Central Venous Pressure Drop After Hypovolemic Phlebotomy is a Strong Independent Predictor of Intraoperative Blood Loss During Liver Resection

Background Intraoperative hypovolemic phlebotomy (HP) has been suggested to reduce central venous pressure (CVP) before hepatectomy. This study aimed to analyze the impact of CVP drop after HP on intraoperative blood loss and postoperative renal function. Methods A retrospective review of a prospect...

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Vydáno v:Annals of surgical oncology Ročník 24; číslo 5; s. 1367 - 1375
Hlavní autoři: Ryckx, Andries, Christiaens, Claudine, Clarysse, Mathias, Vansteenkiste, Franky, Steelant, Pieter Jan, Sergeant, Gregory, Parmentier, Isabelle, Pottel, Hans, D’Hondt, Mathieu
Médium: Journal Article
Jazyk:angličtina
Vydáno: Cham Springer International Publishing 01.05.2017
Springer Nature B.V
Témata:
Adult
Aged
Aged, 80 and over
Blood Loss, Surgical - physiopathology
Blood Volume
Central Venous Pressure
Creatinine - blood
Female
Hepatectomy - adverse effects
Hepatobiliary Tumors
Humans
Hypovolemia - physiopathology
Hypovolemia - surgery
Kidney Function Tests
Male
Medicine
Medicine & Public Health
Middle Aged
Oncology
Phlebotomy - methods
Postoperative Period
Preoperative Period
Retrospective Studies
Surgery
Surgical Oncology
Young Adult
Estimate Blood Loss
Liver Resection
Hepatic Vein
Mean Arterial Pressure
Central Venous Pressure
ISSN:1068-9265, 1534-4681, 1534-4681
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Shrnutí:Background Intraoperative hypovolemic phlebotomy (HP) has been suggested to reduce central venous pressure (CVP) before hepatectomy. This study aimed to analyze the impact of CVP drop after HP on intraoperative blood loss and postoperative renal function. Methods A retrospective review of a prospective database including 100 consecutive patients (43 males and 57 females; mean age, 65 years; range 23–89 years) undergoing liver resection with HP was performed. The primary outcome variable was estimated blood loss (EBL), and the secondary outcome was postoperative serum creatinin (Scr). A multivariate linear regression analysis was performed to identify predictors of intraoperative blood loss. Results The median CVP before blood salvage was 8 mmHg (range 4–30 mmHg). The median volume of hypovolemic phlebotomy was 400 ml (range 200–1000 ml). After HP, CVP decreased to a median of 3 mmHg (range –2 to 16 mmHg), resulting in a median CVP drop of 5.5 mmHg (range 2–14 mmHg). The median EBL during liver resection was 165 ml (range 0–800 ml). The median preoperative serum creatinin (Scr) was 0.82 g/dl (range 0.5–1.74 g/dl), and the postoperative Scr on day 1 was 0.74 g/dl (range 0.44–1.68 g/dl). The CVP drop was associated with EBL ( P  < 0.001). There was no significant impact of CVP drop on postoperative Scr. Conclusion A CVP drop after HP is a strong independent predictor of EBL during liver resection. The authors advocate the routine use of HP to reduce perioperative blood loss and transfusion rates in liver surgery. As a predictive tool, CVP drop might help surgeons decide whether a laparoscopic approach is safe.
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ISSN:1068-9265
1534-4681
1534-4681
DOI:10.1245/s10434-016-5737-7