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Impact of Hypovolemic Phlebotomy With Low Central Venous Pressure on Intraoperative Blood Loss in Open Liver
Warangkana Lapisatepun1,2, Anon Chotirosniramit3, Sunhawit Junrungsee3
1Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Thailand.
Objective:
To assess the efficacy and safety of hypovolemic phlebotomy (HP) versus conventional management (control group) in achieving low central venous pressure (CVP) to reduce blood loss during open liver resections.
Background:
Excessive blood loss increases perioperative complications and worsens patient outcomes. HP is used to reduce blood loss and the need for allogenic transfusions. This study compares intraoperative blood loss between HP and conventional techniques in liver resection.
Methods:
This prospective, randomized controlled trial, conducted between 2020 and 2024, evaluated intraoperative blood loss as the primary endpoint, with secondary endpoints of allogenic transfusion and postoperative outcomes.
Results:
One hundred participants were randomized to either the HP or control groups, with similar baseline characteristics. The HP group had significantly lower blood loss during parenchymal transection [300 (250-500) vs. 500 (300-750) mL, difference=150, 95% CI: 50-275; P =0.02], shorter time to achieve low CVP [50 (30-100) vs. 107.5 (45-150) minutes, difference=-75.0, 95% CI: -95.0 to -56.0; P = 0.01], and a lower surgical bleeding score [2 (1-3) vs. 2 (2-4), difference=-1.0, 95% CI: -1.0 to -0.5; P =0.01]. Transfusion rates and postoperative complications were similar. HP was an independent protective against blood loss >500 mL (AOR=0.19, 95% CI: 0.04-0.80; P =0.02).
Conclusions:
HP significantly reduces intraoperative blood loss and enhances bleeding control by achieving a low CVP more quickly. It is an effective technique for minimizing blood loss and improving outcomes in open liver resections.
