scholarly journals High Central Venous Pressure after Cardiac Surgery Might Depict Hemodynamic Deterioration Associated with Increased Morbidity and Mortality

2021 ◽  
Vol 10 (17) ◽  
pp. 3945
Author(s):  
Fridtjof Schiefenhövel ◽  
Ralf F. Trauzeddel ◽  
Michael Sander ◽  
Matthias Heringlake ◽  
Heinrich V. Groesdonk ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Central Venous Pressure ◽  
Venous Pressure ◽  
Kidney Injury ◽  
Morbidity And Mortality ◽  
Central Venous ◽  
Icu Mortality ◽  
Roc Curve Analysis ◽  
Hemodynamic Deterioration ◽  
The Impact

Background: Cardiac surgery patients represent a high-risk cohort in intensive care units (ICUs). Central venous pressure (CVP) measurement seems to remain an integral part in hemodynamic monitoring, especially in cardio-surgical ICUs. However, its value as a prognostic marker for organ failure is still unclear. Therefore, we analyzed postoperative CVP values after adult cardiac surgery in a large cohort with regard to its prognostic value for morbidity and mortality. Methods: All adult patients admitted to our ICUs between 2006 and 2019 after cardiac surgery were eligible for inclusion in the study (n = 11,198). We calculated the median initial CVP (miCVP) after admission to the ICU, which returned valid values for 9802 patients. An ROC curve analysis for optimal cut-off miCVP to predict ICU mortality was conducted with consecutive patient allocation into a (a) low miCVP (LCVP) group (≤11 mmHg) and (b) high miCVP (HCVP) group (>11 mmHg). We analyzed the impact of high miCVP on morbidity and mortality by propensity score matching (PSM) and logistic regression. Results: ICU mortality was increased in HCVP patients. In addition, patients in the HCVP group required longer mechanical ventilation, had a higher incidence of acute kidney injury, were more frequently treated with renal replacement therapy, and showed a higher risk for postoperative liver dysfunction, parametrized by a postoperative rise of ≥ 10 in MELD Score. Multiple regression analysis confirmed HCVP has an effect on postoperative ICU-mortality and intrahospital mortality, which seems to be independent. Conclusions: A high initial CVP in the early postoperative ICU course after cardiac surgery is associated with worse patient outcome. Whether or not CVP, as a readily and constantly available hemodynamic parameter, should promote clinical efforts regarding diagnostics and/or treatment, warrants further investigations.

scholarly journals Postoperative diastolic perfusion pressure is associated with the development of acute kidney injury in patients after cardiac surgery: A retrospective analysis

2019 ◽  
Author(s):  
Jifu Jin ◽  
Jiawei Yu ◽  
Su Chi Chang ◽  
Jiarui Xu ◽  
Sujuan Xu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Mean Arterial Pressure ◽  
Central Venous Pressure ◽  
Odds Ratio ◽  
Perfusion Pressure ◽  
Venous Pressure ◽  
Kidney Injury ◽  
Hemodynamic Parameters ◽  
Central Venous

Abstract Background We aimed to investigate the relationship between the perioperative hemodynamic parameters and the occurrence of cardiac surgery-associated acute kidney injury. Methods A retrospective study was performed in patients underwent cardiac surgery at a tertiary referral teaching hospital. Acute kidney injury was determined according to the KDIGO criteria. We investigated the association between the following perioperative hemodynamic parameters and cardiac surgery-associated acute kidney injury: mean arterial pressure, mean perfusion pressure, central venous pressure, and diastolic perfusion pressure. Multivariate regression analysis was conducted to identify the independent hemodynamic predictors for the development of acute kidney injury. Subgroup analysis was further performed in patients with chronic hypertension. Results Among 300 patients, 29.3% developed acute kidney injury during postoperative intensive care unit period. Multivariate logistic analysis showed the postoperative nadir diastolic perfusion pressure, but not mean arterial pressure, central venous pressure and mean perfusion pressure, was independently linked to the development of acute kidney injury after cardiac surgery (odds ratio 0.945, P = 0.045). Subgroup analyses in hypertensive subjects showed the postoperative nadir diastolic perfusion pressure and peak central venous pressure were both independently related to the development of acute kidney injury (nadir diastolic perfusion pressure, odds ratio 0.886, P = 0.033; peak central venous pressure, odds ratio 1.328, P = 0.010, respectively). Conclusions Postoperative nadir diastolic perfusion pressure was independently associated with the development of cardiac surgery-associated acute kidney injury. Furthermore, central venous pressure should be considered as a potential hemodynamic target for hypertensive patients undergoing cardiac surgery.

scholarly journals Congestive kidney failure in cardiac surgery: the relationship between central venous pressure and acute kidney injury

2016 ◽  
Vol 23 (5) ◽  
pp. 800-805 ◽  
Author(s):  
Ivancarmine Gambardella ◽  
Mario Gaudino ◽  
Claudio Ronco ◽  
Christopher Lau ◽  
Natalia Ivascu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Central Venous Pressure ◽  
Kidney Failure ◽  
Venous Pressure ◽  
Kidney Injury ◽  
Central Venous ◽  
The Relationship

scholarly journals Postoperative diastolic perfusion pressure is associated with the development of acute kidney injury in patients after cardiac surgery: a retrospective analysis

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Jifu Jin ◽  
Jiawei Yu ◽  
Su Chi Chang ◽  
Jiarui Xu ◽  
Sujuan Xu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Central Venous Pressure ◽  
Odds Ratio ◽  
Perfusion Pressure ◽  
Venous Pressure ◽  
Kidney Injury ◽  
Chronic Hypertension ◽  
Hemodynamic Parameters ◽  
Central Venous

Abstract Background We aimed to investigate the relationship between the perioperative hemodynamic parameters and the occurrence of cardiac surgery-associated acute kidney injury. Methods A retrospective study was performed in patients who underwent cardiac surgery at a tertiary referral teaching hospital. Acute kidney injury was determined according to the KDIGO criteria. We investigated the association between the perioperative hemodynamic parameters and cardiac surgery-associated acute kidney injury to identify the independent hemodynamic predictors for acute kidney injury. Subgroup analysis was further performed in patients with chronic hypertension. Results Among 300 patients, 29.3% developed acute kidney injury during postoperative intensive care unit period. Multivariate logistic analysis showed the postoperative nadir diastolic perfusion pressure, but not mean arterial pressure, central venous pressure and mean perfusion pressure, was independently linked to the development of acute kidney injury after cardiac surgery (odds ratio 0.945, P = 0.045). Subgroup analyses in hypertensive subjects (n = 91) showed the postoperative nadir diastolic perfusion pressure and peak central venous pressure were both independently related to the development of acute kidney injury (nadir diastolic perfusion pressure, odds ratio 0.886, P = 0.033; peak central venous pressure, odds ratio 1.328, P = 0.010, respectively). Conclusions Postoperative nadir diastolic perfusion pressure was independently associated with the development of cardiac surgery-associated acute kidney injury. Furthermore, central venous pressure should be considered as a potential hemodynamic target for hypertensive patients undergoing cardiac surgery.

scholarly journals Postoperative diastolic perfusion pressure is associated with the development of acute kidney injury in patients after cardiac surgery: A retrospective analysis

2019 ◽  
Author(s):  
Jifu Jin ◽  
Jiawei Yu ◽  
Su Chi Chang ◽  
Jiarui Xu ◽  
Sujuan Xu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Central Venous Pressure ◽  
Odds Ratio ◽  
Perfusion Pressure ◽  
Venous Pressure ◽  
Kidney Injury ◽  
Chronic Hypertension ◽  
Hemodynamic Parameters ◽  
Central Venous

Abstract Background:We aimed to investigate the relationship between the perioperative hemodynamic parameters and the occurrence of cardiac surgery-associated acute kidney injury. Methods:A retrospective study was performed in patients who underwent cardiac surgery at a tertiary referral teaching hospital. Acute kidney injury was determined according to the KDIGO criteria. We investigated the association between the perioperative hemodynamic parameters and cardiac surgery-associated acute kidney injuryto identify the independent hemodynamic predictors for acute kidney injury.Subgroup analysis was further performed in patients with chronic hypertension. Results:Among 300 patients, 29.3% developed acute kidney injury during postoperative intensive care unit period. Multivariate logistic analysis showed the postoperative nadir diastolic perfusion pressure, but not mean arterial pressure, central venous pressure and mean perfusion pressure, was independently linked to the development of acute kidney injury after cardiac surgery (odds ratio 0.945, P= 0.045). Subgroup analyses in hypertensive subjects (n = 91)showed the postoperative nadir diastolic perfusion pressure and peak central venous pressure were both independently related to the development of acute kidney injury (nadir diastolic perfusion pressure, odds ratio 0.886, P= 0.033; peak central venous pressure, odds ratio 1.328, P= 0.010, respectively). Conclusions:Postoperative nadir diastolic perfusion pressure was independently associated with the development of cardiac surgery-associated acute kidney injury. Furthermore, central venous pressure should be considered as a potential hemodynamic target for hypertensive patients undergoing cardiac surgery.

scholarly journals Postoperative diastolic perfusion pressure is associated with the development of acute kidney injury in patients after cardiac surgery: A retrospective analysis

2019 ◽  
Author(s):  
Jifu Jin ◽  
Jiawei Yu ◽  
Su Chi Chang ◽  
Jiarui Xu ◽  
Sujuan Xu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Central Venous Pressure ◽  
Odds Ratio ◽  
Perfusion Pressure ◽  
Venous Pressure ◽  
Kidney Injury ◽  
Chronic Hypertension ◽  
Hemodynamic Parameters ◽  
Central Venous

Abstract Background: We aimed to investigate the relationship between the perioperative hemodynamic parameters and the occurrence of cardiac surgery-associated acute kidney injury. Methods: A retrospective study was performed in patients who underwent cardiac surgery at a tertiary referral teaching hospital. Acute kidney injury was determined according to the KDIGO criteria. We investigated the association between the perioperative hemodynamic parameters and cardiac surgery-associated acute kidney injuryto identify the independent hemodynamic predictors for acute kidney injury.Subgroup analysis was further performed in patients with chronic hypertension. Results: Among 300 patients, 29.3% developed acute kidney injury during postoperative intensive care unit period. Multivariate logistic analysis showed the postoperative nadir diastolic perfusion pressure, but not mean arterial pressure, central venous pressure and mean perfusion pressure, was independently linked to the development of acute kidney injury after cardiac surgery (odds ratio 0.945, P = 0.045). Subgroup analyses in hypertensive subjects ( n = 91)showed the postoperative nadir diastolic perfusion pressure and peak central venous pressure were both independently related to the development of acute kidney injury (nadir diastolic perfusion pressure, odds ratio 0.886, P = 0.033; peak central venous pressure, odds ratio 1.328, P = 0.010, respectively). Conclusions: Postoperative nadir diastolic perfusion pressure was independently associated with the development of cardiac surgery-associated acute kidney injury. Furthermore, central venous pressure should be considered as a potential hemodynamic target for hypertensive patients undergoing cardiac surgery.

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