Disminución de la presión venosa central: efecto sobre el gasto cardíaco

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Abstract

Introduction The reduction of central venous pressure (CVP) below 5 mmHg has been recommended to decrease bleeding during hepatic surgery. The effect of this practice on cardiac function has not been quantified. Objective To measure the repercussion of the decrease of CVP on left ventricular end diastolic volume (LVEDV) and cardiac index (CI). Method Patients undergoing general anaesthesia for major surgery were studied. Monitoring included direct arterial pressure, CVP, and transesophageal echocardiography (TEE). During a stable period of anaesthesia, all of these parameters were measured before and after lowering CVP to 3-4 mmHg. Results Thirty-two patients were studied. Twelve patients met TEE diagnostic criteria for diastolic dysfunction (DD). Basal and post CVP reduction values of LVEDVI and CI were 49.4 ± 13 and 40.1 ± 13 ml/m2, 2.8 ± 0.56 and 2.5 ± 0.7 l/m2 respectively (both P < .01). All these variations were greater in patients with DD. Conclusions Reduction of CVP produced a moderate but significant decrease in LVEDV and CI This should be considered in patients with conditions that may increase the effect of decreasing the CVP.

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Concha P., M., Mertz K., V., Cortínez F., L., Jarufe C., N., Martínez C., J., Guerra C., J. F., & Carmona B., J. (2017). Disminución de la presión venosa central: efecto sobre el gasto cardíaco. Revista Chilena de Cirugia, 69(4), 310–314. https://doi.org/10.1016/j.rchic.2017.01.001

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