Supplemental perioperative fluid administration increases tissue oxygen pressure

Cem F. Arkiliç, Akiko Taguchi, Neeru Sharma, Jebadurai Ratnaraj, Daniel I. Sessler, Thomas E. Read, James W. Fleshman, Andrea Kurz

Research output: Contribution to journalArticlepeer-review

117 Scopus citations

Abstract

Background. Wound infections are common and serious surgical complications. Wound perfusion delivers oxygen, inflammatory cells, growth factors, and cytokines to injured tissues. Hypoperfused regions experience low oxygen tensions that do not support adequate oxidative killing or wound healing. Clinicians may fail to recognize clinically important hypovolemia because hemodynamic stability and urine output are maintained after peripheral perfusion is compromised. We tested the hypothesis that supplemental fluid administration during and after elective colon resection increases tissue perfusion and tissue oxygen pressure. Methods. Fifty-six patients undergoing colon resection were randomly assigned to conservative (8 mL·kg-1·h-1, n = 26) or aggressive (16 to 18 mL·kg-1·h-1, n = 30) fluid management. Anesthetic technique was standardized. We used 60% nitrous oxide in 40% oxygen. During surgery and postanesthetic recovery, subcutaneous oxygen tension (PsqO2) was measured by using a polarographic sensor implanted subcutaneously into 1 upper arm. Capillary blood flow was evaluated postoperatively with a thermal diffusion system. Data were analyzed with 2-tailed t tests; P value less than .05 was considered statistically significant. Results. Hemodynamic and renal responses were similar in the groups. Intraoperative tissue oxygen tension was significantly greater in patients given supplemental fluid: 81 ± 26 vs 67 ± 18 mm Hg, P = .03. Postoperative PsqO2 (77 ± 26 vs 59 ± 15 mm Hg, P = .009) and capillary blood flow (69 ± 12 vs 53 ± 12, P < .001) were also greater in the supplemental fluid patients. Conclusions. Supplemental perioperative fluid administration significantly increases tissue perfusion and tissue oxygen partial pressure. Optimizing tissue perfusion will require providing more fluid than indicated by normal clinical criteria or use of invasive monitoring to guide treatment. The actual effect of supplemental fluid administration on incidence of wound infection requires further investigation.

Original languageEnglish
Pages (from-to)49-55
Number of pages7
JournalSurgery
Volume133
Issue number1
DOIs
StatePublished - Jan 1 2003

Fingerprint

Dive into the research topics of 'Supplemental perioperative fluid administration increases tissue oxygen pressure'. Together they form a unique fingerprint.

Cite this