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He H, Gruartmoner G, Ince Y, et al. Effect of pneumoperitoneum and steep reverse-Trendelenburg position on mean systemic filling pressure, venous return, and microcirculation during esophagectomy. J Thorac Dis. 2018;10(6):3399-3408doi: 10.21037/jtd.2018.05.169.
He, H., Gruartmoner, G., Ince, Y., van Berge Henegouwen, M. I., Gisbertz, S. S., Geerts, B. F., Ince, C., Hollmann, M. W., Liu, D., & Veelo, D. P. (2018). Effect of pneumoperitoneum and steep reverse-Trendelenburg position on mean systemic filling pressure, venous return, and microcirculation during esophagectomy. Journal of thoracic disease, 10(6), 3399-3408. https://doi.org/10.21037/jtd.2018.05.169
He, Huaiwu, et al. "Effect of pneumoperitoneum and steep reverse-Trendelenburg position on mean systemic filling pressure, venous return, and microcirculation during esophagectomy." Journal of thoracic disease vol. 10,6 (2018): 3399-3408. doi: https://doi.org/10.21037/jtd.2018.05.169
He H, Gruartmoner G, Ince Y, van Berge Henegouwen MI, Gisbertz SS, Geerts BF, Ince C, Hollmann MW, Liu D, Veelo DP. Effect of pneumoperitoneum and steep reverse-Trendelenburg position on mean systemic filling pressure, venous return, and microcirculation during esophagectomy. J Thorac Dis. 2018 Jun;10(6):3399-3408. doi: 10.21037/jtd.2018.05.169. PMID: 30069335; PMCID: PMC6051808.
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J Thorac Dis. 2018 Jun;10(6):3399-3408. doi: 10.21037/jtd.2018.05.169.

Effect of pneumoperitoneum and steep reverse-Trendelenburg position on mean systemic filling pressure, venous return, and microcirculation during esophagectomy.

Journal of thoracic disease

Huaiwu He, Guillem Gruartmoner, Yilmaz Ince, Mark I van Berge Henegouwen, Suzanne S Gisbertz, Bart F Geerts, Can Ince, Markus W Hollmann, Dawei Liu, Denise P Veelo

Affiliations

  1. Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100000, China.
  2. Critical Care Department, Hospital de Sabadell, Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona Sabadell, Sabadell, Spain.
  3. Department of Translational Physiology, Academic Medical Center, Amsterdam, The Netherlands.
  4. Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
  5. Department of Anaesthesiology, Academic Medical Center, Amsterdam, The Netherlands.

PMID: 30069335 PMCID: PMC6051808 DOI: 10.21037/jtd.2018.05.169

Abstract

BACKGROUND: Keeping adequate tissue perfusion during high-risk abdominal surgery is of utmost importance to decrease postoperative complications. The objective was to investigate the alteration in mean systemic filling pressure (MSFP), venous return (VR) and sublingual microcirculation during pneumoperitoneum and steep reverse-Trendelenburg position during thoracolaparoscopic esophagectomy.

METHODS: This is a single-center prospective observational study in operating room at a university hospital. Eleven consecutive patients undergoing minimally invasive esophagectomy. Intraoperative hemodynamic and sublingual microcirculatory variables were simultaneously measured within 5 minutes at the following time points: T1, baseline supine position before the start of surgery; T2, pneumoperitoneum in supine position; T3, steep reverse-Trendelenburg position after the pneumoperitoneum. The cardiac output (CO) was obtained with continuous pulse contour waveform-derived measurements, and the MSFP was estimated with the analogue method.

RESULTS: The pneumoperitoneum and reverse-Trendelenburg caused an increase in stroke volume variation (SVV), MSFP and central venous pressure (CVP), and a decrease in the microcirculatory perfusion index (MFI, <0.05). However, changes in CO, pressure gradient of VR, resistance of VR and blood pressure were not consistent and did not differ significantly across timepoints. Moreover, MFI is significantly related to CVP and MSFP but not to CO and blood pressure (BP). Measurements with MFI ≤2 have a higher CVP and MSFP compared to those with MFI >2. Using a CVP ≥23 mmHg to detect MFI ≤2 results in a sensitivity of 61.54% and a specificity of 100%.

CONCLUSIONS: A high CVP is related to poor microcirculatory flow perfusion even if the macrocirculation has been maintained during pneumoperitoneum.

Keywords: Microcirculation; central venous pressure (CVP); esophageal surgery; minimally-invasive laparoscopy

Conflict of interest statement

Conflicts of Interest: DP Veelo and MW Hollmann have received support [contract was made, under name: quality improvement project, Academic Medical Center (AMC)] from Edwards regarding a different pro

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