Meta-Analysis
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World J Gastroenterol. Jan 7, 2014; 20(1): 303-309
Published online Jan 7, 2014. doi: 10.3748/wjg.v20.i1.303
Controlled low central venous pressure reduces blood loss and transfusion requirements in hepatectomy
Zhi Li, Yu-Ming Sun, Fei-Xiang Wu, Li-Qun Yang, Zhi-Jie Lu, Wei-Feng Yu
Zhi Li, Yu-Ming Sun, Fei-Xiang Wu, Li-Qun Yang, Zhi-Jie Lu, Wei-Feng Yu, Department of Anesthesiology, Eastern Hepatobiliary Surgery Hospital, the Second Military Medical University, Shanghai 200438, China
Author contributions: Li Z and Sun YM contributed equally to this study; Yu WF and Li Z designed the study and wrote the manuscript; Li Z and Sun YM performed the majority of analyses; Li Z, Wu FX, Yang LQ and Lu ZJ were also involved in revising the manuscript.
Correspondence to: Wei-Feng Yu, MD, Professor, Department of Anaesthesiology, Eastern Hepatobiliary Surgery Hospital, the Second Military Medical University, No. 225, Changhai Road, Shanghai 200438, China. ywf808@sohu.com
Telephone: +86-21-81875231 Fax: +86-21-81875231
Received: August 18, 2013
Revised: October 7, 2013
Accepted: November 1, 2013
Published online: January 7, 2014
Processing time: 154 Days and 20.8 Hours
Abstract

AIM: To evaluate the effect of low central venous pressure (LCVP) on blood loss and blood transfusion in patients undergoing hepatectomy.

METHODS: Electronic databases and bibliography lists were searched for potential articles. A meta-analysis of all randomized controlled trials (RCTs) investigating LCVP in hepatectomy was performed. The following three outcomes were analyzed: blood loss, blood transfusion and duration of operation.

RESULTS: Five RCTs including 283 patients were assessed. Meta-analysis showed that blood loss in the LCVP group was significantly less than that in the control group (MD = -391.95, 95%CI: -559.35--224.56, P < 0.00001). In addition, blood transfusion in the LCVP group was also significantly less than that in the control group (MD = -246.87, 95%CI: -427.06--66.69, P = 0.007). The duration of operation in the LCVP group was significantly shorter than that in the control group (MD = -18.89, 95%CI: -35.18--2.59, P = 0.02). Most studies found no significant difference in renal and liver function between the two groups.

CONCLUSION: Controlled LCVP is a simple and effective technique to reduce blood loss and blood transfusion during liver resection, and appears to have no detrimental effects on liver and renal function.

Keywords: Low central venous pressure; Hepatectomy; Blood loss; Blood transfusion

Core tip: The morbidity and mortality after hepatic resection have been reported to correlate with excessive intraoperative blood loss and blood transfusion. This meta-analysis showed that controlled low central venous pressure is a simple and effective technique to reduce blood loss and blood transfusion during liver resection, and appears to have no detrimental effects on liver and renal function.