Association between serosal intestinal microcirculation and blood pressure during major abdominal surgery

Arthur Lm Tavy; Anton Fj de Bruin; E Christiaan Boerma; Can Ince; Matthias P Hilty; Peter G Noordzij; Djamila Boerma; Mat van Iterson

doi:10.1016/j.jointm.2021.03.003

Association between serosal intestinal microcirculation and blood pressure during major abdominal surgery

J Intensive Med. 2021 Apr 24;1(1):59-64. doi: 10.1016/j.jointm.2021.03.003. eCollection 2021 Jul.

Authors

Arthur Lm Tavy¹, Anton Fj de Bruin¹, E Christiaan Boerma², Can Ince³, Matthias P Hilty⁴, Peter G Noordzij¹, Djamila Boerma⁵, Mat van Iterson¹

Affiliations

¹ Department of Anesthesiology, Intensive Care and Pain Medicine, St. Antonius Hospital, Nieuwegein 3435 CM, the Netherlands.
² Department of Intensive Care, Medical Center Leeuwarden, Leeuwarden 8934 AD, the Netherlands.
³ Department of Intensive Care Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam 3015 GD, the Netherlands.
⁴ Institute of Intensive Care Medicine, University Hospital of Zurich, Zürich 8006, Switzerland.
⁵ Department of Surgery, St. Antonius Hospital, Nieuwegein 3435 CM, the Netherlands.

Abstract

Background: In clinical practice, blood pressure is used as a resuscitation goal on a daily basis, with the aim of maintaining adequate perfusion and oxygen delivery to target organs. Compromised perfusion is often indicated as a key factor in the pathophysiology of anastomotic leakage. This study was aimed at assessing the extent to which the microcirculation of the bowel coheres with blood pressure during abdominal surgery.

Methods: We performed a prospective and observational cohort study. In patients undergoing abdominal surgery, the serosal microcirculation of either the small intestine or the colon was visualized using handheld vital microscopy (HVM). From the acquired HVM image sequences, red blood cell velocity (RBCv) and total vessel density (TVD) were calculated using MicroTools and AVA software, respectively. The association between microcirculatory parameters and blood pressure was assessed using Pearson's correlation analysis. We considered a two-sided P-value of <0.050 to be significant.

Results: In 28 patients undergoing abdominal surgery, a total of 76 HVM images were analyzed. The RBCv was 335 ± 96 µm/s and the TVD was 13.7 ± 3.4 mm/mm². Mean arterial pressure (MAP) was 71 ± 12 mm Hg during microcirculatory imaging. MAP was not correlated with RBCv (Pearson's r = -0.049, P = 0.800) or TVD (Pearson's r = 0.310, P = 0.110).

Conclusion: In 28 patients undergoing abdominal surgery, we found no association between serosal intestinal microcirculatory parameters and blood pressure.

Keywords: Abdominal surgery; Handheld vital microscopy; Hemodynamic management; Intestinal microcirculation.