Association of the Arteriovenous Difference in Carbon Dioxide and Its Relation to the Difference in Arteriovenous Oxygen Content With the Occurrence of Postoperative Complication

Study Overview
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Brief Summary
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Intra-operative hemodynamic management in high-risk surgery is a priority for the anesthesiologist. The current strategy is based on the continuous measurement of cardiac output and its maximization by vascular filling has many limitations: invasiveness, measurement difficulties, impaired performance, imperative surgical restriction of filling, lack of evaluation of flow rate and metabolic needs. Biomarkers may be able to detect early an inadequacy between cardiac output and tissue oxygen requirements, venous saturation with oxygen (ScvO2) and arteriovenous difference in partial pressure of carbon dioxide (ΔPCO2) as well as the appearance of cellular hypoxia (lactate and arteriovenous difference in partial pressure of carbon dioxide/arteriovenous difference in oxygen) (ΔPCO2) / DAVO2). Moreover, the medical literature remains poor on the evaluation of these markers in per-operative context all the more for ΔPCO2 and ΔPCO2 / DAVO2. It seems interesting to evaluate the potential of these tools, in patients with major surgery and at high risk (major hepatectomy, oesophagectomy and duodeno-pancreatectomy), to predict the risk of postoperative complications, especially since surgery involves a restrictive vascular filling strategy that may be potentially deleterious to the patient.

Official Title
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Association of the Arteriovenous Difference in Carbon Dioxide and Its Relation to the Difference in Arteriovenous Oxygen Content With the Occurrence of Postoperative Complication

Conditions
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Surgery--Complications

Intervention / Treatment
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* Procedure: patient having to undergo a high risk programmed digestive surgery


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Major patient Patient eligible for a high risk scheduled gastrointestinal surgery from: Esophagectomy Major hepatectomy (≥ 3 segments) Cephalic duodeno-pancreatectomy Patient with an arterial catheter and a central venous line in superior vena cava. Patient hospitalized post-operatively in intensive care unit as agreed in consultation with preoperative anesthesia. Exclusion Criteria: Pregnant or lactating patients Patient with an unstable acute condition at the time of surgery (acute heart, respiratory or renal failure, severe sepsis or septic shock, hemorrhagic shock) Patient opposing his participation in the study Patient protected by law (guardianship) Patient deprived of liberty Patient with a contraindication to the establishment of a central venous route in superior vena cava territory or a radial or femoral arterial catheter

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| patient who will have a high risk digestive surgery<br>patient who will have a high risk digestive surgery: esophagectomy, major hepatectomy> 3 segments, duodeno cephalic pancreatectomy | Procedure: patient having to undergo a high risk programmed digestive surgery<br>* The objective is to determine if there is an association between the mean intraoperative values and within 24 hours postoperative ΔPCO2 and the occurrence of major post-operative complications at day 28 in high-risk surgery (major hepatectomy, esophagectomy or duodeno- cephalic pancreatectomy)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| mean intraoperative PCO2 values | PCO2 values will be collected every 2 hours during surgery | during surgery | 
| mean postoperative PCO2 values |  | within 24 hours after surgery | 
| post-operative complications | post-operative complications of grade III or greater according to Clavien-Dindo classification | 28 days after surgery | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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high-risk digestive surgery, intensive care unit