High Central Venous Pressure after Cardiac Surgery Might Depict Hemodynamic Deterioration Associated with Increased Morbidity and Mortality
Open accessAbstract
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.
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Central venous pressure remains a vital part of the hemodynamic monitoring post-cardiopulmonary bypass, despite its limited utility in assessing fluid responsiveness.
“Central venous pressure (CVP), measured at the junction of the superior vena cava and right atrium, remains a vital part of the hemodynamic monitoring post-cardiopulmonary bypass, despite its limited utility in assessing fluid responsiveness [15,16].”
From Trends and Challenges in Noninvasive Hemodynamic Monitoring of Neonates Following Cardiac Surgery: A Narrative Review (2025) · cites this paper as [15]
Current clinical guidelines emphasize the utility of CVP monitoring and recommend maintaining CVP at the lowest feasible level.
“Current clinical guidelines emphasize the utility of CVP monitoring and recommend maintaining CVP at the lowest feasible level [15].”
From Trends and Challenges in Noninvasive Hemodynamic Monitoring of Neonates Following Cardiac Surgery: A Narrative Review (2025) · cites this paper as [15]
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- Authors
- Schiefenhövel, F., Trauzeddel, R. F., Sander, M., Heringlake, M., Groesdonk, H. V., Grubitzsch, H., Kruppa, J., Berger, C., Treskatsch, S., & Balzer, F.
- Affiliations
- Humboldt-Universität zu Berlin (DE)
- Justus-Liebig-Universität Gießen (DE)
- Department of Anesthesia, Heart and Diabetes Center, Klinikum Karlsburg, 17495 Karlsburg, Germany
- Helios Klinikum Erfurt (DE)
- Corresponding author
- Balzer, Felix
- ORCID
- Venue
- Journal of Clinical Medicine
- Publisher
- MDPI AG
- Published
- 2021-08-31
- Volume
- 10
- Issue
- 17
- Pages
- 3945
- ISSN
- 2077-0383 (ISSN-L)
- PMC
- PMC8432196
- OpenAlex
- W3198867814
- Cited by
- 19
- References
- 50
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 1 · 2023: 2 · 2022: 4
- FWCI
- 1.64
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of Clinical Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion)
- Library Osnabrück University (Hochschule Osnabrück) (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Abdominal Surgery and Complications
- Keywords
- central venous pressure, cardiac surgery, postoperative hemodynamic monitoring, ICU mortality, prognostic factors, mechanical ventilation, acute kidney injury, renal replacement therapy, postoperative liver dysfunction, MELD score, postoperative morbidity
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