The impact of pelvic venous pressure on blood loss during open radical cystectomy and urinary diversion: Results from a secondary analysis of a randomized clinical trial

Wüthrich, Patrick Yves; Burkhard, Fiona C.; Thalmann, George; Stüber, Frank; Studer, Urs (2015). The impact of pelvic venous pressure on blood loss during open radical cystectomy and urinary diversion: Results from a secondary analysis of a randomized clinical trial. Journal of urology, 194(1), pp. 146-152. Elsevier 10.1016/j.juro.2014.12.094

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PURPOSE Blood loss and blood substitution are associated with higher morbidity after major abdominal surgery. During major liver resection, low local venous pressure, has been shown to reduce blood loss. Ambiguity persists concerning the impact of local venous pressure on blood loss during open radical cystectomy. We aimed to determine the association between intraoperative blood loss and pelvic venous pressure (PVP) and determine factors affecting PVP. MATERIAL AND METHODS In the frame of a single-center, double-blind, randomized trial, PVP was measured in 82 patients from a norepinephrine/low-volume group and in 81 from a control group with liberal hydration. For this secondary analysis, patients from each arm were stratified into subgroups with PVP <5 mmHg or ≥5 mmHg measured after cystectomy (optimal cut-off value for discrimination of patients with relevant blood loss according to the Youden's index). RESULTS Median blood loss was 800 ml [range: 300-1600] in 55/163 patients (34%) with PVP <5 mmHg and 1200 ml [400-3000] in 108/163 patients (66%) with PVP ≥5 mmHg; (P<0.0001). A PVP <5 mmHg was measured in 42/82 patients (51%) in the norepinephrine/low-volume group and 13/81 (16%) in the control group (P<0.0001). PVP dropped significantly after removal of abdominal packing and abdominal lifting in both groups at all time points (at begin and end of pelvic lymph node dissection, end of cystectomy) (P<0.0001). No correlation between PVP and central venous pressure could be detected. CONCLUSIONS Blood loss was significantly reduced in patients with low PVP. Factors affecting PVP were fluid management and abdominal packing.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Urology
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy

UniBE Contributor:

Wüthrich, Patrick Yves; Burkhard, Fiona C.; Thalmann, George; Stüber, Frank and Studer, Urs

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0022-5347

Publisher:

Elsevier

Language:

English

Submitter:

Jeannie Wurz

Date Deposited:

26 Feb 2015 13:41

Last Modified:

23 Jan 2018 12:15

Publisher DOI:

10.1016/j.juro.2014.12.094

PubMed ID:

25577973

Uncontrolled Keywords:

radical cystectomy, blood loss, fluid management, norepinephrine, pelvic venous pressure

BORIS DOI:

10.7892/boris.63404

URI:

https://boris.unibe.ch/id/eprint/63404

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