Improved tissue perfusion during pressure regulated hyperthermic regional isolated perfusion. A clinical study

Abstract

In previous studies on isolated hindlimb perfusions in dogs, the authors proved that the extracorporeal circuit should be regulated at a delta pressure (systemic mean arterial pressure minus hindlimb mean arterial pressure) of not more than 15 mmHg, to achieve adequate tissue perfusion. To confirm this in patients the authors performed clinical perfusions, divided into three groups. In group I and II the extracorporeal circuit was regulated at a delta pressure of 15 mmHg and 50 mmHg, respectively. In group III perfusions were performed using the common technique of a predetermined fixed flow. Tissue oxygenation, determined by means of a transcutaneous pO2 electrode, was adequate in group I and was severely impaired in group II and III. Although in group I high perfusion flows were needed, leakage was less than 10%. To achieve adequate tissue perfusion during clinical regional perfusions, the extracorporeal circuit must be regulated at a delta pressure of 15 mmHg.

Isolated Limb Perfusion and External Beam Radiotherapy for Soft Tissue Sarcomas of the Extremity: Long-Term Effects on Normal Tissue According to the LENT-SOMA Scoring System

“… 30 Improved perfusion technique and enhanced technical insights have led to the following suggestions: reduce the doses of TNFα, decrease systemic leakage, reduce maximum temperatures and strictly regulate perfusion pressures. 15 , 30 , 41 To prevent the significant toxicity related to muscle and nerve damage, a prophylactic fasciotomy should be performed in all cases and the isolating tourniquet should not be applied too tightly. 30 , 31 Furthermore, all patients should receive an individualized rehabilitation program to achieve an optimum functional situation.…”

Cisplatin and platinum pharmacokinetics during hyperthermic isolated limb perfusion for human tumours of the extremities

“…More physiological perfusions are performed taking into account such variables as the patients blood pressure and perfusion pressure (Fontijne et al, 1985, Van Os et al, 1985De Vries et al, 1988;Van Os et al, 1989).…”