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

Blood loss during liver resection constitutes the primary determinant of the postoperative outcome. Various techniques of vascular control and maintenance of a low central vein pressure (CVP) have been used in order to prevent intraoperative blood loss and postoperative complications. Our study aims...

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Bibliographic Details
Published in:The American journal of surgery 2004-03, Vol.187 (3), p.398-402
Main Authors: Smyrniotis, Vassilios, Kostopanagiotou, Georgia, Theodoraki, Kassiani, Tsantoulas, Dimitrios, Contis, John C
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Biological and medical sciences
Blood
Blood loss
Blood Loss, Surgical - prevention & control
Blood transfusions
Catheters
Central Venous Pressure - physiology
Chi-Square Distribution
Child
Cohort Studies
Embolisms
Female
Follow-Up Studies
General aspects
Hemorrhage
Hemostasis, Surgical - methods
Hepatectomy
Hepatectomy - adverse effects
Hepatectomy - methods
Humans
Liver
Liver Diseases - mortality
Liver Diseases - pathology
Liver Diseases - surgery
Liver surgery
Male
Medical imaging
Medical sciences
Middle Aged
Monitoring, Intraoperative - methods
Mortality
NMR
Nuclear magnetic resonance
Outcome
Postoperative Hemorrhage - epidemiology
Postoperative Hemorrhage - prevention & control
Postoperative period
Probability
Retrospective Studies
Risk Assessment
Statistics, Nonparametric
Treatment Outcome
Vascular exclusion of liver
Veins & arteries
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Summary:Blood loss during liver resection constitutes the primary determinant of the postoperative outcome. Various techniques of vascular control and maintenance of a low central vein pressure (CVP) have been used in order to prevent intraoperative blood loss and postoperative complications. Our study aims at assessing the effects of different levels of CVP in relation to type of vascular control on perioperative blood loss and patient outcome. The records of 102 consecutive patients who underwent a major hepatectomy were retrospectively analyzed. Forty-two patients were operated on with a CVP of 6 mm Hg or more and 60 patients had a CVP of 5 mm Hg or less. The Pringle maneuver was used in 45 patients and selective hepatic vascular exclusion (SHVE) in 57 patients. Blood loss, complications, and mortality were analyzed comparing the two CVP groups in relation to type of vascular control. The Pringle maneuver is associated with more blood loss when CVP is 6 mm Hg or more compared with CVP 5 mm Hg or less (1,250 mL [250 to 2,850] versus 780 mL [150 to 3,100]; P
ISSN:0002-9610
1879-1883
DOI:10.1016/j.amjsurg.2003.12.001