and metabolic state of patients undergoing thoracic surgery is severely affected by HIC. Standard monitoring may not disclose the intraoperative hemodynamic changes of patients undergoing HIC. Furthermore, it does not provide key information about oxygen delivery with the hazard of an imbalance between tissue oxygen demand and consumption. We believe that a beat-to-beat hemodynamic monitoring should be used whenever a HIC is scheduled for thoracic surgery patients to avoid the risk of a low output state, tissue hypoperfusion, and bad outcome.

References

  1. 1.

    Ratto GB, et al.: Pleural perfusion with cisplatin in the treatment of malignant mesothelioma. J Thorac Cardiovasc Surg 1999, 117: 759-765. 10.1016/S0022-5223(99)70297-7

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  2. 2.

    Scolletta S, et al.: PRAM for measurement of CO during various hemodynamic states. Br J Anesth 2005, 95: 159-165. 10.1093/bja/aei154

    CAS  Article  Google Scholar 

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Scolletta, S., Franchi, F., Garosi, M. et al. Cardiac output and oxygen delivery are affected by intraoperative hyperthermic intrathoracic chemotherapy. Crit Care 12, P254 (2008). https://doi.org/10.1186/cc6475

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Keywords

  • Cardiac Output
  • Mean Arterial Pressure
  • Oxygen Delivery
  • Systemic Vascular Resistance
  • Malignant Mesothelioma