High Central Venous Pressure after Cardiac Surgery Might Depict Hemodynamic Deterioration Associated with Increased Morbidity and Mortality

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.

Incidence of and Risk Factors for Prolonged Intensive Care Unit Stay After Open Heart Surgery Among Elderly Patients

“…CPB time and aortic clamping time are prolonged in patients who undergo multiple valves replacement surgery. Prolonged CPB and aortic clamping times are associated with prolonged ICU stay [30].…”

“…CPB time and aortic clamping time are prolonged in patients who undergo multiple valves replacement surgery. Prolonged CPB and aortic clamping times are associated with prolonged ICU stay [ 30 ]. In our study, concomitant multiple valves replacement and higher incidence of comorbidity associated with advanced age prolonged the length of ICU stay.…”

“…In our study, concomitant multiple valves replacement and higher incidence of comorbidity associated with advanced age prolonged the length of ICU stay. Venous congestion due to high CVP during perioperative cardiac surgery is associated with poor patient outcomes and prolonged ICU/hospital stays [ 30 , 31 ]. High CVP impedes venous return and causes multiple organ dysfunction.…”

Association between central venous pressure measurement and outcomes in critically ill patients with severe coma

“…Many clinical studies have reported that higher CVP values may be associated with patients’ poor outcomes in different conditions, such as patients undergoing cardiac surgery [ 11 ], early Fontan failure [ 10 ], acute kidney injury (AKI) [ 8 , 9 ], patients undergoing cardiopulmonary bypass surgery [ 9 ], and critically ill patients [ 2 ]. A controlled lower CVP can also reduce blood loss during hepatectomy [ 12 ].…”

Persistent Liver Dysfunction in Pediatric Patients After Total Cavopulmonary Connection Surgery

“…( 9 , 10 ). Furthermore, a recent study of a large sample size ( n = 11, 198) reported that postoperative initial CVP of >11 mmHg was associated with a higher risk for postoperative liver dysfunction and in-hospital mortality in adult patients after cardiac surgery ( 11 ). But the relationship between high CVP and LD after TCPC surgery remains unclear and there is also no report about the risk factors for LD in patients after TCPC surgery.…”