Early Determinants of Death Due to Multiple Organ Failure After Noncardiac Surgery in High-Risk Patients

Lobo, Suzana Margareth; Rezende, Ederlon; Knibel, Marcos Freitas; Silva, Nilton B.; Páramo, José A.; Nácul, Flávio E.; Mendes, Ciro Leite; Assunção, Murilo; Costa, RC; Grion, Cíntia C.; Pinto, Sérgio F.; Mello, Patrícia Machado Veiga de Carvalho; Maia, Marcelo O.; Duarte, Péricles Almeida Delfino; Gutiérrez, Fernando; Silva, João M.; Lopes, Marcel Rezende; Cordeiro, José Antônio; Mellot, Charles

doi:10.1097/01.sa.0000412382.92989.55

Cited by 14 publications

(22 citation statements)

References 2 publications

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“…Patients are at higher risk of mortality if hypovolemia is inadequately resuscitated [4]. The association between elevated CVP and increased mortality has been found by numerous studies [14][15][16][17][18][19]. Besides, since CVP serves as the backpressure of venous return, upstream capillary pressures must be even higher in the setting of increased CVP to maintain an intact venous return.…”

Section: Discussionmentioning

confidence: 99%

Association Between Early Central Venous Pressure Measurement and Mortality in Patients With Sepsis: A Retrospective Study

Chen¹,

Gong²,

Shang³

et al. 2020

Preprint

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Background: It remains controversial to abandon central venous pressure (CVP) in the monitoring of fluid resuscitation in sepsis patients. We hypothesized that early CVP measurement was associated with decreased mortality in critically ill patients with sepsis. Methods: Critically ill patients with sepsis were identified from the Medical Information Mart for Intensive Care (MIMIC)-III database. Patients were divided into two groups base on whether or not they had a CVP measurement within the first 6 hours of ICU stay. The primary endpoint was 28-day mortality. Patients were further divided into four subgroups base on the time when the first CVP measurement was obtained: within 3 hours, between 3 and 6 hours, between 6 and 12 hours, and not measured within 12 hours. Kaplan-Meier survival analysis and Cox regression model were used for univariate and multivariate analyses of survival, respectively.RESULTS: A total of 4733 sepsis patients were included. The 28-day mortality was significantly lower in the CVP measured group than in the control group (34.2 vs. 40.7, p < 0.001). A “U”-shaped relationship between initial CVP and mortality was identified. With patients without CVP measured within 12 hours serving as the reference subgroup, timely CVP measurement was associated with decreased 28-day mortality before and after adjusting for confounding variables.CONCLUSIONS: Early CVP measurement is associated with decreased 28-day mortality in patients with sepsis. CVP should be considered as a valuable and easily accessible safety parameter during (early) fluid resuscitation.

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Section: Discussionmentioning

confidence: 99%

Association Between Early Central Venous Pressure Measurement and Mortality in Patients With Sepsis: A Retrospective Study

Chen¹,

Gong²,

Shang³

et al. 2020

Preprint

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show abstract

“…After application of the inclusion criteria, 15 studies were included in the meta-analysis ( Fig. 1) [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20].…”

Section: Study Selectionmentioning

confidence: 99%

“…So far, previous studies have evaluated the association of CVP and mortality and AKI in critically ill patients but have shown inconsistent results [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Thus, we performed a meta-analysis to investigate the association of elevated CVP and mortality and AKI in critically ill adult patients, hypothesizing that elevated CVP is associated with increased mortality and acute kidney injury in critically ill adult patients.…”

Section: Introductionmentioning

confidence: 99%

Elevated central venous pressure is associated with increased mortality and acute kidney injury in critically ill patients: a meta-analysis

Chen¹,

Zhou²,

Wang³

et al. 2020

Crit Care

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Background: The association of central venous pressure (CVP) and mortality and acute kidney injury (AKI) in critically ill adult patients remains unclear. We performed a meta-analysis to determine whether elevated CVP is associated with increased mortality and AKI in critically ill adult patients. Methods: We searched PubMed and Embase through June 2019 to identify studies that investigated the association between CVP and mortality and/or AKI in critically ill adult patients admitted into the intensive care unit. We calculated the summary odds ratio (OR) and 95% CI using a random-effects model. Results: Fifteen cohort studies with a broad spectrum of critically ill patients (mainly sepsis) were included. On a dichotomous scale, elevated CVP was associated with an increased risk of mortality (3 studies; 969 participants; OR, 1.65; 95% CI, 1.19-2.29) and AKI (2 studies; 689 participants; OR, 2.09; 95% CI, 1.39-3.14). On a continuous scale, higher CVP was associated with greater risk of mortality (5 studies; 7837 participants; OR, 1.10; 95% CI, 1.03-1.17) and AKI (6 studies; 5446 participants; OR, 1.14; 95% CI, 1.06-1.23). Furthermore, per 1 mmHg increase in CVP increased the odds of AKI by 6% (4 studies; 5150 participants; OR, 1.06; 95% CI, 1.01-1.12). Further analyses restricted to patients with sepsis showed consistent results. Conclusions: Elevated CVP is associated with an increased risk of mortality and AKI in critically ill adult patients admitted into the intensive care unit.

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“…However, despite the unique details of each and every surgical procedure, the final common pathway in many perioperative organ insults is tissue dysoxia or an imbalance between oxygen supply and demand. 1 As such, an important way in which the authors are able to reduce perioperative risk and improve outcomes is through ensuring optimal end-organ perfusion during surgery.…”

Section: Defining Perioperative Gdtmentioning

confidence: 99%

Perioperative Goal-Directed Therapy

Waldron

Miller

Gan

2014

Journal of Cardiothoracic and Vascular Anesthesia

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Early Determinants of Death Due to Multiple Organ Failure After Noncardiac Surgery in High-Risk Patients

Cited by 14 publications

References 2 publications

Association Between Early Central Venous Pressure Measurement and Mortality in Patients With Sepsis: A Retrospective Study

Association Between Early Central Venous Pressure Measurement and Mortality in Patients With Sepsis: A Retrospective Study

Elevated central venous pressure is associated with increased mortality and acute kidney injury in critically ill patients: a meta-analysis

Perioperative Goal-Directed Therapy

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