Intraoperative baseline oxygen consumption as a prognostic factor in emergency open abdominal surgery

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• 作者：Toshiro Masuda ; MD ; PhD^a ; ^c ; Masafumi Kuramoto ; MD ; PhD^a ; ^{kuramoto@kumamoto-gh.jp" class="auth_mail" title="E-mail the corresponding author} ; Hironari Tanimoto ; MD ; PhD^b ; Kenichiro Yamamoto ; MD ; PhD^a ; Satoshi Ikeshima ; MD^a ; Yuuki Kitano ; MD^a ; Daisuke Kuroda ; MD^a ; Shinya Shimada ; MD ; PhD^a ; Hideo Baba ; MD ; PhD ; FACS^c
• 关键词：VO2 ; VCO2 ; Emergency abdominal operation
• 刊名：Journal of Critical Care
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：32
• 期：Complete
• 页码：42-47
• 全文大小：889 K

文摘

A new anesthesia system, the E-CAIOVX (GE Healthcare) enables the continuous monitoring of oxygen consumption (VO₂) and carbon dioxide elimination (VCO₂) during the surgical operation. The aim of this study was to evaluate the prognostic role of intraoperative baseline VO₂ and VCO₂ in an emergency open abdominal operation.

Methods

A total of 103 patients who had an emergency open abdominal operation were enrolled in the study. VO₂ and VCO₂ were continuously measured from the induction of anesthesia to the end of the operation.

Results

There were significant correlations between intraoperative baseline VO₂ and body surface area (BSA; P < .001, r = 0.68), VO₂ and tidal volume (P < .001, r = 0.59), and VO₂ and baseline body temperature (P < .0001, r = 0.49). Also, there were significant correlations between intraoperative baseline VCO₂ and BSA (P < .001, r = 0.70), VCO₂ and tidal volume (P < .001, r = 0.70), and VCO₂ and body temperature (P < .001, r = 0.41). Fifteen (14.6%) of the 103 patients died within 4 months after the operation without having been discharged from hospital. Baseline VO₂/BSA was higher in surviving patients (123.7 ± 23.6 mL/min ∙ m²) than the deceased (103.8 ± 15.6 mL/min ∙ m²; P = .002). There was no significant difference in baseline VCO₂/BSA levels between surviving (106.2 ± 20.1 mL/min ∙ m²) and deceased patients (99.4 ± 21.4 mL/min ∙ m²). In multivariate analysis, baseline body temperature lower than 36.2°C (P = .02), serum albumin less than 3.0 g/dL (P = .002), and baseline VO₂/BSA less than 111.9 mL/min ∙ m² (P = .03) were independent factors.

Conclusion

Baseline low VO₂/BSA less than 111.9 mL/min ∙ m² was one of the poor predictors for the prognosis of an emergency open abdominal surgery.