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Renal medullary oxygenation during laparoscopic vs open surgery: the impact of blood pressure management—a pilot randomized controlled trial

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Abstract

The impact of blood pressure targets and surgical approach (laparoscopic or open) on continuous urinary oxygenation (PuO2), a validated surrogate of renal medullary PO2, during general surgery, is unclear. We aimed to assess the effects of different blood pressure targets and surgical procedures on PuO2. We randomized patients receiving either laparoscopic or open surgery into two mean arterial pressure (MAP) target groups: usual MAP or a high MAP. We measured PuO2 in real-time and analyzed it according to the type of surgery and blood pressure target. The study was retrospectively registered on the 5th of July 2023 (ACTRN12623000726651). We included 43 participants who underwent either laparoscopic (n = 20) or open surgery (n = 23). We found that PuO2 significantly decreased during both laparoscopic and open surgery under a usual blood pressure target (− 51% and − 49%, respectively). However, there was a sharper fall with laparoscopic surgery resulting in a higher PuO2 with open surgery (mean difference: 11 ± 1 mmHg higher; p < 0.001). Targeting a higher MAP resulted in a higher PuO2 over time during laparoscopic surgery (mean difference: 7 ± 1 mmHg, p < 0.001). In contrast, targeting a usual MAP resulted in a higher PuO2 during open surgery (mean difference: 7 ± 1 mmHg, p < 0.001). Surgical approach and intraoperative blood pressure targets significantly impact urinary oxygenation. Further studies with larger sample sizes are needed to confirm these findings and understand their potential clinical implications.

Registration number: ACTRN12623000726651; Date of registration: 05/07/2023 (retrospectively registered).

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Data availability

The study protocol, data set and statistical code are available from the corresponding author on reasonable request.

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Acknowledgements

We acknowledge research support from Austin Health Hospital and the work of all staff in supporting the health system and their patients.

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Intensive Care, Austin Hospital, 145 Studley Road, Heidelberg, Melbourne, VIC, 3084, Australia

    Anis Chaba, Sofia Spano, Akinori Maeda, Glenn Eastwood & Rinaldo Bellomo

  2. Department of Anesthesia, Austin Hospital, Melbourne, Australia

    Doug Hacking, Hugh Slifirski & Rebecca Cogan

  3. Department of Critical Care, The University of Melbourne, Melbourne, Australia

    Rinaldo Bellomo

  4. Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia

    Rinaldo Bellomo

  5. Data Analytics Research and Evaluation Centre, Austin Hospital, Melbourne, Australia

    Rinaldo Bellomo

  6. Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Australia

    Rinaldo Bellomo

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  1. Anis Chaba
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Contributions

Research idea and study design: DH, RB; data acquisition: DH, HS; data analysis/interpretation: all authors; supervision or mentorship: DH, CF, and RB Each author contributed important intellectual content during manuscript drafting or revision and accepted accountability for the overall work by ensuring that questions about the accuracy or integrity of any portion of the work are appropriately investigated and resolved.

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Correspondence to Anis Chaba.

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Implication statement

This study demonstrates that surgical approach and blood pressure targets significantly affect urinary oxygenation. A higher blood pressure target during laparoscopic surgery and usual blood pressure during open surgery yielded better oxygenation results, suggesting the need for individualized intraoperative management strategies.

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Chaba, A., Hacking, D., Slifirski, H. et al. Renal medullary oxygenation during laparoscopic vs open surgery: the impact of blood pressure management—a pilot randomized controlled trial. J Clin Monit Comput 38, 337–345 (2024). https://doi.org/10.1007/s10877-023-01079-1

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  • DOI: https://doi.org/10.1007/s10877-023-01079-1

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