The role of central venous pressure and type of vascular control in blood loss during major liver resections

Smyrniotis, Vassilios; Kostopanagiotou, Georgia; Theodoraki, Kassiani; Tsantoulas, D.; Contis, John

doi:10.1016/j.amjsurg.2003.12.001

Cited by 176 publications

(122 citation statements)

References 15 publications

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“…Performance of surgical practice under low CVP is one of the strategies that have been studied intensively in liver surgery. [30][31][32][33] Although already suggested by Bismuth and colleagues, 33 Jones and colleagues 32 were the first to show that blood loss during liver resection is almost linearly related to the CVP. Low CVP (<5 mm Hg) can be achieved by applying volume contraction, by using vasodilating agents, or by stimulation of forced diuresis (see Box 1).…”

Section: Anesthesiologic Strategies To Reduce Blood Lossmentioning

confidence: 99%

“…It can be achieved by a restrictive use of fluid and blood products, avoidance of fluid overload, and no routine correction of abnormal coagulation tests by infusion of FFP or other large-volume blood products. 2,4,31 Although a low CVP is associated with reduced blood loss, it also carries a higher risk for complications such as air embolism, systemic tissue hypoperfusion, and renal failure. 2,30,34,35 Schroeder and colleagues 34 studied the safety of a fluid restriction policy and low CVP in liver transplant recipients by comparing outcome variables in two centers with different policies.…”

Section: Anesthesiologic Strategies To Reduce Blood Lossmentioning

confidence: 99%

See 1 more Smart Citation

Bleeding in Liver Surgery: Prevention and Treatment

Alkozai

Lisman

Porte

2009

Clinics in Liver Disease

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Section: Anesthesiologic Strategies To Reduce Blood Lossmentioning

confidence: 99%

Section: Anesthesiologic Strategies To Reduce Blood Lossmentioning

confidence: 99%

Bleeding in Liver Surgery: Prevention and Treatment

Alkozai

Lisman

Porte

2009

Clinics in Liver Disease

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“…Maintenance of low central venous pressure values (below 5 mm Hg) can reduce the bleeding to a mean of 200 mL; in contrast, if CVP values are over 5 mm Hg, blood loss can reach values of about 1000 mL. Smyrniotis et al [7], considered that CVP values over 5 mm Hg were associated with greater blood loss and longer hospital stays. Considering CVP values under 5 mm Hg, there were no differences in blood loss with respect to the methods used for vascular access.…”

Section: Discussionmentioning

confidence: 99%

“…Increased blood loss and transfusion requirements are related to increased perioperative morbidity and mortality [3][4][5][6][7][8]. However, CVP often does not identify the true value of blood volume, fluid changes, fluid responsiveness and cardiac preload; sometimes, there is no relation between low CVP values and blood loss during liver resection [9].…”

mentioning

confidence: 99%

Global end-diastolic volume could be more appropiate to reduce intraoperative bleeding than central venous pressure during major liver transection

Redondo

Padilla

Villazala

et al. 2017

Anaesthesiol Intensive Ther

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Background: Central venous pressure often fails to identify the true value of cardiac preload. Our purpose is to investigate whether Global End-Diastolic Volume (GEDV) values can control hemodynamic parameters for the measurement of fluid volume, cardiac preload and blood loss during liver transection. Methods: This was a prospective clinical study that included patients undergoing liver resection. All patients were monitored by means of PiCCO technology and 222 hemodynamic measurements were performed in 74 patients. Fluid restriction was used. Transpulmonary thermodilutions were performed at different times of surgery, namely: 1. at the beginning of surgery; 2. before hepatectomy and after selective vascular exclusion (Time 1); 3. approximately half way through the liver transection (Time 2); and 4. after liver resection (Time 3). Results: One hundred and twenty-nine of the 222 GEDV values were decreased (prevalence of hypovolemia of 58.1%). However, twenty two of the 222 CVP values were decreased (prevalence of 10.8%). Sensitivity of CVP with regard to volume depletion (GEDV > 650 mL m -2 ) on the times (1, 2 and 3) were ) and 21.43 (95% CI: 7.83-35.03), respectively. There was no correlation between CVP and GEDV. Conclusions: GEDV values may be more appropriate for monitoring cardiac preload during liver transection.

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“…Erken postoperatif dönemde hipovoleminin başlıca nedenleri; cerrahi kanama, hipoalbuminemiye sekonder onkotik basınç düşüklüğüne bağlı üçüncü boşluğa ve interstisyel alana sıvı kaçışı ve intraoperatif dönemde cerrahi kanamayı azaltmak için düşük SVB (≤5 mmHg) değerlerinin hedeflenip hastanın negatif sıvı dengesinde yoğun bakıma gelmesidir (27). Bu yüzden birçok olguda kristalloid ve gereğinde albumin solüsyonu veya kan ürünleri ile sıvı replasman tedavisi uygulanır.…”

Section: Sıvı Tedavisiunclassified

Critical Care Management after Adult Liver Transplantation

Akan¹

2017

tybdd

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1ÖZ Karaciğer transplantasyonu uygulanan hastaların yoğun bakım yönetimi çok yönlü bir izlemi ve multidisipliner bir yaklaşımı gerektirir. Günümüzde ideal bir yoğun bakım tedavisi için deneyimli bir ekibe ve gelişmiş yoğun bakım/hastane olanaklarına gereksinim vardır. Karaciğer transplantasyon olgularının postoperatif yoğun bakım yönetimi zaman içinde hızlı bir gelişme göstermiştir. Preoperatif optimizasyon, cerrahi teknik, intraoperatif anestezi yönetimi, organ prezervasyonu, yoğun bakım ve immünosüpresyon tedavilerindeki gelişmeler ile 1998'de %79 düzeyinde olan karaciğer transplantasyonu sonrası bir yıllık sağkalım 2008'de %90'a yükselmiştir. Karaciğer transplantasyonlu olguların yoğun bakım yönetiminde özellikle hızlı kardiyorespiratuvar stabilizasyon, ağır koagülopatinin düzeltilmesi, mekanik ventilasyondan erken ayırma, uygun sıvı-elektrolit tedavisi, böbrek fonksiyonlarının korunması, greft rejeksiyonun önlenmesi ve enfeksiyon profilaksisi/tedavisi büyük önem taşır. Erken postoperatif dönem çok hassas bir süreç olduğundan yakın monitörizasyon, kardiyorespiratuvar fonksiyonların stabilizasyonu, greft fonksiyonunun sık değerlendirilmesi, komplikasyonların erken tanınması ve ekstrahepatik organ yetersizliklerinin hızlı tedavisi mortalite/morbiditenin azaltılabilmesi için zorunludur. Anahtar Kelimeler: Karaciğer transplantasyonu, postoperatif dönem, yoğun bakım, karaciğer yetersizliği ABSTRACT Critical care management after liver transplantation requires a sophisticated monitoring and multi-disciplinary team work. An experienced team and advanced critical care/hospital facilities are necessary for an ideal critical care treatment today. Critical care management after liver transplantation has shown a rapid development since the introduction of liver transplantation. While one-year survival rate after liver transplantation was 79% in 1998, it raised to 90% in 2008 related to the improvements in preoperative optimization, surgical technique, anesthetic management, organ preservation, critial care and immunosuppressive treatment. Treatment of severe coagulopathy, prompt hemodynamic and respiratory stabilization, early weaning from mechanical ventilation, proper fluid-electrolyte therapy, prevention of graft rejection, protection of renal functions and prophylaxis/treatment of infection are particularly important in critical care management after liver transplantation. As early postoperative period of liver transplantation is a critical phase; close monitoring, stabilization of cardiopulmonary functions, frequent evaluation of graft function, early diagnosis of complications and rapid treatment of extrahepatic organ failure are mandatory in order to reduce mortality/morbidity.

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The role of central venous pressure and type of vascular control in blood loss during major liver resections

Cited by 176 publications

References 15 publications

Bleeding in Liver Surgery: Prevention and Treatment

Bleeding in Liver Surgery: Prevention and Treatment

Global end-diastolic volume could be more appropiate to reduce intraoperative bleeding than central venous pressure during major liver transection

Critical Care Management after Adult Liver Transplantation

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