MECHANISM OF INJURY, ASSOCIATED OUTCOME AND INTERVENTION

Learn more about venous hypertension causing cerebral desaturation:

Mechanism of Injury

  • As perfusion pressure is the difference between MAP and central venous pressure, venous hypertension has a detrimental effect on end-organ perfusion pressure.
  • In patients undergoing off-pump coronary artery bypass graft, increased central venous pressure resulting from positioning of the heart for distal anastomoses during off-pump coronary artery bypass grafting is associated with cerebral desaturation.([FOOTNOTE=Moritz S, Rochon J, Volkel S, et al. Determinants of cerebral oximetry in patients undergoing off-pump coronary artery bypass grafting: an observational study. European journal of anaesthesiology. 2010;27(6):542-549.],[ANCHOR=View Abstract],[LINK=/content/mitg/websites/languagemasters/emea/en-gb/support/clinical-evidence.html?id=569318])
  • Increases in CVP caused by Trendelenburg positioning during off-pump coronary artery bypass graft may result in reduced cerebral blood flow.([FOOTNOTE=Talpahewa SP, Ascione R, Angelini GD, Lovell AT. Cerebral cortical oxygenation changes during OPCAB surgery. The Annals of thoracic surgery. 2003;76(5):1516-1522; discussion 1522. ],[ANCHOR=View Abstract],[LINK=/content/mitg/websites/languagemasters/emea/en-gb/support/clinical-evidence.html?id=883119])
  • Murkin et al identified increases in CVP due to right ventricular inflow obstruction as the most likely determinant of change in cerebral perfusion pressure during off-pump coronary artery bypass graft.([FOOTNOTE=Murkin JM. Hemodynamic changes during cardiac manipulation in off-CPB surgery: relevance in brain perfusion. The heart surgery forum. 2002;5(3):221-224.],[ANCHOR=View Abstract],[LINK=/content/mitg/websites/languagemasters/emea/en-gb/support/clinical-evidence.html?id=883114])

Associated Outcome

  • In CABG patients, increased CVP in the immediate postoperative period is highly predictive of mortality and renal failure.([FOOTNOTE=Williams JB, Peterson ED, Wojdyla D, et al. Central venous pressure after coronary artery bypass surgery: does it predict postoperative mortality or renal failure? Journal of critical care. 2014;29(6):1006-1010.],[ANCHOR=View Abstract],[LINK=/content/mitg/websites/languagemasters/emea/en-gb/support/clinical-evidence.html?id=883120])
Intervention % of all interventions([FOOTNOTE=Deschamps A, Lambert J, Couture P, et al. Reversal of decreases in cerebral saturation in high-risk cardiac surgery. Journal of cardiothoracic and vascular anesthesia. 2013;27(6):1260-1266.],[ANCHOR=View Abstract],[LINK=/content/mitg/websites/languagemasters/emea/en-gb/support/clinical-evidence.html?id=805152])
Change in head position/Reduce Central Venous Pressure 7.4