Microcirculatory perfusion during different perioperative hemodynamic strategies.

OBJECTIVE: We investigated whether hemodynamic optimization of systemic tissue perfusion based on PPV and CI improves microcirculatory perfusion when compared to a MAP-based strategy in patients undergoing elective abdominal surgery. METHODS: Patients were randomized into a PPV/CI guided group (n = 13, target PPV <12%, CI >2.5 L/min/m(2) , and MAP >70 mmHg) or MAP-guided group (n = 18, target MAP >70 mmHg). PPV, CI, and MAP were measured using noninvasive arterial blood pressure measurements. Sublingual microcirculatory perfusion was measured at one, two, and three hours following anesthesia induction, and quantified as TVD, PVD or the proportion of perfused vessels. Data were analyzed using ANOVA RM. RESULTS: Patients in the PPV/CI group required more fluid administration than control patients (1927 ± 747 mL versus 1283 ± 582 mL, respectively; p = 0.01). Despite this difference, we observed similar values for TVD (RM; F(1.28) = 0.01; p = 0.92), PVD (RM; F(1.28) = 0.09; p = 0.77) and the proportion of perfused vessels (RM; F(1.28) = 0.01; p = 0.76) in both groups. CONCLUSION: Hemodynamic optimization of systemic tissue perfusion is not associated with improvement of microcirculatory perfusion compared to a MAP-guided protocol in patients undergoing abdominal surgery.

Case Report: Bilateral reexpansion pulmonary edema following treatment of a unilateral hemothorax.

Bilateral re-expansion pulmonary edema (RPE) is an extremely rare entity. We report the unique case of bilateral RPE following a traumatic, unilateral hemopneumothorax in a young healthy male. Bilateral RPE occurred only one hour after drainage of a unilateral hemopneumothorax. The patient was treated with diuretics and supplemental oxygen. Diagnosis was confirmed by excluding other causes, using laboratory findings, chest radiography, pulmonary and cardiac ultrasound and high resolution computed tomography. His recovery was uneventful. The pathophysiology of bilateral RPE is not well known. Treatment is mainly supportive and consists of diuretics, mechanical ventilation, inotropes and steroids. In case of a pulmonary deterioration after the drainage of a traumatic pneumothorax, bilateral RPE should be considered after exclusion of more common causes of dyspnea.