The effects of maximizing stroke volume versus maintaining preoperative resting cardiac index on oxygen delivery, oxygen consumption, and microcirculatory tissue perfusion in patients having major abdominal surgery: The exploratory randomized CUSTOM trial

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-06-25 DOI:10.1016/j.jclinane.2025.111905

Moritz Flick , Luisa Briesenick-Weskamm , Pawel Sierzputowski , Marie-Christin Süykers , Parisa Moll-Khosrawi , Linda Krause , Alina Bergholz , Kristen K. Thomsen , Alexandre Joosten , Karim Kouz , Bernd Saugel

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引用次数: 0

Abstract

Background

Mechanistic effects of intraoperative blood flow-guided hemodynamic therapy remain poorly understood. Therefore, we aimed to determine the effects of a) maximizing stroke volume and b) maintaining preoperative resting cardiac index on oxygen delivery, oxygen consumption, and sublingual and abdominal microcirculatory tissue perfusion in major abdominal surgery patients.

Methods

We randomized 76 patients to maximizing stroke volume, maintaining preoperative resting cardiac index, or routine care during and for the first 6 h after surgery. We measured oxygen delivery index, oxygen consumption index, sublingual microvascular flow index, and urethral perfusion index.

Results

At the end of surgery and 6 h after surgery, the median (25th percentile, 75th percentile) oxygen delivery index was higher in patients assigned to stroke volume maximization (460 (404, 556) ml/min/m² and 503 (466, 595) ml/min/m²) or to preoperative cardiac index maintenance (507 (460, 664) ml/min/m² and 516 (403, 604) ml/min/m²) than in patients assigned to routine care (403 (338, 517) ml/min/m² and 390 (351, 510) ml/min/m²). There were no important differences in oxygen consumption index and sublingual microvascular flow index among the three groups. The intraoperative average urethral perfusion index was slightly higher in patients assigned to stroke volume maximization or to preoperative cardiac index maintenance than in patients assigned to routine care.

Conclusion

In our trial, both maximizing stroke volume and maintaining preoperative resting cardiac index resulted in higher intraoperative and postoperative oxygen delivery index than routine care in major abdominal surgery patients. Large clinical trials are required to determine whether achieving higher perioperative oxygen delivery index translates into better outcomes.

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最大卒中容量与维持术前静息心脏指数对腹大手术患者氧输送、耗氧量和微循环组织灌注的影响：一项随机定制的探索试验

背景术中血流引导血流动力学治疗的机制作用仍然知之甚少。因此，我们的目的是确定a)最大卒中量和b)维持术前静息心脏指数对腹大手术患者的氧输送、耗氧量、舌下和腹部微循环组织灌注的影响。方法对76例患者进行随机分组，分别给予最大卒中容量、维持术前静息心脏指数或手术期间及术后前6小时的常规护理。测量输氧指数、耗氧量指数、舌下微血管流量指数、尿道灌注指数。结果在手术结束和术后6 h，最大搏气量组(460 （404,556)ml/min/m2和503 (466,595)ml/min/m2）或术前心脏指数维持组(507 （460,664)ml/min/m2和516 (403,604)ml/min/m2）的血氧输送指数中位数（第25和75个百分点）高于常规护理组(403 （338,517)ml/min/m2和390 (351,510)ml/min/m2）。三组间耗氧量指数和舌下微血管流量指数无明显差异。术中平均尿道灌注指数在卒中容量最大化或术前心脏指数维持的患者中略高于常规护理的患者。结论在我们的试验中，与常规护理相比，最大卒中量和维持术前静息心脏指数可使腹部大手术患者术中和术后氧输送指数更高。需要大型临床试验来确定更高的围手术期氧输送指数是否转化为更好的结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.