Key result
Continuous monitoring of oesophageal photoplethysmography detected a loss of haemodynamic coherence and severe alteration of tissue perfusion triggered by a norepinephrine-induced MAP increase.
Case Report (n=1)
Continuous oesophageal photoplethysmography monitoring can detect loss of haemodynamic coherence and guide vasopressor therapy to prevent adverse tissue perfusion effects.
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Norepinephrine-driven MAP increases may impair tissue perfusion; leaves open whether oesophageal photoplethysmography can guide safer resuscitation.
We report the case of a 75-year-old man with appendicular peritonitis in whom we observed oesophageal tissue perfusion, using a new photoplethysmographic probe. As the patient suffered from lactic acidosis, we chose to increase the mean arterial pressure (MAP) using norepinephrine. Thanks to an oesophageal photoplethysmographic signal, we could observe a loss of haemodynamic coherence and a severe alteration of tissue perfusion triggered by the MAP increase. Considering new information regarding the tissue perfusion status, we were able to adjust our MAP targets accordingly and restore the initial perfusion index values. This case illustrates the loss of haemodynamic coherence and highlights the clinical relevance of continuous tissue perfusion monitoring to highlight potential adverse norepinephrine effects.
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Vacheron et al. (2019) conducted a case report in Appendicular peritonitis with lactic acidosis (n=1). Continuous monitoring of oesophageal photoplethysmography was evaluated on Loss of haemodynamic coherence and alteration of tissue perfusion. Continuous monitoring of oesophageal photoplethysmography detected a loss of haemodynamic coherence and severe alteration of tissue perfusion triggered by a norepinephrine-induced MAP increase.
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