Flick M, Rosenau L, Sadtler H, Kouz K, Krause L, Joosten A, Schulte-Uentrop L, Saugel B. The Urethral Perfusion Index During Off-Pump Coronary Artery Bypass Surgery: An Observational Study.
J Cardiothorac Vasc Anesth 2024;
38:417-422. [PMID:
38114369 DOI:
10.1053/j.jvca.2023.09.015]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/28/2023] [Accepted: 09/12/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVES
The IKORUS system (Vygon, Écouen, France) allows continuous monitoring of the urethral perfusion index (uPI) using a photoplethysmographic sensor mounted near the base of the balloon of a dedicated urinary catheter. We aimed to test the hypothesis that the uPI decreases during off-pump coronary artery bypass (OPCAB) surgery and to investigate the relationship between the uPI and macrocirculatory variables.
DESIGN
Prospective observational study.
SETTING
University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
PARTICIPANTS
Twenty patients having OPCAB surgery.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
The primary endpoint was changes in the uPI during OPCAB surgery. We additionally investigated associations between the uPI and cardiac output, mean arterial pressure, heart rate, and point-of-care variables. Twenty patients with 24,137 uPI measurements were included. Overall, there was a high interindividual variability in the uPI. Compared with the preparation phase (during which the median [interquartile range] uPI was 7.7 [5.6-12.0]), the uPI decreased by 14% (95% CI 13%-15%) during the bypass grafting phase, by 35% (95% CI 34%-36%) during the cardiac positioning phase, and by 7% (95% CI 6%-9%) during hemostasis. There was no clinically important association between uPI and either cardiac output, mean arterial pressure, or heart rate.
CONCLUSIONS
The uPI decreases during OPCAB surgery, specifically during the cardiac positioning phase. There was no clinically important association between uPI and either cardiac output, mean arterial pressure, or heart rate. It, therefore, remains to be determined whether intraoperative uPI decreases are clinically important, reflect alterations in intra-abdominal tissue perfusion that are not reflected by systemic macrohemodynamics, and can help clinicians guide therapeutic interventions.
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