Research progress on the application of controlled low central venous pressure in hepatectomy_West China Medical Journal

Authors：

JIN Hongyu ¹ , ZHANG Man ² , LI Jingwei ² ,  ZENG Yong ¹

1. Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

ZENG Yong, Email: zengyong@medmail.com.cn

Keywords：

Hepatectomy; Low central venous pressure; Hemodynamic indicators

DOI：

10.7507/1002-0179.202005088

Video：

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Controlling intraoperative bleeding is the core technology of liver surgery, and it is also an important way to improve the benefits of liver surgery and reduce the risk of surgery. In recent years, a number of methods to maintain low central venous pressure have been proposed, including inferior vena cava clamping, restricted fluid infusion, postural changes, intraoperative assisted ventilation, intraoperative hypovolemic venous incision, etc. In addition, more and more indicators used to guide intraoperative fluid input management to maintain low central venous pressure have been discovered, including global end-diastolic volume and stroke volume variability. Therefore, this article summarizes the relationship between low central venous pressure and surgical effect in liver surgery, and the ways to achieve low central venous pressure on the basis of previous research.

Citation： JIN Hongyu, ZHANG Man, LI Jingwei, ZENG Yong. Research progress on the application of controlled low central venous pressure in hepatectomy. West China Medical Journal, 2021, 36(9): 1303-1309. doi: 10.7507/1002-0179.202005088 Copy

1.	Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
2.	Mullen JT, Ribero D, Reddy SK, et al. Hepatic insufficiency and mortality in 1,059 noncirrhotic patients undergoing major hepatectomy. J Am Coll Surg, 2007, 204(5): 854-862.
3.	Combeer EL, Quiney NF, Karanjia ND, et al. A risk score for predicting perioperative blood transfusion in liver surgery (Br J Surg 2007; 94: 860-865). Br J Surg, 2007, 94(12): 1574.
4.	Cheng ES, Hallet J, Hanna SS, et al. Is central venous pressure still relevant in the contemporary era of liver resection?. J Surg Res, 2016, 200(1): 139-146.
5.	Liu TS, Shen QH, Zhou XY, et al. Application of controlled low central venous pressure during hepatectomy: a systematic review and meta-analysis. J Clin Anesth, 2021, 75: 110467.
6.	Karpavičiūtė J, Skarupskienė I, Balčiuvienė V, et al. Assessment of fluid status by bioimpedance analysis and central venous pressure measurement and their association with the outcomes of severe acute kidney injury. Medicina (Kaunas), 2021, 57(6): 518.
7.	Kamel YA, Ammar AS, Baiomy OG, et al. Plethysmography variability index and stroke volume variation changes in relation to central venous pressure changes during living related donor right hepatotomy: a diagnostic test accuracy. Exp Clin Transplant, 2021, 19(7): 693-702.
8.	Xiao LK, Huang P, Wu K, et al. Effect of infrahepatic inferior vena cava partial clamping on central venous pressure and intraoperative blood loss during laparoscopic hepatectomy. Surg Endosc, 2021, 35(6): 2773-2780.
9.	Huntington JT, Royall NA, Schmidt CR. Minimizing blood loss during hepatectomy: a literature review. J Surg Oncol, 2014, 109(2): 81-88.
10.	Jones RM, Moulton CE, Hardy KJ. Central venous pressure and its effect on blood loss during liver resection. Br J Surg, 1998, 85(8): 1058-1060.
11.	Hughes MJ, Ventham NT, Harrison EM, et al. Central venous pressure and liver resection: a systematic review and meta-analysis. HPB (Oxford), 2015, 17(10): 863-871.
12.	Li Z, Sun YM, Wu FX, et al. Controlled low central venous pressure reduces blood loss and transfusion requirements in hepatectomy. World J Gastroenterol, 2014, 20(1): 303-309.
13.	Smyrniotis V, Kostopanagiotou G, Theodoraki K, et al. The role of central venous pressure and type of vascular control in blood loss during major liver resections. Am J Surg, 2004, 187(3): 398-402.
14.	Harimoto N, Matsuyama H, Kajiyama K, et al. Significance of stroke volume variation during hepatic resection under infrahepatic inferior vena cava and portal triad clamping. Fukuoka Igaku Zasshi, 2013, 104(10): 362-369.
15.	McNally SJ, Revie EJ, Massie LJ, et al. Factors in perioperative care that determine blood loss in liver surgery. HPB (Oxford), 2012, 14(4): 236-241.
16.	Wang WD, Liang LJ, Huang XQ, et al. Low central venous pressure reduces blood loss in hepatectomy. World J Gastroenterol, 2006, 12(6): 935-939.
17.	Lin CX, Guo Y, Lau WY, et al. Optimal central venous pressure during partial hepatectomy for hepatocellular carcinoma. Hepatobiliary Pancreat Dis Int, 2013, 12(5): 520-524.
18.	Leelanukrom R, Songthamwat B, Thonnagith A, et al. Factors affecting intraoperative blood loss during liver resection. J Med Assoc Thai, 2013, 96(1): 58-63.
19.	Yu L, Sun H, Jin H, et al. The effect of low central venous pressure on hepatic surgical field bleeding and serum lactate in patients undergoing partial hepatectomy: a prospective randomized controlled trial. BMC Surg, 2020, 20(1): 25.
20.	Ryu HG, Nahm FS, Sohn HM, et al. Low central venous pressure with milrinone during living donor hepatectomy. Am J Transplant, 2010, 10(4): 877-882.
21.	Gagnière J, Le Roy B, Antomarchi O, et al. Effects of clamping procedures on central venous pressure during liver resection. J Visc Surg, 2016, 153(2): 89-94.
22.	Zhu P, Lau WY, Chen YF, et al. Randomized clinical trial comparing infrahepatic inferior vena cava clamping with low central venous pressure in complex liver resections involving the Pringle manoeuvre. Br J Surg, 2012, 99(6): 781-788.
23.	Ueno M, Kawai M, Hayami S, et al. Partial clamping of the infrahepatic inferior vena cava for blood loss reduction during anatomic liver resection: a prospective, randomized, controlled trial. Surgery, 2017, 161(6): 1502-1513.
24.	Kato M, Kubota K, Kita J, et al. Effect of infra-hepatic inferior vena cava clamping on bleeding during hepatic dissection: a prospective, randomized, controlled study. World J Surg, 2008, 32(6): 1082-1087.
25.	Ukere A, Meisner S, Greiwe G, et al. The influence of PEEP and positioning on central venous pressure and venous hepatic hemodynamics in patients undergoing liver resection. J Clin Monit Comput, 2017, 31(6): 1221-1228.
26.	Iguchi T, Ikegami T, Fujiyoshi T, et al. Low positive airway pressure without positive end-expiratory pressure decreases blood loss during hepatectomy in living liver donors. Dig Surg, 2017, 34(3): 192-196.
27.	Sand L, Rizell M, Houltz E, et al. Effect of patient position and PEEP on hepatic, portal and central venous pressures during liver resection. Acta Anaesthesiol Scand, 2011, 55(9): 1106-1112.
28.	Fors D, Eiriksson K, Arvidsson D, et al. Elevated PEEP without effect upon gas embolism frequency or severity in experimental laparoscopic liver resection. Br J Anaesth, 2012, 109(2): 272-278.
29.	Giustiniano E, Procopio F, Ruggieri N, et al. Impact of the FloTrac/VigileoTM monitoring on intraoperative fluid management and outcome after liver resection. Dig Surg, 2018, 35(5): 435-441.
30.	Zatloukal J, Pradl R, Kletecka J, et al. Comparison of absolute fluid restriction versus relative volume redistribution strategy in low central venous pressure anesthesia in liver resection surgery: a randomized controlled trial. Minerva Anestesiol, 2017, 83(10): 1051-1060.
31.	Wax DB, Zerillo J, Tabrizian P, et al. A retrospective analysis of liver resection performed without central venous pressure monitoring. Eur J Surg Oncol, 2016, 42(10): 1608-1613.
32.	Sahmeddini MA, Janatmakan F, Khosravi MB, et al. The effect of intraoperative restricted normal saline during orthotopic liver transplantation on amount of administered sodium bicarbonate. Iran J Med Sci, 2014, 39(3): 247-253.
33.	Ryckx A, Christiaens C, Clarysse M, et al. Central venous pressure drop after hypovolemic phlebotomy is a strong independent predictor of intraoperative blood loss during liver resection. Ann Surg Oncol, 2017, 24(5): 1367-1375.
34.	Sand L, Lundin S, Rizell M, et al. Nitroglycerine and patient position effect on central, hepatic and portal venous pressures during liver surgery. Acta Anaesthesiol Scand, 2014, 58(8): 961-967.
35.	Redondo FJ, Padilla D, Villazala R, et al. Global end-diastolic volume could be more appropiate to reduce intraoperative bleeding than central venous pressure during major liver transection. Anaesthesiol Intensive Ther, 2017, 49(2): 100-105.
36.	Shih TH, Tsou YH, Huang CJ, et al. The correlation between CVP and SVV and intraoperative minimal blood loss in living donor hepatectomy. Transplant Proc, 2018, 50(9): 2661-2663.
37.	Ratti F, Cipriani F, Reineke R, et al. Intraoperative monitoring of stroke volume variation versus central venous pressure in laparoscopic liver surgery: a randomized prospective comparative trial. HPB (Oxford), 2016, 18(2): 136-144.
38.	Takeda K, Kumamoto T, Nojiri K, et al. Stroke volume variation for the evaluation of circulating blood volume after living donor liver transplantation. Hepatogastroenterology, 2015, 62(139): 693-697.
39.	Wang SC, Teng WN, Chang KY, et al. Fluid management guided by stroke volume variation failed to decrease the incidence of acute kidney injury, 30-day mortality, and 1-year survival in living donor liver transplant recipients. J Chin Med Assoc, 2012, 75(12): 654-659.
40.	Fayed NA, Yassen KA, Abdulla AR. Comparison between 2 strategies of fluid management on blood loss and transfusion requirements during liver transplantation. J Cardiothorac Vasc Anesth, 2017, 31(5): 1741-1750.
41.	El Sharkawy OA, Refaat EK, Ibraheem AE, et al. Transoesophageal Doppler compared to central venous pressure for perioperative hemodynamic monitoring and fluid guidance in liver resection. Saudi J Anaesth, 2013, 7(4): 378-386.

1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
2. Mullen JT, Ribero D, Reddy SK, et al. Hepatic insufficiency and mortality in 1,059 noncirrhotic patients undergoing major hepatectomy. J Am Coll Surg, 2007, 204(5): 854-862.
3. Combeer EL, Quiney NF, Karanjia ND, et al. A risk score for predicting perioperative blood transfusion in liver surgery (Br J Surg 2007; 94: 860-865). Br J Surg, 2007, 94(12): 1574.
4. Cheng ES, Hallet J, Hanna SS, et al. Is central venous pressure still relevant in the contemporary era of liver resection?. J Surg Res, 2016, 200(1): 139-146.
5. Liu TS, Shen QH, Zhou XY, et al. Application of controlled low central venous pressure during hepatectomy: a systematic review and meta-analysis. J Clin Anesth, 2021, 75: 110467.
6. Karpavičiūtė J, Skarupskienė I, Balčiuvienė V, et al. Assessment of fluid status by bioimpedance analysis and central venous pressure measurement and their association with the outcomes of severe acute kidney injury. Medicina (Kaunas), 2021, 57(6): 518.
7. Kamel YA, Ammar AS, Baiomy OG, et al. Plethysmography variability index and stroke volume variation changes in relation to central venous pressure changes during living related donor right hepatotomy: a diagnostic test accuracy. Exp Clin Transplant, 2021, 19(7): 693-702.
8. Xiao LK, Huang P, Wu K, et al. Effect of infrahepatic inferior vena cava partial clamping on central venous pressure and intraoperative blood loss during laparoscopic hepatectomy. Surg Endosc, 2021, 35(6): 2773-2780.
9. Huntington JT, Royall NA, Schmidt CR. Minimizing blood loss during hepatectomy: a literature review. J Surg Oncol, 2014, 109(2): 81-88.
10. Jones RM, Moulton CE, Hardy KJ. Central venous pressure and its effect on blood loss during liver resection. Br J Surg, 1998, 85(8): 1058-1060.
11. Hughes MJ, Ventham NT, Harrison EM, et al. Central venous pressure and liver resection: a systematic review and meta-analysis. HPB (Oxford), 2015, 17(10): 863-871.
12. Li Z, Sun YM, Wu FX, et al. Controlled low central venous pressure reduces blood loss and transfusion requirements in hepatectomy. World J Gastroenterol, 2014, 20(1): 303-309.
13. Smyrniotis V, Kostopanagiotou G, Theodoraki K, et al. The role of central venous pressure and type of vascular control in blood loss during major liver resections. Am J Surg, 2004, 187(3): 398-402.
14. Harimoto N, Matsuyama H, Kajiyama K, et al. Significance of stroke volume variation during hepatic resection under infrahepatic inferior vena cava and portal triad clamping. Fukuoka Igaku Zasshi, 2013, 104(10): 362-369.
15. McNally SJ, Revie EJ, Massie LJ, et al. Factors in perioperative care that determine blood loss in liver surgery. HPB (Oxford), 2012, 14(4): 236-241.
16. Wang WD, Liang LJ, Huang XQ, et al. Low central venous pressure reduces blood loss in hepatectomy. World J Gastroenterol, 2006, 12(6): 935-939.
17. Lin CX, Guo Y, Lau WY, et al. Optimal central venous pressure during partial hepatectomy for hepatocellular carcinoma. Hepatobiliary Pancreat Dis Int, 2013, 12(5): 520-524.
18. Leelanukrom R, Songthamwat B, Thonnagith A, et al. Factors affecting intraoperative blood loss during liver resection. J Med Assoc Thai, 2013, 96(1): 58-63.
19. Yu L, Sun H, Jin H, et al. The effect of low central venous pressure on hepatic surgical field bleeding and serum lactate in patients undergoing partial hepatectomy: a prospective randomized controlled trial. BMC Surg, 2020, 20(1): 25.
20. Ryu HG, Nahm FS, Sohn HM, et al. Low central venous pressure with milrinone during living donor hepatectomy. Am J Transplant, 2010, 10(4): 877-882.
21. Gagnière J, Le Roy B, Antomarchi O, et al. Effects of clamping procedures on central venous pressure during liver resection. J Visc Surg, 2016, 153(2): 89-94.
22. Zhu P, Lau WY, Chen YF, et al. Randomized clinical trial comparing infrahepatic inferior vena cava clamping with low central venous pressure in complex liver resections involving the Pringle manoeuvre. Br J Surg, 2012, 99(6): 781-788.
23. Ueno M, Kawai M, Hayami S, et al. Partial clamping of the infrahepatic inferior vena cava for blood loss reduction during anatomic liver resection: a prospective, randomized, controlled trial. Surgery, 2017, 161(6): 1502-1513.
24. Kato M, Kubota K, Kita J, et al. Effect of infra-hepatic inferior vena cava clamping on bleeding during hepatic dissection: a prospective, randomized, controlled study. World J Surg, 2008, 32(6): 1082-1087.
25. Ukere A, Meisner S, Greiwe G, et al. The influence of PEEP and positioning on central venous pressure and venous hepatic hemodynamics in patients undergoing liver resection. J Clin Monit Comput, 2017, 31(6): 1221-1228.
26. Iguchi T, Ikegami T, Fujiyoshi T, et al. Low positive airway pressure without positive end-expiratory pressure decreases blood loss during hepatectomy in living liver donors. Dig Surg, 2017, 34(3): 192-196.
27. Sand L, Rizell M, Houltz E, et al. Effect of patient position and PEEP on hepatic, portal and central venous pressures during liver resection. Acta Anaesthesiol Scand, 2011, 55(9): 1106-1112.
28. Fors D, Eiriksson K, Arvidsson D, et al. Elevated PEEP without effect upon gas embolism frequency or severity in experimental laparoscopic liver resection. Br J Anaesth, 2012, 109(2): 272-278.
29. Giustiniano E, Procopio F, Ruggieri N, et al. Impact of the FloTrac/VigileoTM monitoring on intraoperative fluid management and outcome after liver resection. Dig Surg, 2018, 35(5): 435-441.
30. Zatloukal J, Pradl R, Kletecka J, et al. Comparison of absolute fluid restriction versus relative volume redistribution strategy in low central venous pressure anesthesia in liver resection surgery: a randomized controlled trial. Minerva Anestesiol, 2017, 83(10): 1051-1060.
31. Wax DB, Zerillo J, Tabrizian P, et al. A retrospective analysis of liver resection performed without central venous pressure monitoring. Eur J Surg Oncol, 2016, 42(10): 1608-1613.
32. Sahmeddini MA, Janatmakan F, Khosravi MB, et al. The effect of intraoperative restricted normal saline during orthotopic liver transplantation on amount of administered sodium bicarbonate. Iran J Med Sci, 2014, 39(3): 247-253.
33. Ryckx A, Christiaens C, Clarysse M, et al. Central venous pressure drop after hypovolemic phlebotomy is a strong independent predictor of intraoperative blood loss during liver resection. Ann Surg Oncol, 2017, 24(5): 1367-1375.
34. Sand L, Lundin S, Rizell M, et al. Nitroglycerine and patient position effect on central, hepatic and portal venous pressures during liver surgery. Acta Anaesthesiol Scand, 2014, 58(8): 961-967.
35. Redondo FJ, Padilla D, Villazala R, et al. Global end-diastolic volume could be more appropiate to reduce intraoperative bleeding than central venous pressure during major liver transection. Anaesthesiol Intensive Ther, 2017, 49(2): 100-105.
36. Shih TH, Tsou YH, Huang CJ, et al. The correlation between CVP and SVV and intraoperative minimal blood loss in living donor hepatectomy. Transplant Proc, 2018, 50(9): 2661-2663.
37. Ratti F, Cipriani F, Reineke R, et al. Intraoperative monitoring of stroke volume variation versus central venous pressure in laparoscopic liver surgery: a randomized prospective comparative trial. HPB (Oxford), 2016, 18(2): 136-144.
38. Takeda K, Kumamoto T, Nojiri K, et al. Stroke volume variation for the evaluation of circulating blood volume after living donor liver transplantation. Hepatogastroenterology, 2015, 62(139): 693-697.
39. Wang SC, Teng WN, Chang KY, et al. Fluid management guided by stroke volume variation failed to decrease the incidence of acute kidney injury, 30-day mortality, and 1-year survival in living donor liver transplant recipients. J Chin Med Assoc, 2012, 75(12): 654-659.
40. Fayed NA, Yassen KA, Abdulla AR. Comparison between 2 strategies of fluid management on blood loss and transfusion requirements during liver transplantation. J Cardiothorac Vasc Anesth, 2017, 31(5): 1741-1750.
41. El Sharkawy OA, Refaat EK, Ibraheem AE, et al. Transoesophageal Doppler compared to central venous pressure for perioperative hemodynamic monitoring and fluid guidance in liver resection. Saudi J Anaesth, 2013, 7(4): 378-386.

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