masterThesis
Uso de catéter de venoso central para hepatectomías de donante vivo: una cohorte retrospectiva
Autor
Ramírez Herrera, Laura
Beltrán Ríos, Andrés Guillermo
Institución
Resumen
Introduction: Low central venous pressure (CVP) has been recommended during liver resection to reduce blood loss and transfusion requirements. Consequently, CVP monitoring is considered an integral part of the anesthetic management of major liver surgery, including living donor hepatectomy. However, the routine implementation of this monitoring remains controversial and it may not be the best option concerning the living donor´s safety (1,2). The objective of this study is to evaluate the impact of CVP monitoring on intraoperative bleeding, procedural and in-hospital outcomes, in patients undergoing living donor hepatectomy. Methods: Following approval from the institutional review board, all patients who underwent living donor hepatectomy from January 2014 to December 2019 at our institution were reviewed. Patients were divided into two groups, according to whether they were monitored intraoperatively with CVP or without CVP. The primary endpoint was the estimated blood loss and secondary endpoints were procedural and in-hospital outcomes. In addition, the central venous catheter features and complications were recorded. Data were analyzed by t-test, Fisher´s exact test, or Chi-square as appropriate. P < 0.05 was considered statistically significant. Results: 122 subjects were initially selected for our study, 44% with central venous cathere insertion. 2 patients were excluded, as they were simultaneously liver and kidney donors. A total of 120 individuals underwent hepatectomy monitored with CVP (n=53) and without CVP (n=67). There were no differences between the two groups in baseline characteristics or anesthesia technique. Likewise, no significant difference was found between the groups, regarding the estimated blood loss with CVP (median 200 mL; interquartile range: 200-400) vs without CVP median 200 mL; interquartile range: 200-300) (p value: 0.14), as well as renal function and crystalloids. We found that CVP was associated with longer intraoperative time (p<0,01), more requirement of postoperative ICU (p<0,01), new interventions (p=0,04) and longer hospital stay (p<0,01). Complications associated with central venous catheter placement range within values described in literature Conclusions: The use of CVP as an intraoperative monitoring strategy to decrease blood loss in living donors during hepatectomy may not be necessary. It can lead to unwanted outcomes, which are normally not expected in this population composed mainly of healthy individuals.