Please see Bibliography of References for a list of abstracts, manuscripts and posters.
Al-Subaie N, Ranjan S, Thomson S, Tuccillo ML, Addei A, Hagger R, Hamilton M, Rhodes A. Int Care Med. 2009;35(Suppl 1):S157.
Introduction: Dynamic changes in tissue oxygen saturation (StO2) in response to a vascular occlusion test (VOT) were shown to predict prognosis in patients with sever sepsis. It is unknown how these changes relate to surgical outcome.
Objective: Assess the value of dynamic StO2 changes in response to a VOT in identifying patients at risk of developing postoperative complications following major bowel surgery.
Methods: A VOT was performed 10 min after a standardised intravenous anaesthetic induction, whilst general anaesthesia was maintained with oxygen, air and isoflurane. The test was performed by the rapid inflation of a pneumatic cuff placed above the elbow for 3 min. The pressure used to achieve vascular occlusion was 50 mmHg above patient’s systolic. Muscle tissue oxygen saturation was measured using a Hutchinson TechnologyTM InSpectraTM 650 StO2 tissue oxygenation monitor, with a 15 mm probe applied to the right hand thenar eminence. Patients were divided to two groups based on whether they developed postoperative complication or not. Complications included were: cardiovascular, respiratory, infective and major gastrointestinal complications. Data were described and analysed as nonparametric.
Results: A total of 20 patients were enrolled. Table 1 illustrates the differences in the VOT derived StO2 variables expressed in medians (interquartile range) along with statistical significance. Analysis of the receiver operating characteristics, for having an uncomplicated post operative course, showed that the maximum and minimum StO2 values attained during VOT had an area under the curve of 0.85 (p = 0.008). Proposed cut-off values to determine patients with no postoperative complications are: minimum StO2 of 59% (sensitivity and specificity of 80 and 70%, respectively) and a maximum StO2 value of 97% (sensitivity and specificity of 80 and 70%, respectively).
TABLE 1 STO2 CHARECTERSTICS OF STUDY PTS
|
No complications |
Complications |
p | |
|
Variables |
|||
|
Down slope StO2 %/min |
-7.96 (1.93) |
-8.93 (4.07) |
0.257 |
|
Baseline StO2 % |
87 (5) |
82.5 (15) |
0.016 |
|
Upslope StO2 %/min |
144 (77.2) |
197.14 (76.71) |
0.226 |
|
Minimum StO2 % |
62.5 (6) |
55 (26) |
0.0008 |
|
StO2 area within occlusion curve %.mn |
35.45 (11.8) |
46.25 (14) |
0.257 |
|
StO2 area under the reperfusion curve %.min |
18.45 (18.9) |
28.25 (14) |
0.212 |
|
Maximum StO2% |
98 (2) |
95 (5) |
0.007 |
Conclusion: Dynamic StO2 changes in response to a standardised vascular occlusion test show promise in predicting patients post operative course following major bowel surgery.