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Whipple surgery is a complex abdominal procedure associated with a high risk of hemodynamic instability and splanchnic hypoperfusion leading to anastomotic leaks, delayed gastric emptying, and organ dysfunction Traditional markers (e.g., MAP, mixed venous oxygen saturation [SvO₂], lactate) are indirect, invasive and often delayed.
CO₂-derived variables (e.g., venous-to-arterial CO₂ gap [ΔCO₂], tissue CO₂ [PtCO₂], end-tidal CO₂ [EtCO₂] changes) provide earlier and more sensitive signs of microcirculatory dysfunction.
Whipple surgery is a complex abdominal procedure associated with a high risk of hemodynamic instability and splanchnic hypoperfusion leading to anastomotic leaks, delayed gastric emptying, and organ dysfunction Traditional markers (e.g., MAP, mixed venous oxygen saturation [SvO₂], lactate) are indirect, invasive and often delayed.
CO₂-derived variables (e.g., venous-to-arterial CO₂ gap [ΔCO₂], tissue CO₂ [PtCO₂], end-tidal CO₂ [EtCO₂] changes) provide earlier and more sensitive signs of microcirculatory dysfunction.
The present study investigate the hypothesis that simultaneous measurement of Venous-to-Arterial CO₂ Gap Indexed to Oxygen Content Difference (Pv-aCO₂/Ca-vO₂ Ratio & blood lactate may provide one or more early markers for post-operative adverse outcome in Whipple procedure
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Predictors of Postoperative outcome in Whipple Procedures | Other | Patients undergoing Whipple surgery monitored for CO₂-derived perfusion markers (Pv-aCO₂/Ca-vO₂ ratio) & Lactate as a traditional perfusion markers. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| predictors of postoperative outcome in Whipple Procedures | Other | CO₂-Derived Parameters & Lactate as Predictors of Postoperative outcome in Whipple Procedures and the occurrence of complications |
| Measure | Description | Time Frame |
|---|---|---|
| Venous-to-Arterial CO₂ Gap (Pv-aCO₂ = PvCO₂ - PaCO₂) | Measured via arterial and central venous blood gases sampling throughout the Whipple procedure | T0 baseline (After induction of anesthesia) T1 intraoperative (After major vessel dissection) T2 intraoperative (Immediately post-pancreatic resection) T3 intraoperative (After GIT anastomosis) T4 End of surgery T5 postoperative (2 hours) |
| Arterial-Venous oxygen content difference (Ca-vO₂ = CaO₂ - CvO₂) | Measured via arterial and central venous blood gases | T0 baseline (After induction of anesthesia) T1 intraoperative (After major vessel dissection) T2 intraoperative (Immediately post-pancreatic resection) T3 intraoperative (After GIT anastomosis) T4 End of surgery T5 postoperative (2 hours) in ICU |
| Veno-arterial CO2 Pressure Difference to Arterio-venous O2 Difference Ratio (Pv-aCO₂/Ca-vO₂ ratio ) | calculated by dividing the previous 2 measurements (Pv-aCO₂/Ca-vO₂ ) | T0 baseline (After induction of anesthesia) T1 intraoperative (After major vessel dissection) T2 intraoperative (Immediately post-pancreatic resection) T3 intraoperative (After GIT anastomosis) T4 End of surgery T5 postoperative (2 hours) in ICU |
| Measure | Description | Time Frame |
|---|---|---|
| Traditional Perfusion Markers :Lactate | Measured via arterial blood gases sampling | T0 baseline (After induction of anesthesia) T1 intraoperative (After major vessel dissection) T2 intraoperative (Immediately post-pancreatic resection) T3 intraoperative (After GIT anastomosis) T4 End of surgery T5 postoperative (2 hours) in ICU |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Alaa Anwar Abdelrahman, MD | Contact | 00201281218573 | A_Aly16@alexmed.edu.eg |
| Name | Affiliation | Role |
|---|---|---|
| Alaa Anwar Abdelrahman, Dr | University of Alexandria | Principal Investigator |
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| occurrence of Postoperative complications |
• Anastomotic leak rate (pancreaticojejunostomy, hepaticojejunostomy), Delayed gastric emptying (DGE), Postoperative pancreatic fistula (POPF), |
| within 3 days in ICU for complications, 30 days postoperatively for mortality |
| ICU length of stay | total ICU stay ( days) | postoperative 3 days |
| Occurrence of post-operative complications | 30-day mortality | postoperatively within 1 month |
| occurrence of Organ dysfunction (AKI) | Organ dysfunction (AKI), a patient is considered to have AKI postoperatively if any one of the following occurs: Increase in serum creatinine ≥ 0.3 mg/dL (≥ 26.5 µmol/L) within 48 hours, OR Increase in serum creatinine to ≥ 1.5 times baseline, OR Urine output < 0.5 mL/kg/hr for ≥ 6 hours. | postoperatively within 3 days in ICU |
| occurrence of postoperative complication as acute liver dysfunction | Postoperative liver dysfunction is defined as new impairment in liver function occurring after surgery, typically within the first 48-72 hours, manifested by one or more of the following: 1.Hyperbilirubinemia Total bilirubin > 2 mg/dL (34 µmol/L) OR a rise > 50% from baseline, 2.Elevated Liver Enzymes Increase in AST or ALT greater than 2-3 × upper limit of normal (ULN) Coagulopathy INR ≥ 1.5 | postoperatively within 3 days |