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

   
@article{JTD21930,
	author = {Huaiwu He and Guillem Gruartmoner and Yilmaz Ince and Mark I. van Berge Henegouwen and Suzanne S. Gisbertz and Bart F. Geerts and Can Ince and Markus W. Hollmann and Dawei Liu and Denise P. Veelo},
	title = {Effect of pneumoperitoneum and steep reverse-Trendelenburg position on mean systemic filling pressure, venous return, and microcirculation during esophagectomy},
	journal = {Journal of Thoracic Disease},
	volume = {10},
	number = {6},
	year = {2018},
	keywords = {},
	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, 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.},
	issn = {2077-6624},	url = {https://jtd.amegroups.org/article/view/21930}
}