Hemodynamics and oxygen transport dynamics during hepatic resection at different central venous pressures in a pig model

摘要

BACKGROUND: Although low central venous pressure (CVP) has  been  used  to  minimize  blood  loss  during  hepatectomy, the  impact  of  variations  of  CVP  on  the  rate  of  blood  loss and on the perfusion of end-organs has not been evaluated. This  animal  study  aimed  to  evaluate  the  hemodynamics and  oxygen  transport  changes  during  hepatic  resection  at different CVP levels. METHODS: Forty-eight  anesthetized  Bama  miniature  pigs were divided into 8 groups with CVP during hepatic resection controlled at 0 to <1, 1 to <2, 2 to <3, 3 to <4, 4 to <5, 5 to <6, 6 to <7, and 7 to <8 cmH2O. Intergroup comparisons were made for hemodynamic parameters, oxygen transport dynamics, and the rate of blood loss. RESULTS: The  rate  of  blood  loss  and  the  hepatic  venous pressure during hepatic resection were almost linearly related to  the  CVP.  A  significant  drop  in  the  mean  arterial  pressure, cardiac output, and cardiac index occurred between CVP ≥2 and <2 cmH2O. Oxygen delivery (DO2), oxygen consumption (VO2) and oxygen extraction ratio (ERO2) remained relatively constant between CVPs of 2 to <8 cmH2O. There was a significant drop in DO2 when the CVP was <2 cmH2O. There was also a significant drop in VO2 and ExO2 when the CVP was <1 cmH2O. CONCLUSION: The  optimal  CVP  for hepatic resection is 2 to 3 cmH2O.