Can perioperative pCO gaps predict complications in patients undergoing major elective abdominal surgery randomized to goal-directed therapy or standard care? A secondary analysis.

The difference between venous and arterial carbon dioxide pressure (pCO gap), has been used as a diagnostic and prognostic tool. We aimed to assess whether perioperative pCO gaps can predict postoperative complications. This was a secondary analysis of a multicenter RCT comparing goal-directed therapy (GDT) to standard care in which 464 patients undergoing high-risk elective abdominal surgery were included.

Impact of clinicians' behavior, an educational intervention with mandated blood pressure and the hypotension prediction index software on intraoperative hypotension: a mixed methods study.

Purpose: Intraoperative hypotension (IOH) is associated with adverse outcomes. We therefore explored beliefs regarding IOH and barriers to its treatment. Secondarily, we assessed if an educational intervention and mandated mean arterial pressure (MAP), or the implementation of the Hypotension Prediction Index-software (HPI) were associated with a reduction in IOH.

Perioperative monitoring of the oxygen reserve: where do we stand?

The Oxygen Reserve Index (ORi) is an advanced plethysmography-derived variable that may help to quantify the degree of hyperoxia in patients receiving supplemental oxygen administration. ORi is a (relative) indicator of the actual partial pressure of oxygen dissolved in arterial blood (PaO). As such, it may help in the titration of oxygen administration or it may help to warn the clinician of a deterioration of oxygen status of the patient.

Agreement of somatic and renal near-infrared spectroscopy with reference blood samples during a controlled hypoxia sequence: a healthy volunteer study.

Purpose: O3® Regional Oximetry (Masimo Corporation, California, USA) is validated for cerebral oximetry. We aimed to assess agreement of somatic and renal near-infrared spectroscopy with reference blood samples.

Methods: O3 sensors were placed bilaterally on the quadriceps and flank of 26 healthy volunteers.

What is new in microcirculation and tissue oxygenation monitoring?

Ensuring and maintaining adequate tissue oxygenation at the microcirculatory level might be considered the holy grail of optimal hemodynamic patient management. However, in clinical practice we usually focus on macro-hemodynamic variables such as blood pressure, heart rate, and sometimes cardiac output. Other macro-hemodynamic variables like pulse pressure or stroke volume variation are additionally used as markers of fluid responsiveness.

Cerebral monitoring in surgical ICU patients.

Purpose Of Review: To give an overview of cerebral monitoring techniques for surgical ICU patients.

Recent Findings: As the burden of postsurgical neurological and neurocognitive complications becomes increasingly recognized, cerebral monitoring in the surgical ICU might gain a relevant role in detecting and possibly preventing adverse outcomes. However, identifying neurological alterations in surgical ICU patients, who are often sedated and mechanically ventilated, can be challenging.

Perioperative Hemodynamic Monitoring: An Overview of Current Methods.

Perioperative hemodynamic monitoring is an essential part of anesthetic care. In this review, we aim to give an overview of methods currently used in the clinical routine and experimental methods under development. The technical aspects of the mentioned methods are discussed briefly.

Comparison of renal region, cerebral and peripheral oxygenation for predicting postoperative renal impairment after CABG.

Patients undergoing coronary artery bypass grafting (CABG) are at risk of developing postoperative renal impairment, amongst others caused by renal ischemia and hypoxia. Intra-operative monitoring of renal region tissue oxygenation (SrtO) might be a useful tool to detect renal hypoxia and predict postoperative renal impairment. Therefore, the aim of this study was to assess the ability of intra-operative SrtO to predict postoperative renal impairment, defined as an increase of serum creatinine concentrations of  > 10% from individual baseline, and compare this with the predictive abilities of peripheral and cerebral tissue oxygenation (SptO and SctO, respectively) and renal specific tissue deoxygenation.