The influence of PEEP and positioning on central venous pressure and venous hepatic hemodynamics in patients undergoing liver resection

Ukere, Asi; Meisner, Sebastian; Greiwe, Gillis; Opitz, Benjamin; Benten, Daniel; Nashan, Björn; Fischer, Lutz; Trepte, Constantin; Reuter, Daniel A.; Haas, Sebastian; Behem, Christoph

doi:10.1007/s10877-016-9970-1

Cited by 14 publications

(7 citation statements)

References 29 publications

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“…Patients were placed in a supine position, with a surgeon on the right-hand side and a surgeon-assistant and camera-assistant on the left-hand side. The systematic ‘7+3’ approach was used in all LRPHs, based on procedures described previously ( 15 , 20 – 22 ), including low central venous pressure (CVP), intermittent clamping of the hepatic pedicle, pneumoperitoneum at 12 mmHg, parenchymal section with ultrasonic dissector and sterile glove pouch. The seven key points include the following: Special triangular positioning ( 15 , 23 – 27 ), lifting the right arm, rotating internally with an angle of 90° elbow flexion fixed on the support and elevating the right side of the body at an angle of 15–30° (β) inclined to left, which looks like a triangle ( Fig.…”

Section: Methodsmentioning

confidence: 99%

A systematic surgical procedure: The ̔7+3̓ approach to laparoscopic right partial hepatectomy [deep segment (S) VI, S VII or S VIII] in 52ï¿½patients with liver tumors

Ren

et al. 2018

Oncol Lett

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Laparoscopic right partial hepatectomy (LRPH), located in the deep segment (S) VI, S VII or S VIII, is a complicated procedure, due to its poor operative field and high risk of bleeding. The present study aimed to summarize our experience of LRPH and to share our systematic surgical procedure, the ‘7+3’ approach. This approach includes seven key points and three main instruments. A total of 81 cases were included, which were divided into 2 groups [LRPH, n=52; open hepatectomy (OH), n=29]. The demographic profile, intraoperative parameters and postoperative parameters were obtained and analyzed. Blood loss (245.38±268.37 ml) in the LRPH group was not significantly more than in the OH group (230.93±257.62 ml; P=0.936). The durations of surgery, liver parenchyma transection and portal triad clamping were also not significantly more than those in the OH group (145.52±48.29 vs. 129.83±35.04 min; P=0.149 for surgery; 28.52±10.16 vs. 23.97±10.44 min; P=0.059 for liver parenchyma transection; 20.62±9.61 vs. 17.31±10.12 min; P=0.149 for portal triad clamping). However, the number of postoperative hospital days in the LRPH group was smaller (10.67 in LRPH vs. 12.07 in OH; P=0.025). The present study demonstrated the satisfactory surgical outcomes and economic benefits of the systematic ‘7+3’ surgical technique for LRPH. Further studies in larger cohorts and other centers are required to confirm its feasibility and superiority.

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Section: Methodsmentioning

confidence: 99%

A systematic surgical procedure: The ̔7+3̓ approach to laparoscopic right partial hepatectomy [deep segment (S) VI, S VII or S VIII] in 52ï¿½patients with liver tumors

Ren

et al. 2018

Oncol Lett

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“…[76] Moreover, mechanical ventilation may also affect visceral perfusion, including the blood flow within the hepatic portal vein and mesenteric vasculature. [77,78] However, current research evaluating the impact of mechanical ventilation on local microvascular perfusion is based on controlled laboratory studies. Therefore, further investigations are warranted to understand the impact of mechanical ventilation on microcirculatory perfusion and to develop more effective clinical monitoring methods.…”

Section: The Significance Of Microcirculation On the Treatment Interv...mentioning

confidence: 99%

Research progress on microcirculatory disorders in septic shock: A narrative review

Wang,

Ding,

Wang

et al. 2024

Medicine

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Hemodynamic coherence plays a critical role in the outcomes of septic shock. Due to the potential negative consequences of microcirculatory disorders on organ failure and clinical outcomes, the maintenance of a balance between the macrocirculation and microcirculation is a topic of significant research focus. Although physical methods and specialized imaging techniques are used in clinical practice to assess microcirculation, the use of monitoring devices is not widespread. The integration of microcirculation research tools into clinical practice poses a significant challenge for the future. Consequently, this review aims to evaluate the impact of septic shock on the microcirculation, the methods used to monitor the microcirculation and highlight the importance of microcirculation in the treatment of critically ill patients. In addition, it proposes an evaluation framework that integrates microcirculation monitoring with macrocirculatory parameters. The optimal approach should encompass dynamic, multiparametric, individualized, and continuous monitoring of both the macrocirculation and microcirculation, particularly in cases of hemodynamic separation.

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“…In addition, Pringle maneuver is often used to control IBL in LH. Reverse Trendelenburg position and pneumoperitoneum pressure can also reduce hepatic venous pressure and blood loss during surgery (Ukere et al 2017). For anesthesiologists, these measures tend to be difficult to manage hemodynamics and may increase the risk of gas embolism for patients.…”

Section: Introductionmentioning

confidence: 99%

Low preoperative serum total bilirubin level is a risk factor for intraoperative blood loss in the laparoscopic hepatectomy ---a retrospective study

Liu

Yang

et al. 2023

Preprint

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Background Reduction of Intraoperative blood loss (IBL) is necessary for laparoscopic hepatectomy (LH). However, the risk factors before liver resection for IBL in LH is poorly understood. The research aimed to analyze the risk factors before liver resection for IBL in LH. Methods The data of consecutive patients who underwent LH for hepatocellular carcinoma from 2021 to 2022, were retrieved retrospectively. The patients were divided into two groups: the group A was for those with an IBL less than 250 mL (Group A, IBL༜250ml), and the group B was for those with an IBL more than 250 mL (Group B, IBL ≥ 250ml). Results We analyzed 246 patients who underwent LH. Median IBL was 250 (IQR: 100–500) ml in our research. Tumor size ≥ 3cm contributed to a higher level of IBL with Odds ratio of 2.496(95% CI 1.422–4.381, p = 0.001). High preoperative total bilirubin levels may be a protective factor for IBL ≥ 250ml and Odds ratio was 0.438༈95% CI 0.258–0.743, p = 0.002༉and a dose-response relationship was observed. In other words, low preoperative total bilirubin levels may be a risk factor for IBL ≥ 250ml. After correcting for other variables of characteristics, their statistical significance remained unchanged. The incidence of postoperative complications was 16.3%. The incidence of postoperative complications was significantly higher in Group B compared to Group A (21.8 vs. 10.7%, p = 0.018). Conclusions Increased IBL (≥ 250 ml) may adversely impact the short-term outcomes. In addition to tumor size, low preoperative serum total bilirubin level may be a risk factor for blood loss in LH.

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The influence of PEEP and positioning on central venous pressure and venous hepatic hemodynamics in patients undergoing liver resection

Cited by 14 publications

References 29 publications

A systematic surgical procedure: The ̔7+3̓ approach to laparoscopic right partial hepatectomy [deep segment (S) VI, S VII or S VIII] in 52ï¿½patients with liver tumors

A systematic surgical procedure: The ̔7+3̓ approach to laparoscopic right partial hepatectomy [deep segment (S) VI, S VII or S VIII] in 52ï¿½patients with liver tumors

Research progress on microcirculatory disorders in septic shock: A narrative review

Low preoperative serum total bilirubin level is a risk factor for intraoperative blood loss in the laparoscopic hepatectomy ---a retrospective study

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