Colorectal Surgery Clinical Trial
Official title:
Investigating the Peripheral Perfusion Index; Correlations Between Peripheral and Mesenteric Perfusion in Elective Surgical Patients
An important goal of haemodynamic monitoring and resuscitation is early detection of
insufficient tissue perfusion and oxygenation. The mesenteric haemodynamic response to
circulatory shock is complex, and diagnosis of bowel ischaemia poses significant difficulty.
Assuming blood flow is diverted from the peripheral tissue and the gastrointestinal tract to
vital organs, during circulatory shock, an objective, simple and non-invasive method of
detecting peripheral tissue perfusion impairment might detect this at an early stage.
The peripheral perfusion index (PPI) reflects changes in peripheral perfusion and laser
doppler flowmetry allows measurement of bowel tissue perfusion.
The aim of this study is to explore the association between changes in peripheral and
intestinal perfusion in patients undergoing elective colorectal surgery exposed to
intraoperative haemodynamic challenges.
An important goal of haemodynamic monitoring and resuscitation is early detection of
insufficient tissue perfusion and oxygenation, but in clinical practice, monitoring and
resuscitation is routinely based on measuring of blood pressure and heart rate, which might
be inadequate endpoints for optimal resuscitation. Haemodynamic management targeting cardiac
output and stroke volume (SV), and to some extent, flow and tissue perfusion is feasible when
applying minimally-invasive or non-invasive methods, but has been limited to a narrow number
of critically ill patients and to the intraoperative setting. Another approach to
resuscitation is aimed at flow and perfusion of vital organs. Ideally, measurements would be
done directly on these organs, but no feasible methods exist. Assuming blood flow is diverted
from the peripheral tissue and the gastrointestinal tract to vital organs, during circulatory
shock, an objective, simple and non-invasive method of detecting peripheral tissue perfusion
impairment might detect this at an early stage. The peripheral perfusion index (PPI) is
derived from the photoelectric plethysmographic pulse oximetry signal, which all patients are
monitored by perioperatively to assess arterial oxygen saturation. The PPI is a numerical
non-invasive measure representing the ratio between the pulsatile (arterial) and
non-pulsatile component of the light reaching the pulse oximeter, and PPI decreases in states
of hypoperfusion. PPI reflects changes in peripheral perfusion and blood volume and decreased
peripheral perfusion determined by PPI predicts surgical complications and morbidity in acute
surgical and septic shock patients.
The mesenteric haemodynamic response to circulatory shock is complex, and diagnosis of bowel
ischaemia poses significant difficulty for the clinicians due to its non specific
presentations and lack of a simple diagnostic test. In patients undergoing colorectal surgery
for malignancy, laser doppler flowmetry allows measurement of bowel tissue perfusion.
The aim of this study is to explore the association between changes in peripheral and
intestinal perfusion in patients undergoing elective colorectal surgery exposed to
intraoperative haemodynamic challenges.
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