Key result
Goal-directed hemodynamic therapy increases end-surgery oxygen delivery index by up to ~26% over routine care.
Why the study?
Mechanistic effects of intraoperative blood flow-guided hemodynamic therapy on oxygen delivery, consumption, and microcirculatory tissue perfusion remain poorly understood in major abdominal surgery.
Does maximizing stroke volume or maintaining preoperative resting cardiac index improve oxygen delivery and tissue perfusion in patients having major abdominal surgery?
RCT (n=76)
Does maximizing stroke volume or maintaining preoperative resting cardiac index improve oxygen delivery and tissue perfusion in patients having major abdominal surgery?
Intraoperative blood flow-guided hemodynamic therapy targeting stroke volume maximization or cardiac index maintenance improves oxygen delivery index compared to routine care in major abdominal surgery.
Answers are grounded in this paper and cite their sources.
Supports targeted hemodynamic optimization to raise intraoperative oxygen delivery in major abdominal surgery; confirms RCT benefit of stroke volume or cardiac index goals over routine care.
Background Mechanistic effects of intraoperative blood flow-guided hemodynamic therapy remain poorly understood. Therefore, we aimed to determine the effects of a) maximizing stroke volume and b) maintaining preoperative resting cardiac index on oxygen delivery, oxygen consumption, and sublingual and abdominal microcirculatory tissue perfusion in major abdominal surgery patients. Methods We randomized 76 patients to maximizing stroke volume, maintaining preoperative resting cardiac index, or routine care during and for the first 6 h after surgery. We measured oxygen delivery index, oxygen consumption index, sublingual microvascular flow index, and urethral perfusion index. Results At the end of surgery and 6 h after surgery, the median (25th percentile, 75th percentile) oxygen delivery index was higher in patients assigned to stroke volume maximization (460 (404, 556) ml/min/m 2 and 503 (466, 595) ml/min/m 2 ) or to preoperative cardiac index maintenance (507 (460, 664) ml/min/m 2 and 516 (403, 604) ml/min/m 2 ) than in patients assigned to routine care (403 (338, 517) ml/min/m 2 and 390 (351, 510) ml/min/m 2 ). There were no important differences in oxygen consumption index and sublingual microvascular flow index among the three groups. The intraoperative average urethral perfusion index was slightly higher in patients assigned to stroke volume maximization or to preoperative cardiac index maintenance than in patients assigned to routine care. Conclusion In our trial, both maximizing stroke volume and maintaining preoperative resting cardiac index resulted in higher intraoperative and postoperative oxygen delivery index than routine care in major abdominal surgery patients. Large clinical trials are required to determine whether achieving higher perioperative oxygen delivery index translates into better outcomes.
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Flick et al. (2025) conducted an RCT in Major abdominal surgery (n=76). Maximizing stroke volume or maintaining preoperative resting cardiac index vs. Routine care was evaluated on Oxygen delivery index. Maximizing stroke volume or maintaining preoperative cardiac index yielded higher oxygen delivery index at the end of surgery (medians 460 and 507 ml/min/m2) than routine care (403 ml/min/m2).
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