Association between mean arterial pressure and sublingual microcirculation during major non-cardiac surgery: Post hoc analysis of a prospective cohort

IF 1.9 4区 医学 Q3 HEMATOLOGY Microcirculation Pub Date : 2023-03-11 DOI:10.1111/micc.12804
Eleni Laou, Nikolaos Papagiannakis, Anastasia Michou, Nicoleta Ntalarizou, Dimitrios Ragias, Zacharoula Angelopoulou, Daniel I. Sessler, Athanasios Chalkias
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引用次数: 2

Abstract

Objective

To test the hypothesis that there is an association between mean arterial pressure (MAP) and sublingual perfusion during major surgery, and perhaps an identifiable harm threshold.

Methods

This post hoc analysis of a prospective cohort included patients who had elective major non-cardiac surgery with a duration of ≥2 h under general anesthesia. We assessed sublingual microcirculation every 30 min using SDF+ imaging and determined the De Backer score, Consensus Proportion of Perfused Vessels (Consensus PPV), and the Consensus PPV (small). Our primary outcome was the relationship between MAP and sublingual perfusion which was evaluated with linear mixed effects modeling.

Results

A total of 100 patients were included, with MAP ranging between 65 mmHg and 120 mmHg during anesthesia and surgery. Over a range of intraoperative MAPs between 65 and 120 mmHg, there were no meaningful associations between blood pressure and various measures of sublingual perfusion. There were also no meaningful changes in microcirculatory flow over 4.5 h of surgery.

Conclusions

In patients having elective major non-cardiac surgery with general anesthesia, sublingual microcirculation is well maintained when MAP ranges between 65 and 120 mmHg. It remains possible that sublingual perfusion will be a useful marker of tissue perfusion when MAP is lower than 65 mmHg.

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重大非心脏手术期间平均动脉压与舌下微循环的关系:前瞻性队列的事后分析
目的验证大手术期间平均动脉压(MAP)与舌下灌注之间存在关联的假设,以及可能存在的可识别的伤害阈值。方法这项前瞻性队列的事后分析包括接受择期非心脏大手术且持续时间≥2年的患者 h全身麻醉。我们使用SDF+成像每30分钟评估一次舌下微循环,并确定De Backer评分、灌注血管一致比例(一致PPV)和一致PPV(小)。我们的主要结果是MAP和舌下灌注之间的关系,通过线性混合效应模型进行评估。结果共纳入100名患者,MAP在65之间 mmHg和120 mmHg。在65至120之间的一系列术中MAP mmHg,血压与舌下灌注的各种测量之间没有显著的相关性。微循环流量在4.5以上也没有明显变化 手术时间。结论在全麻下进行选择性非心脏大手术的患者中,当MAP在65至120之间时,舌下微循环得到了很好的维持 mmHg。当MAP低于65时,舌下灌注仍有可能成为组织灌注的有用标志 mmHg。
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来源期刊
Microcirculation
Microcirculation 医学-外周血管病
CiteScore
5.00
自引率
4.20%
发文量
43
审稿时长
6-12 weeks
期刊介绍: The journal features original contributions that are the result of investigations contributing significant new information relating to the vascular and lymphatic microcirculation addressed at the intact animal, organ, cellular, or molecular level. Papers describe applications of the methods of physiology, biophysics, bioengineering, genetics, cell biology, biochemistry, and molecular biology to problems in microcirculation. Microcirculation also publishes state-of-the-art reviews that address frontier areas or new advances in technology in the fields of microcirculatory disease and function. Specific areas of interest include: Angiogenesis, growth and remodeling; Transport and exchange of gasses and solutes; Rheology and biorheology; Endothelial cell biology and metabolism; Interactions between endothelium, smooth muscle, parenchymal cells, leukocytes and platelets; Regulation of vasomotor tone; and Microvascular structures, imaging and morphometry. Papers also describe innovations in experimental techniques and instrumentation for studying all aspects of microcirculatory structure and function.
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