Intention to control low central venous pressure reduced blood loss during laparoscopic hepatectomy: A double-blind randomized clinical trial

Surgery ◽  
2020 ◽  
Vol 167 (6) ◽  
pp. 933-941
Author(s):  
Yang-Xun Pan ◽  
Jun-Cheng Wang ◽  
Xiao-Yun Lu ◽  
Jin-Bin Chen ◽  
Wei He ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Blood Loss ◽  
Central Venous Pressure ◽  
Randomized Clinical Trial ◽  
Venous Pressure ◽  
Laparoscopic Hepatectomy ◽  
Central Venous ◽  
Double Blind ◽  
Low Central Venous Pressure

Controlled low central venous pressure and its effect on blood loss in hepatic resection

2005 ◽  
Vol 22 (Supplement 34) ◽  
pp. 80
Author(s):  
G. Droc ◽  
D. Tomescu ◽  
G. Musat ◽  
H. Popescu ◽  
D. Tulbure
Keyword(s):  
Blood Loss ◽  
Hepatic Resection ◽  
Central Venous Pressure ◽  
Venous Pressure ◽  
Central Venous ◽  
Low Central Venous Pressure

scholarly journals P-L03 The efficacy and safety of controlled low central venous pressure for liver resection: a systematic review and meta-analysis

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Zhong Chen ◽  
Dundong Sun ◽  
Feiran Wang
Keyword(s):  
Liver Resection ◽  
Blood Loss ◽  
Central Venous Pressure ◽  
Meta Analysis ◽  
Venous Pressure ◽  
Control Group ◽  
Significant Heterogeneity ◽  
Complication Rates ◽  
Central Venous ◽  
Low Central Venous Pressure

Abstract Background Partial hepatectomy is an effective treatment for benign and malignant liver diseases . However, intraoperative bleeding is one of the major factors affecting the outcome of hepatectomy. Currently, the most commonly used method of hepatic blood flow occlusion in clinical practice is Pringle method, but this method has a great impact on liver function and can cause hepatic ischemia-reperfusion injury. .Studies have shown that blood loss volume during hepatectomy is related to central venous pressure (CVP) . Intraoperative control of central venous pressure (LCVP) is increasingly popular in hepatectomy, but its effectiveness and safety remain controversial.  Methods The main result of the analysis was to reduce the blood loss and blood infusion. Secondary outcomes included operative time, fluid infusion, urine volume, ALT, TBIL, BUN, CR, postoperative complication rates and length of hospital stay. Statistical analysis was performed using RevMan 5.3 software (Cochrane Collaboration, Oxford, England). The results of all studies were measured by mean ± standard deviation. If there is significant heterogeneity between the results (P < 0.05), a random-effects model is used. A fixed-effect model was used when there was no significant heterogeneity (P > 0.05). Heterogeneity was assessed using the Cochrane χ2 text .  Results In total, 10 studies, involving 324 patients undergoing liver resection with controlled low central venous pressure, were identified. Meta-analysis showed that blood loss in the LCVP group was significantly less than that in the control group ( P = 0.0002). blood transfusion in the LCVP group was also significantly less than that in the control group(P = 0.0006). there was no difference between LCVP group and control group in operation time(P = 0.17), fluid infusion( P = 0.46), urinary volume(P = 0.38), ALT( P = 0.23), TBIL(P = 0.86), BUN(P = 0.67), CR(P =0.59), postoperative complication rates( P = 0.01) and hospital stay(P = 0.26).  Conclusions Compared with the control, controlled low central venous pressure showed comparable efficacy and safety for the treatment during liver resection.

scholarly journals Should Low Central Venous Pressure Be Maintained during Liver Transplantation?

2017 ◽  
Vol 11 (1) ◽  
pp. 17-28
Author(s):  
Jong Hae Kim
Keyword(s):  
Liver Transplantation ◽  
Blood Loss ◽  
Central Venous Pressure ◽  
Venous Pressure ◽  
Liver Graft ◽  
Intraoperative Blood Loss ◽  
Central Venous ◽  
Venous Outflow ◽  
Hepatic Venous Outflow ◽  
Low Central Venous Pressure

Low central venous pressure, which indirectly reflects free hepatic venous pressure, is maintained during hepatic resection surgery to reduce intraoperative blood loss by facilitating hepatic venous outflow. However, whether the low central venous pressure protocol established for non-transplant hepatobiliary surgery should be generalized to liver transplantation is controversial because patients with cirrhosis have decreased portal and hepatic venous blood flow and vulnerability to renal failure. However, consistent with observations from hepatic resection surgeries, lowering central venous pressure during the preanhepatic phase significantly reduces blood loss and transfusion volume. Conversely, inherent study limitations and different study designs have yielded different results in terms of renal dysfunction. Although hepatic venous outflow promoted by lowering blood volume seems to facilitate a liver graft to accommodate portal blood flow increased by portal hypertension-induced splanchnic vasodilatation, the association between low central venous pressure and reduced incidence of portal hyperperfusion injury has not been demonstrated. Stroke volume variation predicts fluid responsiveness better than central venous pressure, but it has not been associated with a greater clinical benefit than central venous pressure to date. Therefore, the safety of maintaining low central venous pressure during liver transplantation has not been verified, and further randomized controlled studies are warranted to establish a fluid management protocol for each phase of liver transplantation to reduce intraoperative blood loss and transfusion rate, thereby maintaining liver graft viability. In conclusion, low central venous pressure reduces intraoperative blood loss but does not guarantee renoprotection or graft protection.

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