Sublingual microcirculation in pancreatico-biliary surgery: An observational study.

Background: An observational cohort study was conducted to identify potential sublingual microcirculation parameters as a target for goal-directed fluid therapy. Methods: Patients that were scheduled for an open elective pancreatico-biliary surgery in Erasmus Medical Center were included. All patients underwent sublingual microcirculatory measurement at three time points: one day before surgery (T0), within the first 24 hours after surgery (T1) and on the fourth day after surgery (T2). The following parameters were obtained: microvascular flow index (MFI (AU)), Total vessels density (TVD (mm/mm(2)/)), Perfused vessels density (PVD (mm/mm(2))), and proportion of perfused vessels (PPV (%)). Results: Sixteen patients were included in the final analysis. The differences between the time points T1 and T0 in patients without clinical significant complication and in patients with these complications gave a significant difference for PVD small vessels (PVDs) (delta PVDs mean -0.1 vs -8.2, p = 0.01) and PPV small vessels (PPVs) (delta PPVs median 7.0% vs -15.5%, p= 0.01). Conclusion: The most significant microcirculatory parameter for a perioperative complicated course is the change of PVD and PPV. In the first 24 hours after surgery, if these parameters decrease there is a high chance of a complicated perioperative course.