Journalartikel
Autorenliste: Schiefenhoevel, Fridtjof; Trauzeddel, Ralf F.; Sander, Michael; Heringlake, Matthias; Groesdonk, Heinrich, V; Grubitzsch, Herko; Kruppa, Jochen; Berger, Christian; Treskatsch, Sascha; Balzer, Felix
Jahr der Veröffentlichung: 2021
Zeitschrift: Journal of Clinical Medicine
Bandnummer: 10
Heftnummer: 17
eISSN: 2077-0383
Open Access Status: Gold
DOI Link: https://doi.org/10.3390/jcm10173945
Verlag: MDPI
Abstract:
Background: Cardiac surgery patients represent a high-risk cohort in intensive care units (ICUs). Central venous pressure (CVP) measurement seems to remain an integral part in hemodynamic monitoring, especially in cardio-surgical ICUs. However, its value as a prognostic marker for organ failure is still unclear. Therefore, we analyzed postoperative CVP values after adult cardiac surgery in a large cohort with regard to its prognostic value for morbidity and mortality. Methods: All adult patients admitted to our ICUs between 2006 and 2019 after cardiac surgery were eligible for inclusion in the study (n = 11,198). We calculated the median initial CVP (miCVP) after admission to the ICU, which returned valid values for 9802 patients. An ROC curve analysis for optimal cut-off miCVP to predict ICU mortality was conducted with consecutive patient allocation into a (a) low miCVP (LCVP) group (<= 11 mmHg) and (b) high miCVP (HCVP) group (>11 mmHg). We analyzed the impact of high miCVP on morbidity and mortality by propensity score matching (PSM) and logistic regression. Results: ICU mortality was increased in HCVP patients. In addition, patients in the HCVP group required longer mechanical ventilation, had a higher incidence of acute kidney injury, were more frequently treated with renal replacement therapy, and showed a higher risk for postoperative liver dysfunction, parametrized by a postoperative rise of >= 10 in MELD Score. Multiple regression analysis confirmed HCVP has an effect on postoperative ICU-mortality and intrahospital mortality, which seems to be independent. Conclusions: A high initial CVP in the early postoperative ICU course after cardiac surgery is associated with worse patient outcome. Whether or not CVP, as a readily and constantly available hemodynamic parameter, should promote clinical efforts regarding diagnostics and/or treatment, warrants further investigations.
Zitierstile
Harvard-Zitierstil: Schiefenhoevel, F., Trauzeddel, R., Sander, M., Heringlake, M., Groesdonk, H., Grubitzsch, H., et al. (2021) High Central Venous Pressure after Cardiac Surgery Might Depict Hemodynamic Deterioration Associated with Increased Morbidity and Mortality, Journal of Clinical Medicine, 10(17), Article 3945. https://doi.org/10.3390/jcm10173945
APA-Zitierstil: Schiefenhoevel, F., Trauzeddel, R., Sander, M., Heringlake, M., Groesdonk, H., Grubitzsch, H., Kruppa, J., Berger, C., Treskatsch, S., & Balzer, F. (2021). High Central Venous Pressure after Cardiac Surgery Might Depict Hemodynamic Deterioration Associated with Increased Morbidity and Mortality. Journal of Clinical Medicine. 10(17), Article 3945. https://doi.org/10.3390/jcm10173945
Schlagwörter
Cardiac surgery; central venous pressure; CONGESTION; ESOPHAGEAL; GUIDELINES; venous congestion
