Perioperative advanced haemodynamic monitoring of patients undergoing multivisceral debulking surgery: an observational pilot study

Abstract

Background Patients undergoing high-risk surgery show haemodynamic instability and an increased risk of morbidity. However, most of the available data concentrate on the intraoperative period. This study aims to characterise patients with advanced haemodynamic monitoring throughout the whole perioperative period using electrical cardiometry. Methods In a prospective, observational, monocentric pilot study, electrical cardiometry measurements were obtained using an Osypka ICON™ monitor before surgery, during surgery, and repeatedly throughout the hospital stay for 30 patients with primary ovarian cancer undergoing multivisceral cytoreductive surgery. Severe postoperative complications according to the Clavien–Dindo classification were used as a grouping criterion. Results The relative change from the baseline to the first intraoperative timepoint showed a reduced heart rate (HR, median – 19 [25-quartile − 26%; 75-quartile − 10%]%, p < 0.0001), stroke volume index (SVI, − 9.5 [− 15.3; 3.2]%, p = 0.0038), cardiac index (CI, − 24.5 [− 32; − 13]%, p < 0.0001) and index of contractility (− 17.5 [− 35.3; − 0.8]%, p < 0.0001). Throughout the perioperative course, patients had intraoperatively a reduced HR and CI (both p < 0.0001) and postoperatively an increased HR (p < 0.0001) and CI (p = 0.016), whereas SVI was unchanged. Thoracic fluid volume increased continuously versus preoperative values and did not normalise up to the day of discharge. Patients having postoperative complications showed a lower index of contractility (p = 0.0435) and a higher systolic time ratio (p = 0.0008) over the perioperative course in comparison to patients without complications, whereas the CI (p = 0.3337) was comparable between groups. One patient had to be excluded from data analysis for not receiving the planned surgery. Conclusions Substantial decreases in HR, SVI, CI, and index of contractility occurred from the day before surgery to the first intraoperative timepoint. HR and CI were altered throughout the perioperative course. Patients with postoperative complications differed from patients without complications in the markers of cardiac function, a lower index of contractility and a lower SVI. The analyses of trends over the whole perioperative time course by using non-invasive technologies like EC seem to be useful to identify patients with altered haemodynamic parameters and therefore at an increased risk for postoperative complications after major surgery.

Capillary leak and endothelial permeability in critically ill patients: a current overview

“…Patients with an elevated extracellular water ratio on the third day in the ICU showed a higher likelihood of postoperative complications and in-hospital mortality [ 159 ]. In a recent study conducted on patients undergoing multivisceral debulking surgery, thoracic fluid content, assessed via electrical cardiometry, was found to continuously increase up to the third postoperative day and remained elevated until discharge [ 163 ]. This prolonged alteration in fluid status suggests that bioelectrical impedance analysis, including metrics like thoracic fluid content, may offer nuanced insights into volume shifts and their association with postoperative complications.…”