Format

Send to

Choose Destination
HPB (Oxford). 2015 Oct;17(10):863-71. doi: 10.1111/hpb.12462. Epub 2015 Aug 20.

Central venous pressure and liver resection: a systematic review and meta-analysis.

Author information

1
Department of Clinical Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.

Abstract

BACKGROUND:

A liver resection under low central venous pressure (CVP) has become standard practice; however, the benefits beyond a reduction in blood loss are not well reported. Moreover, the precise method to achieve CVP reduction has not been established. A systematic review and meta-analysis of randomized controlled trials (RTCs) was performed to assess the effects of CVP on clinical outcome and to identify the optimum method of CVP reduction.

METHODS:

EMBASE, Medline, PubMed and the Cochrane database were searched for trials comparing low CVP surgery with controls. The primary outcome was post-operative complications within 30 days. Secondary outcomes included estimated blood loss (EBL), blood transfusion rates and length of stay (LOS). Sub-group analysis was performed to assess the CVP reduction method on the outcome.

RESULTS:

Eight trials were identified. No difference was observed in the morbidity rate between the high CVP and control groups [odds ratio (OR) = 0.96 (95% confidence interval (CI) 0.66, 1.40) P = 0.84, I(2) = 0%]. EBL [weighted mean difference (WMD) = -308.63 ml (95% CI -474.67, -142.58) P = < 0.001, I(2) = 73%] and blood transfusion rates [OR 0.65 (95% CI 0.44, 0.97) P = 0.040, I(2) = 37%] were significantly lower in the low CVP groups. Neither anaesthetic nor surgical methods of CVP reduction were associated with a reduced post-operative morbidity.

CONCLUSION:

Low CVP surgery is associated with a reduction in EBL; however, this does not translate into an improvement in post-operative morbidity. The optimum method of CVP reduction has not been identified.

PMID:
26292655
PMCID:
PMC4571753
DOI:
10.1111/hpb.12462
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Elsevier Science Icon for PubMed Central
Loading ...
Support Center