Surgery--Complications
Conditions
Keywords
high-risk digestive surgery, intensive care unit
Brief summary
Intra-operative hemodynamic management in high-risk surgery is a priority for the anesthesiologist. The current strategy is based on the continuous measurement of cardiac output and its maximization by vascular filling has many limitations: invasiveness, measurement difficulties, impaired performance, imperative surgical restriction of filling, lack of evaluation of flow rate and metabolic needs. Biomarkers may be able to detect early an inadequacy between cardiac output and tissue oxygen requirements, venous saturation with oxygen (ScvO2) and arteriovenous difference in partial pressure of carbon dioxide (ΔPCO2) as well as the appearance of cellular hypoxia (lactate and arteriovenous difference in partial pressure of carbon dioxide/arteriovenous difference in oxygen) (ΔPCO2) / DAVO2). Moreover, the medical literature remains poor on the evaluation of these markers in per-operative context all the more for ΔPCO2 and ΔPCO2 / DAVO2. It seems interesting to evaluate the potential of these tools, in patients with major surgery and at high risk (major hepatectomy, oesophagectomy and duodeno-pancreatectomy), to predict the risk of postoperative complications, especially since surgery involves a restrictive vascular filling strategy that may be potentially deleterious to the patient.
Interventions
PROCEDUREpatient having to undergo a high risk programmed digestive surgery
The objective is to determine if there is an association between the mean intraoperative values and within 24 hours postoperative ΔPCO2 and the occurrence of major post-operative complications at day 28 in high-risk surgery (major hepatectomy, esophagectomy or duodeno- cephalic pancreatectomy)
Sponsors
Hospices Civils de Lyon
Study design
Observational model
OTHER
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Major patient Patient eligible for a high risk scheduled gastrointestinal surgery from: * Esophagectomy * Major hepatectomy (≥ 3 segments) * Cephalic duodeno-pancreatectomy Patient with an arterial catheter and a central venous line in superior vena cava. Patient hospitalized post-operatively in intensive care unit as agreed in consultation with preoperative anesthesia.
Exclusion criteria
* Pregnant or lactating patients * Patient with an unstable acute condition at the time of surgery (acute heart, respiratory or renal failure, severe sepsis or septic shock, hemorrhagic shock) * Patient opposing his participation in the study * Patient protected by law (guardianship) * Patient deprived of liberty * Patient with a contraindication to the establishment of a central venous route in superior vena cava territory or a radial or femoral arterial catheter
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| mean intraoperative PCO2 values | during surgery | PCO2 values will be collected every 2 hours during surgery |
| mean postoperative PCO2 values | within 24 hours after surgery | — |
| post-operative complications | 28 days after surgery | post-operative complications of grade III or greater according to Clavien-Dindo classification |
Countries
France
Outcome results
None listed