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High Central Venous Pressure after Cardiac Surgery Might Depict Hemodynamic Deterioration Associated with Increased
Fridtjof Schiefenhövel1,2, Ralf F Trauzeddel3, Michael Sander4
1Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13353 Berlin, Germany.
Insights
High central venous pressure (CVP) after cardiac surgery indicates worse outcomes, including increased mortality and organ failure. This readily available hemodynamic parameter warrants further investigation for clinical use.
Area of Science:
- Cardiology
- Intensive Care Medicine
- Nephrology
Background:
- Cardiac surgery patients are a high-risk ICU population.
- Central venous pressure (CVP) is a key hemodynamic monitoring parameter in cardiac ICUs.
- The prognostic value of CVP for organ failure remains unclear.
Purpose of the Study:
- To analyze the prognostic value of postoperative central venous pressure (CVP) for morbidity and mortality in adult cardiac surgery patients.
- To determine if initial CVP measurements can predict adverse outcomes.
Main Methods:
- Retrospective analysis of 11,198 adult cardiac surgery patients (2006-2019).
- Median initial CVP (miCVP) calculated for 9802 patients.
- ROC analysis to define high (HCVP, >11 mmHg) and low (LCVP, ≤11 mmHg) miCVP groups; PSM and logistic regression used for outcome analysis.
Main Results:
- High miCVP (HCVP) was associated with increased ICU mortality.
- HCVP patients experienced longer mechanical ventilation, higher rates of acute kidney injury, and increased need for renal replacement therapy.
- HCVP correlated with a higher risk of postoperative liver dysfunction (MELD Score increase ≥10) and independent effects on ICU and intrahospital mortality.
Conclusions:
- Elevated initial CVP in the early postoperative period after cardiac surgery is linked to poorer patient outcomes.
- The clinical utility of CVP for guiding diagnostics and treatment requires further research.
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.
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