0 39

Cited 0 times in

Skin perfusion pressure as an indicator of tissue perfusion in valvular heart surgery: Preliminary results from a prospective, observational study.

Authors
 Young Song  ;  Sarah Soh  ;  Jae-Kwang Shim  ;  Kyoung-Un Park  ;  Young-Lan Kwak 
Citation
 PLoS One, Vol.12(9) : e0184555, 2017 
Journal Title
 PLoS One 
Issue Date
2017
MeSH
Acute Kidney Injury/etiology ; Aged ; Area Under Curve ; Cardiopulmonary Bypass/adverse effects ; Female ; Heart Valve Diseases/mortality ; Heart Valve Diseases/surgery ; Hemodynamics ; Humans ; Hyperlactatemia/etiology ; Lactic Acid/blood ; Logistic Models ; Male ; Middle Aged ; Myocardial Infarction/etiology ; Postoperative Period ; Prospective Studies ; ROC Curve ; Skin/physiopathology ; Stroke/etiology ; Survival Analysis
Abstract
Hemodynamic management aims to provide adequate tissue perfusion, which is often altered during cardiac surgery with cardiopulmonary bypass (CPB). We evaluated whether skin perfusion pressure (SPP) can be used for monitoring of adequacy of tissue perfusion in patients undergoing valvular heart surgery. Seventy-two patients undergoing valve replacement were enrolled. SPP and serum lactate level were assessed after anaesthesia induction (baseline), during CPB, after CPB-off, end of surgery, arrival at intensive care unit, and postoperative 6 h. Lactate was further measured until postoperative 48 h. Association of SPP with lactate and 30-day morbidity comprising myocardial infarction, acute kidney injury, stroke, prolonged intubation, sternal infection, reoperation, and mortality was assessed. Among the lactate levels, postoperative 6 h peak value was most closely linked to composite of 30-day morbidity. The SPP value during CPB and its % change from the baseline value were significantly associated with the postoperative 6 h peak lactate (r = -0.26, P = 0.030 and r = 0.47, P = 0.001, respectively). Optimal cut-off of % decrease in SPP during CPB from baseline value for the postoperative 6 h hyperlactatemia was 48% (area under curve, 0.808; 95% confidence interval (CI), 0.652-0.963; P = 0.001). Decrease in SPP >48% during CPB from baseline value was associated with a 12.8-fold increased risk of composite endpoint of 30-day morbidity (95% CI, 1.48-111.42; P = 0.021) on multivariate logistic regression. Large decrease in SPP during CPB predicts postoperative 6 h hyperlactatemia and 30-day morbidity, which implicates a promising role of SPP monitoring in the achievement of optimal perfusion during CPB.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/161122
DOI
10.1371/journal.pone.0184555
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실)
Yonsei Authors
곽영란(Kwak, Young Lan) ; 박경은(Park, Kyoungun) ; 소사라(Soh, Sa Rah) ; 송영(Song, Young) ; 심재광(Shim, Jae Kwang)
사서에게 알리기
  feedback
Export
RIS (EndNote)
XLS (Excel)
XML

qrcode

Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.

Browse