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Article

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

by
Fridtjof Schiefenhövel
1,2,
Ralf F. Trauzeddel
3,
Michael Sander
4,
Matthias Heringlake
5,
Heinrich V. Groesdonk
6,
Herko Grubitzsch
7,
Jochen Kruppa
2,
Christian Berger
3,
Sascha Treskatsch
3,† and
Felix Balzer
1,2,*,†
1
Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13353 Berlin, Germany
2
Institute of Medical Informatics, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany
3
Department of Anesthesiology and Intensive Care Medicine, Charité Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt-Universität zu Berlin, 12203 Berlin, Germany
4
Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital of Gießen, Justus-Liebig University Giessen, 35392 Gießen, Germany
5
Department of Anesthesia, Heart and Diabetes Center, Klinikum Karlsburg, 17495 Karlsburg, Germany
6
Department of Intensive Care Medicine, Helios Klinikum Erfurt, 99089 Erfurt, Germany
7
Department of Cardiovascular Surgery, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
*
Author to whom correspondence should be addressed.
†
These authors contributed equally.
J. Clin. Med. 2021, 10(17), 3945; https://doi.org/10.3390/jcm10173945
Submission received: 8 August 2021 / Revised: 27 August 2021 / Accepted: 31 August 2021 / Published: 31 August 2021
(This article belongs to the Special Issue Interdisciplinary Intensive Care)
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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.
Keywords: central venous pressure; cardiac surgery; outcome; venous congestion central venous pressure; cardiac surgery; outcome; venous congestion

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MDPI and ACS Style

Schiefenhövel, F.; Trauzeddel, R.F.; Sander, M.; Heringlake, M.; Groesdonk, H.V.; Grubitzsch, H.; Kruppa, J.; Berger, C.; Treskatsch, S.; Balzer, F. High Central Venous Pressure after Cardiac Surgery Might Depict Hemodynamic Deterioration Associated with Increased Morbidity and Mortality. J. Clin. Med. 2021, 10, 3945. https://doi.org/10.3390/jcm10173945

AMA Style

Schiefenhövel F, Trauzeddel RF, Sander M, Heringlake M, Groesdonk HV, Grubitzsch H, Kruppa J, Berger C, Treskatsch S, Balzer F. High Central Venous Pressure after Cardiac Surgery Might Depict Hemodynamic Deterioration Associated with Increased Morbidity and Mortality. Journal of Clinical Medicine. 2021; 10(17):3945. https://doi.org/10.3390/jcm10173945

Chicago/Turabian Style

Schiefenhövel, Fridtjof, Ralf F. Trauzeddel, Michael Sander, Matthias Heringlake, Heinrich V. Groesdonk, Herko Grubitzsch, Jochen Kruppa, Christian Berger, Sascha Treskatsch, and Felix Balzer. 2021. "High Central Venous Pressure after Cardiac Surgery Might Depict Hemodynamic Deterioration Associated with Increased Morbidity and Mortality" Journal of Clinical Medicine 10, no. 17: 3945. https://doi.org/10.3390/jcm10173945

APA Style

Schiefenhövel, F., Trauzeddel, R. F., Sander, M., Heringlake, M., Groesdonk, H. V., Grubitzsch, H., Kruppa, J., Berger, C., Treskatsch, S., & Balzer, F. (2021). High Central Venous Pressure after Cardiac Surgery Might Depict Hemodynamic Deterioration Associated with Increased Morbidity and Mortality. Journal of Clinical Medicine, 10(17), 3945. https://doi.org/10.3390/jcm10173945

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