A retrospective analysis of liver resection performed without central venous pressure monitoring

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• 作者：D.B. Wax^a ; ¹ ; J. Zerillo^a ; ² ; ^{jeron.zerillo@mountsinai.org" class="auth_mail" title="E-mail the corresponding author} ; P. Tabrizian^b ; ³ ; M. Schwartz^b ; ³ ; B. Hill^a ; ⁴ ; H.-M. Lin^a ; ⁵ ; S. DeMaria Jr.^a ; ⁶
• 关键词：Hepatectomy ; Liver resection ; Fluid management
• 刊名：European Journal of Surgical Oncology (EJSO)
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：42
• 期：10
• 页码：1608-1613
• 全文大小：255 K

文摘

Studies have suggested that blood loss can be reduced during liver resection by monitoring and maintaining low central venous pressure (CVP) through fluid restriction or other means, but such a strategy carries risks to the patient including those inherent to central venous catheterization. We sought to characterize fluid management and blood loss during liver resections done without CVP monitoring.

Methods

Retrospective data were extracted from electronic anesthesia records for 993 liver resections. For 135 resections, between 2011 through 2013, where a documentation template was used that recorded fluid administration prior to hepatic inflow occlusion, multivariate analysis was performed to test for an association between pre-clamp fluid volumes administered and blood loss and other adverse outcomes.

Results

The median estimated blood loss was 300 mL and overall rate of transfusion was 8.6%. There was no statistically significant association between crystalloid volume administered prior to inflow clamping (median 900 mL) and blood loss, mortality or length of stay in the subset of patients with supplemental fluid data.

Conclusion

Liver resection can be performed safely without either CVP monitoring or non-invasive continuous cardiac output monitoring. Additionally, there was no disadvantage to a practical approach to fluid administration prior to inflow clamping during liver resections in the absence of CVP monitoring with regard to blood loss or short-term outcomes.