TY  - JOUR
U1  - Wissenschaftlicher Artikel
A1  - Schiefenhövel, Fridtjof
A1  - Trauzeddel, Ralf Felix
A1  - Sander, Michael
A1  - Heringlake, Matthias
A1  - Groesdonk, Heinrich Volker
A1  - Grubitzsch, Herko
A1  - Kruppa-Scheetz, Jochen
A1  - Berger, Christian
A1  - Treskatsch, Sascha
A1  - Balzer, Felix
T1  - High Central Venous Pressure after Cardiac Surgery Might Depict Hemodynamic Deterioration Associated with Increased Morbidity and Mortality
JF  - Journal of Clinical Medicine (JCM)
N2  - 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.
KW  - Central venous pressure
KW  - Cardiac surgery
KW  - Outcome
KW  - Venous congestion
Y1  - 2021
UN  - https://nbn-resolving.org/urn:nbn:de:bsz:959-opus-59027
SN  - 2077-0383
SS  - 2077-0383
U6  - https://doi.org/10.3390/jcm10173945
DO  - https://doi.org/10.3390/jcm10173945
VL  - 10
IS  - 17
SP  - 12
S1  - 12
ER  -