Document Detail


What is the preferred central venous pressure zero reference for hepatic resection?
MedLine Citation:
PMID:  19955507     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The common practice of maintaining central venous pressure (CVP) below 5 mm Hg to reduce blood loss during hepatic resection increases the risk of venous air embolism (VAE). We initiated this study after observing that the anteroposterior (AP) diameter of the liver can be much larger than 7 cm, which is the approximate hydrostatic pressure corresponding to a CVP of 5 mm Hg (1 mm Hg = 1.36 cm H(2)O). The purpose of this study was to characterize the liver AP diameter and thereby describe how this might affect the placement of the CVP transducer to balance the risks of bleeding and VAE. METHODS: We measured the AP liver diameter and its distance from other anatomic sites using consecutive archived chest tomograms with IV contrast from 100 adults. RESULTS: The results of our study demonstrate a large interindividual range in AP liver dimensions (17.9 + or - 2.8 cm, range = 12.0-28.5 cm) and standardized anatomic landmarks relative to the portal triad. CONCLUSIONS: The significant variability in AP liver diameter, along with the variability in the liver surgical site, suggests that we rethink the zero reference point for the CVP transducer during hepatic surgeries. By considering the actual hepatic venous pressure itself, rather than the CVP, we can minimize the risks of VAE and hemorrhage. Two methods for zeroing the reference transducer are suggested.
Authors:
Chris Giordano; Lori A Deitte; Nikolaus Gravenstein; Mark J Rice
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-12-02
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  111     ISSN:  1526-7598     ISO Abbreviation:  Anesth. Analg.     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-08-24     Completed Date:  2010-09-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  660-4     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesiology, University of Florida College of Medicine, PO Box 100254, Gainesville, FL 32610-0254, USA. cgiordano@anest.ufl.ed
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MeSH Terms
Descriptor/Qualifier:
Adult
Blood Loss, Surgical / prevention & control
Central Venous Pressure / physiology*
Cohort Studies
Embolism, Air / prevention & control
Hepatectomy
Humans
Liver / physiology*,  radiography,  surgery*
Reference Values
Retrospective Studies
Risk Assessment
Tomography, X-Ray Computed

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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