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Responsiveness of stroke volume variation and central venous pressure during acute normovolemic and hypervolemic hemodilution

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Chinese Medical Journal 2013年第10期126卷 1838-1843页

作者： JI Fu-hai LI Wen-jing LI Jiang PENG Ke YANG Jian-ping LIU Hong Department of Anesthesiology First Affiliated Hospital of SoochowUniversity Suzhou Jiangsu 215006 China Department of Anesthesiology and Pain Medicine University ofCaiifomia Davis Health System USA

Background Stroke volume variation （SW） is a robust indicator of fluid responsiveness during volume change. We compared the sensibility of SW by Vigileo/Flotrac to central venous pressure （CVP） when volume changes in patients undergoing intraoperative acute normovolemic hemodilution （ANH） and acute hypervolemic hemodilution （AHH）. Methods Forty patients were randomly divided into an ANH group （n=20） and an AHH group （n=20）. All patients received general anesthesia and were mechanically ventilated. Data were collected from 7 different time-points in the ANH group： baseline, after withdrawal of 5%, 10%, and 15% of the estimated blood volume （EBV） and after replacement with an equal volume of 6% hydroxyethyl starch 130/0.4 （HES） in 5% EBV increments to baseline. There were four time points in the AHH group： baseline, after 5%, 10%, and 15% expansion of the EBV with 6% HES. At each time-point, CVP, SW and other hemodynamic parameters measurements were obtained. Results After removal of 10% and 15% EBV, SVV significantly increased from 10.9±3.0 to 14.1±3.4 and 10.9±3.0 to16.0±3.3 （P 〈0.01）, and returned to a final value of 10.6±3.4 after volume replacement. The CVP value was unchanged after removal and replacement of 15% of the EBV. There were no significant changes in SW after 5%, 10% whereas there was a significant reduction after 15% （8.2±1.7） expansion of the EBV compared with baseline （9.9±1.8）（P=0.033）. However, there was a significant increase in CVP after10% （10.3±2.4）, 15% （11.3±2.2） expansion of the EBV compared with baseline （8.2±2.7）（P 〈0.01）. Conclusion SW is a more sensitive parameter for volume than CVP during hypovolemia, on the contrary CVP is more sensitive than SW during hypervolemia.

关键词： hemodilution stroke volume variation central venous pressure

Low central venous pressure reduces blood loss in hepatectomy

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World Journal of Gastroenterology 2006年第6期12卷 935-939页

作者： Wei-Dong Wang Li-Jian Liang Xiong-Qing Huang Xiao-Yu Yin Department of General Surgery The FirstPeople's Hospital of Shun De Fuoshan 528300 GuangdongProvince China Department of Hepatobiliary Surgery The First Affiliated Hospital Sun Yat-Sen University Guangzhou510080 Guangdong Province China Department of Anaesthesia The FirstAffiliated Hospital Sun Yat-Sen University Guangzhou 510080Guangdong Province China

AIM： To investigate the effect of low central venous pressure （LCVP） on blood loss during hepatectomy for hepatocellular carcinoma （HCC）. METHODS： By the method of sealed envelope, 50 HCC patients were randomized into LCVP group （n=25） and control group （n=25）. In LCVP group, CVP was maintained at 2-4 mmHg and systolic blood pressure （SBP） above 90 mmHg by manipulation of the patient＇s posture and administration of drugs during hepatectomy, while in control group hepatectomy was performed routinely without lowering CVP. The patients＇ preoperative conditions, volume of blood loss during hepatectomy, volume of blood transfusion, length of hospital stay, changes in hepatic and renal functions were compared between the two groups. RESULTS： There were no significant differences in patients＇ preoperative conditions, maximal tumor dimension, pattern of hepatectomy, duration of vascular occlusion, operation time, weight of resected liver tissues, incidence of post-operative complications, hepatic and renal functions between the two groups. LCVP group had a markedly lower volume of total intraoperative blood loss and blood loss during hepatectomy than the control group, being 903.9 ± 180.8 mL vs 2 329.4 ±2 538.4 （W=495.5, P〈0.01） and 672.4±429.9 mL vs 1 662.6±1 932.1 （W=543.5, P〈0.01）. There were no remarkable differences in the pre-resection and post-resection blood losses between the two groups. The length of hospital stay was significantly shortened in LCVP group as compared with the control group, being 16.3±6.8 d vs 21.5 ± 8.6 d （W= 532.5, P〈0.05）.CONCLUSION： LCVP is easily achievable in technique. Maintenance of CVP ≤4 mmHg can help reduce blood loss during hepatectomy, shorten the length of hospital stay, and has no detrimental effects on hepatic or renal function.

关键词： Hepatectomy Hepatocellular carcinoma central venous pressure Blood loss

Association of different central venous pressure levels with outcome of living-donor liver transplantation in children under 12 years

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World Journal of Pediatrics 2023年第2期19卷 170-179页

作者： Yi-Chen Fan Xiao-Qiang Wang Dan-Yan Zhu Xiao-Rong Huai Wei-Feng Yu Dian-San Su Zhi-Ying Pan Department of Anesthesiology Shanghai Jiaotong University School of Medicine Affiliated Renji HospitalNo.160 Pujian RoadPudong New DistrictShanghai200127China Nursing Department Shanghai Jiaotong University School of Medicine Affiliated Renji HospitalNo.160 Pujian RoadShanghaiChina

Background Pediatric liver transplantation is an important modality for treating biliary *** overall survival(OS)rate of pediatric liver transplantation has significantly improved compared with that of 20 years ago,but it is still *** anesthesia strategy of maintaining low central venous pressure(CVP)has shown a positive effect on prognosis in adult liver ***,this relationship remains unclear in pediatric liver ***,this study was conducted to review the data of pediatric living-donor liver transplantation to analyze the associations of different CVP levels with the prognosis of *** This was a retrospective study and the patients were divided into two groups according to CVP levels after abdominal closure:low CVP(LCVP)(≤10 cmH2O,n=470)and high CVP(HCVP)(>10 cmH2O,n=242).The primary outcome measured in the study was the overall survival *** secondary outcomes included the duration of mechanical ventilation in the intensive care unit(ICU),length of stay in the ICU,and postoperative stay in the *** demographic and perioperative data were collected and compared between the two ***-Meier curves were constructed to determine the associations of different CVP levels with the survival *** In the study,712 patients,including 470 in the LCVP group and 242 in the HCVP group,were *** propensity score matching,212 pairs remained in the *** LCVP group showed a higher overall survival rate than the HCVP group in the Kaplan-Meier curves and multivariate Cox regression analyses(P=0.018),and the HCVP group had a hazard ratio of 2.445(95%confidence interval,1.163–5.140).Conclusion This study confirmed that a low-CVP level at the end of surgery is associated with improved overall survival and a shorter length of hospital stay.

关键词： central venous pressure General anesthesia Overall survival rate Pediatric living-donor liver transplantation Prognosis

Effect of autologous blood donation on the central venous pressure, blood loss and blood transfusion during living donor left hepatectomy

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World Journal of Gastroenterology 2005年第27期11卷 4233-4236页

作者： Bruno Jawan Yu-Fan Cheng Chia-Chi Tseng Yaw-Sen Chen Chih-Chi Wang Tung-Liang Huang Hock-Liew Eng Po-Ping Liu King-Wah Chiu Shih-Hor Wang Chih-Che Lin Tsan-Shiun Lin Yueh-Wei Liu Chao-Long Chen Department of Anesthesiology Chang Gung Memorial Hospital Kaohsiung Medical Center TaiwanChina Liver Transplantation Program Chang Gung Memorial Hospital Kaohsiung Medical Center Taiwan China

AIM： Autologous blood donation （ABD） is mainly used to reduce the use of banked blood. In fact, ABD can be regarded as acute blood loss. Would ABD 2-3 d before operation affect the CVP level and subsequently result in less blood loss during liver resection was to be ***： Eighty-four patients undergoing living donor left hepatectomy were retrospectively divided as group Ⅰ （GⅠ） and group Ⅱ （GⅡ） according to have donated 250-300 mL blood 2-3 d before living donor hepatectomy or not. The changes of the intraoperative CVP, surgical blood loss,blood products used and the changes of perioperative hemoglobin （Hb） between groups were analyzed and compared by using Mann-Whitney ***： The results show that the intraoperative CVP changes between GⅠ （n = 35） and GⅡ （n = 49） up to graft procurement were the same, subsequently the blood loss,but ABD resulted in significantly lower perioperative Hb levels in ***： Since none of the patients required any blood products perioperatively, all the predonated bloods were discarded after the patients were discharged from the hospital. It indicates that ABD in current series had no any beneficial effects, in term of cost, lowering the CVP, blood loss and reduce the use of banked blood products, but resulted in significant lower Hb in perioperative period.

关键词： Blood Transfusion, Autologous central venous pressure Hepatectomy Liver Transplantation Living Donors Adult Blood Loss, Surgical control Female Humans Intraoperative Care Male Retrospective Studies

Optimal central venous pressure during partial hepatectomy for hepatocellular carcinoma

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Hepatobiliary & Pancreatic Diseases International 2013年第5期12卷 520-524页

作者： Cheng-Xin Lin Ya Guo Wan Yee Lau Guang-Ying Zhang Yi-Ting Huang Wen-Zheng He Eric CH Lai Department of Anesthesiology First Affiliated Hospital of Guangxi Medical University Department of Hepatic and Biliary Surgery First Affiliated Hospital of Guangxi Medical University Faculty of Medicine The Chinese University of Hong Kong

BACKGROUND:Low central venous pressure(CVP) affects hemodynamic stability and tissue *** prospective study aimed to evaluate the optimal CVP during partial hepatectomy for hepatocellular carcinoma(HCC).METHODS:Ninety-seven patients who underwent partial hepatectomy for HCC had their CVP controlled at a level of 0 to 5 mmHg during hepatic parenchymal *** systolic blood pressure(SBP) was maintained,if possible,at 90 mmHg or *** B surface antigen was positive in 90 patients(92.8%) and cirrhosis in 84 patients(86.6%).Pringle maneuver was used routinely in these patients with clamp/unclamp cycles of 15/5 *** average clamp time was 21.4±8.0 *** patients were divided into 5 groups based on the CVP:group A:0-1 mmHg;B:1.1-2 mmHg;C:2.1-3 mmHg;D:3.1-4 mmHg and E:4.1-5 *** blood loss per transection area during hepatic parenchymal transection and the arterial blood gas before and after liver transection were ***:With active fluid load,a constant SBP ≥90 mmHg which was considered as optimal was maintained in 18.6% in group A(95% CI:10.8%-26.3%);39.2% in group B(95% CI:29.5%-48.9%);72.2% in group C(95% CI:63.2%-81.1%);89.7% in group D(95% CI:83.6%-95.7%);and 100% in group E(95% CI:100%-100%).The blood loss per transection area during hepatic parenchymal transection decreased with a decrease in *** to groups D and E,blood loss in groups A,B and C was significantly less(analysis of variance test,P<0.05).Compared with the baseline,the blood oxygenation decreased significantly when the CVP was *** excess and HCO 3-in groups A and B were significantly decreased compared with those in groups C,D and E(P<0.05).CONCLUSION:In consideration of blood loss,SBP,base excess and HCO 3-,a CVP of 2.1-3 mmHg was optimal in patients undergoing partial hepatectomy for HCC.

关键词： central venous pressure hepatectomy blood loss

Optimization of central venous pressure during the perioperative period is associated with improved prognosis of high-risk operation patients

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Journal of Intensive Medicine 2023年第2期3卷 165-170页

作者： Jiafang Wu Jun Li Han Chen Xiuling Shang Rongguo Yu The Third Department of Critical Care Medicine Shengli Clinical Medical College of Fujian Medical UniversityFujian Provincial HospitalFujian Provincial Center for Critical Care MedicineFujian Provincial Key Laboratory of Critical Care MedicineFuzhouFujian 350001China

Background:While central venous pressure(CVP)measurement is used to guide fluid management for high-risk surgical patients during the perioperative period,its relationship to patient prognosis is ***:This single-center,retrospective observational study enrolled patients undergoing high-risk surgery from February 1,2014 to November 31,2020,who were admitted to the surgical intensive care unit(ICU)directly after *** were divided into the following three groups according to the first CVP measurement(CVP1)after admission to the ICU:low,CVP112 *** fluid balance,28-day mortality,length of stay in the ICU,and hospitalization and surgical complications were compared across ***:Of the 775 high-risk surgical patients enrolled in the study,228 were included in the ***(interquartile range)positive fluid balance during surgery was lowest in the low CVP1 group and highest in the high CVP1 group(low CVP1:770[410,1205]mL;moderate CVP1:1070[685,1500]mL;high CVP1:1570[1008,2000]mL;all Ppressure of oxygen(PaO 2)/fraction of inspired oxygen(FiO 2)ratio was significantly lower in the high CVP1 group than in the low and moderate CVP1 groups(low CVP1:400.0[299.5,443.3]mmHg;moderate CVP1:362.5[330.0,434.9]mmHg;high CVP1:335.3[254.0,363.5]mmHg;all P12 mmHg were risk factors for AKI within 72 h after surgery(adjusted odds ratio[aOR]=3.875,95%confidence inter

关键词： Perioperative central venous pressure Fluid management Acute renal injury

Accuracy of Mean Value of central venous pressure from Monitor Digital Display: Influence of Amplitude of central venous pressure during Respiration

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Chinese Medical Sciences Journal 2023年第2期38卷 117-124页

作者： Meng-Ru Xu Wang-Lin Liu Huai-Wu He Xiao-Li Lai Mei-Ling Zhao Da-Wei Liu Yun Long Department of Critical Care Medicine State Key Laboratory of Complex Severe and Rare DiseasesPeking Union Medical HospitalPeking Union Medical College&Chinese Academy of Medical SciencesBeijing 100730China Department of Critical Care Medicine Beihai People's HosptialBeihai 536000Guangxi Zhuang Autonomous RegionChina Department of Critical Care Medicine Zibo Central HospitalMedical College of Shandong UniversityZibo 255020Shandong ProvinceChina

Background A simple measurement of central venous pressure(CVP)-mean by the digital monitor display has become increasingly ***,the agreement between CVP-mean and CVP-end(a standard method of CVP measurement by analyzing the waveform at end-expiration)is not well *** study was designed to identify the relationship between CVP-mean and CVP-end in critically ill patients and to introduce a new parameter of CVP amplitude(ΔCVP=CVPmax-CVPmin)during the respiratory period to identify the agreement/disagreement between CVP-mean and *** In total,291 patients were included in the ***-mean and CVP-end were obtained simultaneously from each *** measurement difference(|CVP-mean-CVP-end|)was defined as the difference between CVP-mean and ***ΔCVP was calculated as the difference between the peak(CVPmax)and the nadir value(CVPmin)during the respiratory cycle,which was automatically recorded on the monitor *** with|CVP-mean-CVP-end|≥2 mm Hg were divided into the inconsistent group,while subjects with|CVP-mean-CVP-end|2 mm Hg were divided into the consistent ***ΔCVP was significantly higher in the inconsistent group[7.17(2.77)vs.5.24(2.18),P0.001]than that in the consistent *** was a significantly positive relationship betweenΔCVP and|CVP-mean-CVP-end|(r=0.283,P 0.0001).Bland-Altman plot showed the bias was-0.61 mm Hg with a wide 95%limit of agreement(-3.34,2.10)of CVP-end and *** area under the receiver operating characteristic curves(AUC)ofΔCVP for predicting|CVP-mean-CVP-end|≥2 mm Hg was *** a high diagnostic specificity,usingΔCVP3 to detect|CVP-mean-CVP-end|lower than 2mm Hg(consistent measurement)resulted in a sensitivity of 22.37%and a specificity of 93.06%.UsingΔCVP8 to detect|CVP-mean-CVPend|8 mm Hg(inconsistent measurement)resulted in a sensitivity of 31.94%and a specificity of 91.32%.Conclusions CVP-end and CVP-mean have statistical discrepancies in specific clinical sce

关键词： central venous pressure monitor digital display monitor cursor-line display respiration

Correlation between Glasgow Coma Scale with central venous pressure and near-infrared spectroscopy in patients with acquired brain injury in the intensive care unit of Adam Malik Hospital Medan

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Emergency and Critical Care Medicine 2023年第1期3卷 12-17页

作者： Galdy Wafie Akhyar H.Nasution Bastian Lubis Department of Anesthesiology and Intensive Therapy Faculty of Medicine Universitas Sumatera Utara Adam Malik Hospital Medan Medan Indonesia

Background:Acquired brain injury(ABI)is caused by trauma or nontrauma to the brain after *** intracranial pressure in patients with traumatic or nontraumatic brain injury affects the cerebral perfusion *** traumatic brain injury,there is an increase in air content in the brain and an increase in volume of blood flow to the brain,which can cause increased intracranial pressure,herniation of brain tissue,impaired cerebral perfusion,and brain *** patients with traumatic brain injury die from uncontrolled increases in intracranial ***-infrared spectroscopy(NIRS)and central venous pressure(CVP)monitoring are also associated with cerebral *** study aimed to determine the relationship between the Glasgow Coma Scale(GCS)scores and CVP and NIRS values in patients with ***:This prospective analytical study used a cross-sectional design to compareGCS scores with CVP and NIRS values in patients with traumatic and nontraumatic brain injury in the intensive care unit(ICU)of Haji Adam Malik Hospital ***,CVP,and NIRS descriptive data in patients with brain injury were presented in terms of mean and standard deviation if the data were normally distributed,or median(interquartile range)values if the data were not normally *** relationship between GCS scores and CVP and NIRS values was assessed using the Pearson correlation test if the data were normally distributed,or the Spearman test if the data were not normally ***:In this study,the mean GCS score and CVP values were 7.04±2.69 and 5.63±25.82 mmHg,*** right tissue oxygen saturation(StO2)was 55.61%±18.72%,and the left StO2 was 57.57%±17.48%with normally distributed *** was no correlation between GCS scores and CVP values(P=0.829),and no correlation between moderate GCS scores and right and left StO2(P=0.343;P=0.121);however,there was a significantly strong positive correlation between severe GCS scores and right and lef

关键词： Acquired brain injury central venous pressure Glasgow Coma Scale Near-infrared spectroscopy

Influence of tissue pressure on central venous pressure/peripheral venous pressure correlation： An experimental report

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World Journal of Emergency Medicine 2011年第2期2卷 93-98页

作者： Martyn G Harvey Grant Cave Department of Emergency Medicine Waikato Hospital Hamilton New Zealand USA

BACKGROUND： Peripheral venous pressure （PVP） has been shown to correlate with central venous pressure （CVP） in a number of reports. Few studies, however, have explored the relationship between tissue pressure （TP） and PVP/CVP correlation. METHODS： PVP and CVP were simultaneously recorded in a bench-top model of the venous circulation of the upper limb and in a single human volunteer after undergoing graded manipulation of tissue pressure surrounding the intervening venous conduit. Measures of correlation were determined below and above a point wherein absolute CVP exceeded TP. RESULTS： Greater correlation was observed between PVP and CVP when CVP exceeded TP in both models. Linear regression slope was 0.975 （95% CI： 0.959-0.990）; r2 0.998 above tissue pressure 10 cmH20 vs. 0.393 （95% CI： 0.360-0.426）; and r2 0.972 below 10 cmH2O at a flow rate of 2000 mL/h in the in vitro model. Linear regression slope was 0.839 （95% CI： 0.754-0.925）; r2 0.933 above tissue pressure 10 mmHg vs. slope 0.238 （95% CI： -0.052-0.528）; and r20.276 in the en vivo model. CONCLUSIONS： PVP more accurately reflects CVP when absolute CVP values exceed tissue pressure.

关键词： Peripheral venous pressure central venous pressure Tissue pressure