Combined receiver operating characteristic curve of the % change of SPP during CPB for the postoperative 6 h hyperlactatemia (peak lactate > 3mmol/L).

<p>An area of 0.808 (95% confidence interval of 0.652–0.963, P = 0.001) was observed below the line of % change in SPP value. The optimal cutoff value for postoperative 6 h hyperlactatemia was 48% decrease from the baseline SPP (after induction of anesthesia), with a sensitivity and specificity of 84.6% and 77.8%, respectively. SPP = skin perfusion pressure; CPB = cardiopulmonary bypass.</p

Skin perfusion pressure as an indicator of tissue perfusion in valvular heart surgery: Preliminary results from a prospective, observational study

<div><p>Hemodynamic management aims to provide adequate tissue perfusion, which is often altered during cardiac surgery with cardiopulmonary bypass (CPB). We evaluated whether skin perfusion pressure (SPP) can be used for monitoring of adequacy of tissue perfusion in patients undergoing valvular heart surgery. Seventy-two patients undergoing valve replacement were enrolled. SPP and serum lactate level were assessed after anaesthesia induction (baseline), during CPB, after CPB-off, end of surgery, arrival at intensive care unit, and postoperative 6 h. Lactate was further measured until postoperative 48 h. Association of SPP with lactate and 30-day morbidity comprising myocardial infarction, acute kidney injury, stroke, prolonged intubation, sternal infection, reoperation, and mortality was assessed. Among the lactate levels, postoperative 6 h peak value was most closely linked to composite of 30-day morbidity. The SPP value during CPB and its % change from the baseline value were significantly associated with the postoperative 6 h peak lactate (r = -0.26, P = 0.030 and r = 0.47, P = 0.001, respectively). Optimal cut-off of % decrease in SPP during CPB from baseline value for the postoperative 6 h hyperlactatemia was 48% (area under curve, 0.808; 95% confidence interval (CI), 0.652–0.963; P = 0.001). Decrease in SPP >48% during CPB from baseline value was associated with a 12.8-fold increased risk of composite endpoint of 30-day morbidity (95% CI, 1.48–111.42; P = 0.021) on multivariate logistic regression. Large decrease in SPP during CPB predicts postoperative 6 h hyperlactatemia and 30-day morbidity, which implicates a promising role of SPP monitoring in the achievement of optimal perfusion during CPB.</p></div

Flow diagram of study participants.

<p>Flow diagram of study participants.</p

Predictive power of selective variables for composite endpoint of 30-day morbidity according to logistic regression analysis.

<p>Predictive power of selective variables for composite endpoint of 30-day morbidity according to logistic regression analysis.</p

Perioperative data according to the % change of SPP during CPB from the baseline value.

<p>Perioperative data according to the % change of SPP during CPB from the baseline value.</p

Flow diagram of study participants.

<p>Flow diagram of study participants.</p

Perioperative SPP values and their associations with the postoperative 6 h peak lactate level.

<p>Perioperative SPP values and their associations with the postoperative 6 h peak lactate level.</p

Relationship between hemodynamic parameters and postoperative 6 h peak lactate level.

<p>Relationship between hemodynamic parameters and postoperative 6 h peak lactate level.</p

Additional file 1: of Effect of perioperative sodium bicarbonate administration on renal function following cardiac surgery for infective endocarditis: a randomized, placebo-controlled trial

Perioperative hemodynamic variables. Changes in heart rate, mean blood pressure, mean pulmonary arterial pressure, and central venous pressure during the perioperative period. (PDF 48 kb

Additional file 2: of Effect of perioperative sodium bicarbonate administration on renal function following cardiac surgery for infective endocarditis: a randomized, placebo-controlled trial

Perioperative body temperature and laboratory findings. Change in blood temperature, C-reactive protein, white blood cell count, and neutrophils during the perioperative period. (PDF 115 kb