Microvascular reactivity and clinical outcomes in cardiac surgeryReport as inadecuate




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Critical Care

, 19:316

First Online: 04 September 2015Received: 08 March 2015Accepted: 12 August 2015

Abstract

IntroductionMicrovascular reactivity is decreased in patients with septic shock; this is associated with worse clinical outcomes. The objectives of the present study were to investigate microvascular reactivity in cardiac surgery patients and to assess any association with clinical outcomes.

MethodsWe retrospectively analyzed a prospectively collected registry. In total, 254 consecutive adult patients undergoing cardiac and thoracic aortic surgeries from January 2013 through May 2014 were analyzed. We performed a vascular occlusion test VOT by using near-infrared spectroscopy to measure microvascular reactivity. VOT was performed three times per patient: prior to the induction of anesthesia, at the end of surgery, and on postoperative day 1. The primary endpoint was a composite of major adverse complications, including death, myocardial infarction, acute kidney injury, acute respiratory distress syndrome, and persistent cardiogenic shock.

ResultsVOT recovery slope decreased during the surgery. VOT recovery slope on postoperative day 1 was significantly lower in patients with composite complications than those without 3.1 ± 1.6 versus 4.0 ± 1.5 %-s, P = 0.001, although conventional hemodynamic values, such as cardiac output and blood pressure, did not differ between the groups. On multivariable regression and linear analyses, low VOT recovery slope on postoperative day 1 was associated with increases of composite complications odds ratio 0.742; 95 % confidence interval CI 0.584 to 0.943; P = 0.015 and hospital length of stay regression coefficient B −1.276; 95 % CI −2.440 to −0.112; P = 0.032.

ConclusionMicrovascular reactivity largely recovered on postoperative day 1 in the patients without composite complications, but this restoration was attenuated in patients with composite complications.

Trial registrationClinicalTrials.gov NCT01713192. Registered 22 October 2012.

AbbreviationsANOVAAnalysis of variance

CIConfidence interval

CPBCardiopulmonary bypass

EuroSCORE IIEuropean System for Cardiac Operative Risk Evaluation II

ICUIntensive care unit

NIRSNear-infrared spectroscopy

OROdds ratio

RIFLERisk, Injury, Failure, Loss, and End-Stage Kidney Disease

SIRSSystemic inflammatory response syndrome

SOFASequential Organ Failure Assessment

StO2Tissue oxygen saturation

VOTVascular occlusion test

Electronic supplementary materialThe online version of this article doi:10.1186-s13054-015-1025-3 contains supplementary material, which is available to authorized users.

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Author: Tae Kyong Kim - Youn Joung Cho - Jeong Jin Min - John M. Murkin - Jae-Hyon Bahk - Deok Man Hong - Yunseok Jeon

Source: https://link.springer.com/







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