Intraoperative maintenance of tissue perfusion prevents ARDS

D. Thangathurai, C. Charbonnet, C. C.J. Wo, W. C. Shoemaker, M. S. Mikhail, P. Roffey, P. Roessler, K. Kuchta, V. Zelman, T. R. DeMeester, R. Katz

Research output: Contribution to journalReview articlepeer-review

15 Citations (Scopus)

Abstract

Patients undergoing prolonged, complex oncological surgery are at increased risk of developing the adult respiratory distress syndrome (ARDS) and other organ failures. Our hypothesis is that maintaining adequate tissue perfusion and oxygenation may prevent tissue hypoxia and acidosis in pulmonary, peripheral, and splanchnic microcirculations. Experimental evidence suggests that the hypoxic, acidotic endothelium stimulates the release of cytokines, kinins, and other mediators. We developed and tested an intraoperative protocol for surgical patients likely to develop ARDS and organ dysfunction; the protocol focuses on the intraoperative period but is not limited to this time. Nitroglycerin and fluids were used to maintain tissue perfusion and prevent tissue hypoxia as reflected by transcutaneous oxygen tension values. In 155 high-risk patients, none developed ARDS. We conclude that maintenance of tissue perfusion and oxygenation in high-risk surgical patients decreases the incidence of ARDS.

Original languageEnglish
Pages (from-to)466-474
Number of pages9
JournalNew Horizons: Science and Practice of Acute Medicine
Volume4
Issue number4
Publication statusPublished - 1996
Externally publishedYes

Keywords

  • adult respiratory distress syndrome
  • cytokine
  • high-risk surgery
  • nitroglycerin
  • splanchnic circulation
  • tissue oxygenation

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