Annals of hepato-biliary-pancreatic surgery · 2026
Feasibility of using head up patient position in maintaining low central venous pressure and restricting the need for pharmacological agents during major hepatectomy.
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Jain Sundeep, Gupta Deepak Kumar, Agarwal Akhil, Nigam Anjali, Bhargava Jyotsna, Gupta Rajeev, Agarwal Shubham
Аннотация
BACKGROUNDS/AIMS: Head-up position is used with fluid restriction and medications to achieve low central venous pressure (LCVP). We evaluated application of head-up position for its effectiveness, safety and potential to reduce need for complex drug interventions in achieving LCVP during hepatectomy.
METHODS: This prospective study included 50 patients undergoing major hepatectomies from 2019 to 2024. CVP was measured in supine, 10 cm and 20 cm head-up positions during liver resection. We assessed relationship between supine CVP and head-up positions with the need for supplemental pharmacological intervention using regression analysis. Additionally, we evaluated correlation between LCVP fluctuation, blood loss, and head-up position.
RESULTS: Mean blood loss was 204.6 ± 29.2 mL, with no incidents of air embolism, hemodynamic instability, renal dysfunction, blood transfusion, or 90-day mortality. Mean CVP values were 7.370 ± 4.094 mmHg in supine, 3.360 ± 4.304 mmHg at head-up 10 cm, and -0.780 ± 4.663 mmHg at head-up 20 cm positions, demonstrating a progressive reduction with each position (p < 0.001). High adjusted R2 identified supine CVP as significant predictor of CVP at head-up positions, indicating strong linear relationship (p < 0.001). LCVP was achieved in 47/50 patients using 20 cm head-up position, while in 3/50 patients with supine CVP > 10 mmHg, additional medications were required. Correlation between blood loss and LCVP fluctuation (ρ = 0.169) was insignificant (p = 0.240), while that between head-up position and LCVP fluctuation (ρ = 0.383) was significant (p = 0.006).
CONCLUSIONS: LCVP can be effectively achieved using a 20 cm head-up position, with the potential to limit drug usage in the majority of patients.
METHODS: This prospective study included 50 patients undergoing major hepatectomies from 2019 to 2024. CVP was measured in supine, 10 cm and 20 cm head-up positions during liver resection. We assessed relationship between supine CVP and head-up positions with the need for supplemental pharmacological intervention using regression analysis. Additionally, we evaluated correlation between LCVP fluctuation, blood loss, and head-up position.
RESULTS: Mean blood loss was 204.6 ± 29.2 mL, with no incidents of air embolism, hemodynamic instability, renal dysfunction, blood transfusion, or 90-day mortality. Mean CVP values were 7.370 ± 4.094 mmHg in supine, 3.360 ± 4.304 mmHg at head-up 10 cm, and -0.780 ± 4.663 mmHg at head-up 20 cm positions, demonstrating a progressive reduction with each position (p < 0.001). High adjusted R2 identified supine CVP as significant predictor of CVP at head-up positions, indicating strong linear relationship (p < 0.001). LCVP was achieved in 47/50 patients using 20 cm head-up position, while in 3/50 patients with supine CVP > 10 mmHg, additional medications were required. Correlation between blood loss and LCVP fluctuation (ρ = 0.169) was insignificant (p = 0.240), while that between head-up position and LCVP fluctuation (ρ = 0.383) was significant (p = 0.006).
CONCLUSIONS: LCVP can be effectively achieved using a 20 cm head-up position, with the potential to limit drug usage in the majority of patients.