Skin perfusion pressure as an indicator of tissue perfusion in valvular heart surgery: Preliminary results from a prospective, observational study

摘要: Hemodynamic management aims to provide adequate tissue perfusion, which is often altered during cardiac surgery with cardiopulmonary bypass (CPB). We evaluated whether skin perfusion pressure (SPP) can be used for monitoring of adequacy in patients undergoing valvular heart surgery. Seventy-two valve replacement were enrolled. SPP and serum lactate level assessed after anaesthesia induction (baseline), CPB, CPB-off, end surgery, arrival at intensive care unit, postoperative 6 h. Lactate was further measured until 48 Association 30-day morbidity comprising myocardial infarction, acute kidney injury, stroke, prolonged intubation, sternal infection, reoperation, mortality assessed. Among the levels, h peak value most closely linked composite morbidity. The CPB its % change from baseline significantly associated (r = -0.26, P 0.030 r 0.47, 0.001, respectively). Optimal cut-off decrease hyperlactatemia 48% (area under curve, 0.808; 95% confidence interval (CI), 0.652-0.963; 0.001). Decrease >48% a 12.8-fold increased risk endpoint (95% CI, 1.48-111.42; 0.021) on multivariate logistic regression. Large predicts morbidity, implicates promising role achievement optimal CPB.