Microcirculatory Perfusion During Different Perioperative Hemodynamic Strategies

Objective We investigated whether hemodynamic optimization of systemic tissue perfusion based on PPV and CI improves microcirculatory perfusion when compared to a MAP ‐based strategy in patients undergoing elective abdominal surgery. Methods Patients were randomized into a PPV / CI guided group ( n  = 13, target PPV <12%, CI >2.5 L/min/m 2 , and MAP >70 mmHg) or MAP ‐guided group ( n  = 18, target MAP >70 mmHg). PPV , CI , and MAP were measured using noninvasive arterial blood pressure measurements. Sublingual microcirculatory perfusion was measured at one, two, and three hours following anesthesia induction, and quantified as TVD , PVD or the proportion of perfused vessels. Data were analyzed using ANOVA RM . Results Patients in the PPV / CI group required more fluid administration than control patients (1927 ± 747 mL versus 1283 ± 582 mL, respectively; p  = 0.01). Despite this difference, we observed similar values for TVD ( RM ; F (1.28) = 0.01; p  = 0.92), PVD ( RM ; F (1.28) = 0.09; p  = 0.77) and the proportion of perfused vessels ( RM ; F (1.28) = 0.01; p  = 0.76) in both groups. Conclusion Hemodynamic optimization of systemic tissue perfusion is not associated with improvement of microcirculatory perfusion compared to a MAP ‐guided protocol in patients undergoing abdominal surgery.