The new transpulmonary thermodilution measurement to assess hemodynamic change in patients undergoing open abdominal cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC); A prospective observational study
Introduction: Current treatment of peritoneal cancer combines cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). This is known for the extensive and quality of life threatening procedure. Optimal anesthetic management of patients treated with this surgery requires control of a complex interplay of physiologic mechanisms. We aimed to investigate the intraoperative physiologic change including extravascular lung water of patients undergoing cytoreductive surgery with HIPEC in our department of colorectal surgery. 
Methods: In this prospective observational study, among 31 patients who underwent cytoreductive surgery with HIPEC, a total of 21 patients were enrolled. We applied the VolumeView system to all patients, a system has been introduced that employs a novel algorithm for the mathematical analysis of the thermodilution curve; an internal jugular vein and a femoral artery access were required to monitor hemodynamic parameters. These reflected the patient’s respiratory, cardiovascular and intravascular volume states, which were monitored by an EV1000 monitor and arterial blood gas analysis. We recorded and analyzed at 7 time-points; before skin incision, 30 minutes before HIPEC, 30 minutes, 60 minutes and 90 minutes after HIPEC, 30 minutes after the end of HIPEC, and 10 minutes before the end of surgery.
Results: During the HIPEC period, patients showed a rise in temperature (up to 38 ℃), a decrease in systemic vascular resistance index, and an increase in cardiac output. The global end diastolic volume index ranged from 715.4 to 809.7, the extravascular lung water index ranged from 6.9 to 7.3 ml/kg, and the pulmonary vascular permeability index ranged from 2.0 to 2.6. An average of 6.8 unit rapid insulin was administered because of increased glucose level. And lactate level steadily increased during the HIPEC period. Only one patient was presented with acute kidney injury postoperatively, and the average hospital length of stay was 17 days.
Conclusions: The hyperdynamic circulation state developed and microcirculation deteriorated because of increased temperature, glucose and lactate level during HIPEC period. Therefore, further developed hemodynamic monitoring including optimal intravascular volume status should be considered for these patients.

The new transpulmonary thermodilution measurement to assess hemodynamic change in patients undergoing open abdominal cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC): a prospective observational study