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Effect of hypoventilation on bleeding during hepatic resection: a randomized controll
Source:
Arch Surg. 2002 Mar;137(3):311-5.
Full Text Article (Fee):
http://archsurg.ama-assn.org/cgi/content/full/137/3/311
Effect of hypoventilation on bleeding during hepatic resection: a randomized controlled trial.
Hasegawa K, Takayama T, Orii R, Sano K, Sugawara Y, Imamura H, Kubota K, Makuuchi M.
Division of Hepato-Biliary-Pancreatic and Transplantation Surgery, Department of Surgery, Faculty of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
HYPOTHESIS: Blood loss in hepatic resection is an important determinant of operative outcome. OBJECTIVE: To clarify whether reducing the tidal volume would be effective in decreasing blood loss during liver transection. DESIGN: Randomized controlled trial. SETTING: University hospital. PATIENTS: Eighty patients scheduled to undergo hepatic resection were randomly assigned to receive liver transection under normoventilation (n = 40) or hypoventilation (n = 40). INTERVENTIONS: During liver transection, in the normoventilation group, the tidal volume was 10 mL/kg and the respiratory rate was 10/min; in the hypoventilation group, the tidal volume was reduced to 4 mL/kg and respiratory rate was increased to 15/min. Liver transection was performed under total or selective inflow occlusion. MAIN OUTCOME MEASURE: Blood loss. RESULTS: Between the normoventilation and hypoventilation groups, no significant difference was found in total blood loss (median [range]: 630 mL [72-3600 mL] vs 630 mL [120-3520 mL]; P =.44) or blood loss per transection area (median [range]: 7.3 mL/cm(2) [1.2-55.4 mL/cm(2)] vs 9.8 mL/cm(2) [0.9-79.9 mL/cm(2)]; P =.55). During liver transection, the central venous pressure was significantly reduced in the hypoventilation group than in the normoventilation group (median [range]: -0.7 cm H(2)O [-3.0 to 1.8 cm H(2)O] vs -0.2 cm H(2)O [-4.0 to 2.0 cm H(2)O]; P =.007). The maximum end-tidal carbon dioxide level in the hypoventilation group was significantly higher than that in the normoventilation group (maximum [range]: 50 mm Hg [28-66 mm Hg] vs 37 mm Hg [27-60 mm Hg]; P<.001). Transection time, postoperative liver function, hospitalization length, morbidity, and mortality were similar in the 2 groups. CONCLUSION: This randomized trial suggested no beneficial effect of reduction of tidal volume on bleeding during hepatic resection.
Publication Types: - Clinical Trial
- Randomized Controlled Trial
PMID: 11888456 [PubMed - indexed for MEDLINE]
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