Background and Goal of Study: The combined use of new monitoring methods during anaesthesia (monitoring blood flow with assessment of fluid status and regional tissue oxygenation) with adherence to appropriate management protocol might radically improve perioperative outcome of high-risk surgical patients. Only few studies have showed the effect of multimodal monitoring on mortality and complications. Our study presents very homogenous groups of patients undergoing major abdominal surgery, with similar perioperative management and anaesthesia technique. The goal is to assess the differences in incidence of postoperative acute kidney injury and myocardial infarction if the multimodal monitoring is being used intraoperatively.
 Materials and Methods: Prospective, randomised trial with 2 parallel groups was conducted at the University medical centre (UMC) Ljubljana in years 2015 - 2017. ASA 2-3 high risk surgical patients that underwent major abdominal procedures were included.  The study was approved by the national medical ethics committee of Slovenia. In control group, only conventional monitoring was used, but in the multimodal group, intraoperative fluid status was optimised according to blood flow monitoring and tissue oxygenation according to cerebral oxygenation monitoring. Postoperatively, clinical examination and laboratory values (including creatinine and troponin I) were conducted every 24 hours first three days. Acute kidney injury was suspected if ≥0.3 mg/dL increase in creatinine level or 1.5 times baseline (KIDGO stage 1). Myocardial infarction was suspected if troponin I was positive according to laboratory reference range.
Results and Discussion: 
According to Lee's Revised Cardiac Risk Index, there were 26 patients in control group and 27 in multimodal group in class II, 12 and 10 in class III, 4 and 5 in class IV respectively. 
There was a rise in creatinine level (KIDGO stage 1 or more in 3 patients in control and in 4 patients in multimodal group (p=0.500, Fisher exact test). Oliguria (urine output less than 500ml) in first 3 days has appeared in 1 patient in control and 3 patients in multimodal group (p=0.247, Fisher exact test). There was no rise in troponin level in control group and in 3 patients in multimodal group (0.241, Fisher exact test).
There were no clinical signs of myocardial infarction in patients with raised troponin. Median intraoperative fluid load was higher in multimodal group (1650 vs 900 ml, p=0.000, Mann-Whitney U test)
At first glance, we can conclude that combination of hemodynamic monitor and measurement of cerebral oxygenation do not provide benefit to patients in our study. However, subsequent analysis has showed that there are some postoperative complications such as need for revision surgery, additional antibiotic treatment required third day after procedure or re-admission to HDU that occur only in control group.
Conclusion: In our study, combined use of hemodynamic monitoring and cerebral monitor does not significantly decrease the incidence of renal or cardiac impairment after major abdominal surgery.


09 / Multimodal monitoring does not decrease incidence of renal or cardiac impairment after major abdominal surgery