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Title: Renal medullary oxygenation during laparoscopic vs open surgery: the impact of blood pressure management-a pilot randomized controlled trial.
Austin Authors: Chaba, Anis;Hacking, Doug;Slifirski, Hugh;Cogan, Rebecca;Spano, Sofia;Maeda, Akinori;Eastwood, Glenn M ;Bellomo, Rinaldo 
Affiliation: Intensive Care
Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia.;Data Analytics Research and Evaluation Centre, Austin Hospital, Melbourne, Australia.;Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Australia.
Department of Critical Care, The University of Melbourne, Melbourne, Australia.
Issue Date: 13-Oct-2023
Date: 2023
Publication information: Journal of Clinical Monitoring and Computing 2023-10-13
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).
DOI: 10.1007/s10877-023-01079-1
Journal: Journal of Clinical Monitoring and Computing
PubMed URL: 37831377
ISSN: 1573-2614
Type: Journal Article
Subjects: Acute kidney injury
Laparoscopic surgery
Mean arterial pressure
Medullary oxygenation
Open surgery
Urinary oxygenation
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