Anastomotic Leak Clinical Trial
Official title:
Association Between the Peripheral Perfusion Index, Haemoglobin Levels and Blood Transfusions in Patients Undergoing Acute Abdominal- and Orthopaedic Surgery.
The peripheral perfusion index (PPI) is a non-invasive, feasible measure of peripheral
perfusion and, assumed, the overall circulation, which all patients are monitored by.
This study is carried out to assess the association between values of PPI, haemoglobin and
blood transfusion.
Hypothetically, patients with low values of hb are more susceptible to a deteriorating
circulation reflected in poorer PPI regardless of blood pressure and that resuscitation with
blood products improves PPI measurements. Moreover, that patients with low values of PPI have
more surgical complications and higher mortality.
Background: Acute surgical patients with e.g. hip fracture (HF) or acute abdominal surgical
conditions often have comorbidities and a fragile circulation. Haemodynamic challenges make
these patients vulnerable during anaesthesia, and perioperative complications are frequent.
Anaemia is associated with increased mortality and adverse outcomes in patients undergoing
surgery. One of the consequences of acute anaemia is reduced blood oxygen content, leading to
reduced tissue oxygen delivery and development of tissue hypoxia. Patients with e.g. HF have
a large drop in haemoglobin (hb) level that occurs after the injury, yet prior to the
surgery. It is therefore important to be aware of the risk of preoperative anaemia even when
the initial hb levels appear to be normal. Perioperative hb are associated with shorter
lengths of hospital stay, reduced mortality and lower readmission rates, and patients with
postoperative anaemia have increased mortality and length of hospital stay.
Haemodynamic monitoring is traditionally based on measurement of blood pressure (BP) and
heart rate (HR) but these measurements may be insufficient in evaluating overall oxygen
delivery and perfusion of vital organs. An apparently sufficient BP and, for patients with
more specialised monitoring, cardiac output (CO), does not necessarily mean a sufficient
peripheral microcirculatory flow due to compensatory mechanisms, but on the other hand a low
CO may be sufficient in context of low metabolic demand.
The non-invasive peripheral perfusion index (PPI) is a numerical value of peripheral
perfusion measured by the pulse oximeter derived from the photoelectric plethysmographic
signal. PPI is represents the ratio between the pulsatile component (arterial) and the
non-pulsatile component (venous blood, capillary blood and other tissues) of the light
reaching the detector of the pulse oximeter, and reflects changes in peripheral blood flow as
the pulsatile component increases with vasodilatation and decreases with vasoconstriction. It
is an accessible way to obtain a measure for peripheral perfusion as pulse oximeters are
universally available in all operating rooms and intensive care units. Previous studies have
shown that PPI is a useful indicator of reduced peripheral blood flow both in clinical and
experimental settings. Correlation between clinical symptoms of reduced peripheral perfusion
such as low temperature, increased capillary response and reduced PPI in critically ill
patients has been demonstrated, and a reduced peripheral perfusion may be a predictor of
mortality and complications in patients undergoing major surgical procedures and in septic
shock patients.
Hypothetically, patients with low values of hb are more susceptible to a deteriorating
circulation reflected in poorer PPI regardless of blood pressure and that resuscitation with
blood products improves PPI measurements. Moreover, that patients with low values of PPI have
more surgical complications and higher mortality.
Method: The main objective of this study is to estimate the association between perioperative
values of PPI and haemoglobin levels. The secondary objectives are to evaluate PPI in
patients with low hb in relation to mean arterial blood pressure (MAP), and evaluate changes
in PPI with patients with low and normal hb in relation to transfusion with blood products.
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