Journal Article

The effects of maximizing stroke volume versus maintaining preoperative resting cardiac index on oxygen delivery, oxygen consumption, and microcirculatory tissue perfusion in patients having major abdominal surgery: The exploratory randomized CUSTOM trial

Thomsen, Kristen K., Saugel, Bernd, Krause, Linda, Bergholz, Alina, Moll-Khosrawi, Parisa, Kouz, Karim, Flick, Moritz, Süykers, Marie-Christin, Joosten, Alexandre, Briesenick-Weskamm, Luisa, Sierzputowski, Pawel

2025

Overview

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. 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. 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/m2 and 503 (466, 595) ml/min/m2) or to preoperative cardiac index maintenance (507 (460, 664) ml/min/m2 and 516 (403, 604) ml/min/m2) than in patients assigned to routine care (403 (338, 517) ml/min/m2 and 390 (351, 510) ml/min/m2). 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. 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. •There are various strategies for intraoperative blood flow-guided management.•Their effects on oxygen delivery and tissue perfusion are unclear.•Stroke volume maximization increased oxygen delivery.•Maintaining preoperative cardiac index increased oxygen delivery.•Both strategies increased abdominal microcirculatory tissue perfusion.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Abdomen / Abdomen - surgery / Abdominal surgery / Aged / Algorithms / Anesthesia / Anesthesiology / Cardiac output / Catheters / Female / General anesthesia / Goal-directed therapy / Hemodynamic monitoring / Hemodynamics / Humans / Indirect calorimetry / Intensive care / Male / Microcirculation - physiology / Middle Aged / Monitoring, Intraoperative - methods / Mouth Floor - blood supply / Oxygen / Oxygen Consumption - physiology / Pain Medicine / Patients / Preoperative Care - methods / Prospective Studies / Stroke Volume - physiology / Sublingual microcirculation / Surgeons / Urethral perfusion index