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.
Adults (>18 years) undergoing open Whipple procedure under general anesthesia
Invasive monitoring (arterial line and central venous catheter)
Informed written consent
Emergency surgery.
Preoperative septic shock or hemodynamic instability.
severe pre-existing **cardiopulmonary disease (e.g., severe COPD, heart failure).
Single group
predictors of postoperative outcome in Whipple Procedures
Other interventionCO₂-Derived Parameters \& Lactate as Predictors of Postoperative outcome in Whipple Procedures and the occurrence of complications
Venous-to-Arterial CO₂ Gap (Pv-aCO₂ = PvCO₂ - PaCO₂)
Measured via arterial and central venous blood gases sampling throughout the Whipple procedure
Arterial-Venous oxygen content difference (Ca-vO₂ = CaO₂ - CvO₂)
Measured via arterial and central venous blood gases
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 )
Traditional Perfusion Markers :Lactate
Measured via arterial blood gases sampling
occurrence of Postoperative complications
• Anastomotic leak rate (pancreaticojejunostomy, hepaticojejunostomy), Delayed gastric emptying (DGE), Postoperative pancreatic fistula (POPF),
ICU length of stay
total ICU stay ( days)
Occurrence of post-operative complications
30-day mortality
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