Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/21515
Title: Is venous congestion associated with reduced cerebral oxygenation and worse neurological outcome after cardiac arrest?
Authors: Ameloot, Koen
GENBRUGGE, Cornelia 
MEEX, Ingrid 
EERTMANS, Ward 
JANS, Frank 
DE DEYNE, Cathy 
DENS, Jo 
MULLENS, Wilfried 
Ferdinande, Bert
DUPONT, Matthias 
Issue Date: 2016
Source: CRITICAL CARE, 20
Abstract: Background: Post-cardiac arrest (CA) patients are at risk of secondary ischemic damage in the case of suboptimal brain oxygenation during an ICU stay. We hypothesized that elevated central venous pressures (CVP) would impair cerebral perfusion and oxygenation (venous cerebral congestion). The aim of the present study was to investigate the relationship between CVP, cerebral tissue oxygen saturation (SctO2) as assessed with near-infrared spectroscopy (NIRS) and outcome in post-CA patients. Methods: This was an observational study in 48 post-CA patients with continuous CVP and SctO2 monitoring during therapeutic hypothermia. Results: The relationship between CVP and mean SctO2 was best described by an S-shaped, third-degree polynomial regression curve (SctO2 = −0.002 × CVP3 + 0.08 × CVP2 – 1.07 × CVP + 69.78 %, R2 0.89, n = 1,949,108 data points) with high CVP (>20 mmHg) being associated with cerebral desaturation. Multivariate linear regression revealed CVP to be a more important determinant of SctO2 than mean arterial pressure (MAP) without important interaction between both (SctO2 = 0.01 × MAP – 0.20 × CVP + 0.001 × MAP × CVP + 65.55 %). CVP and cardiac output were independent determinants of SctO2 with some interaction between both (SctO2 = 1.86 × CO – 0.09 × CVP – 0.05 × CO × CVP + 60.04 %). Logistic regression revealed that a higher percentage of time with CVP above 5 mmHg was associated with lower chance of survival with a good neurological outcome (cerebral performance category (CPC) 1–2) at 180 days (OR 0.96, 95 % CI 0.92–1.00, p = 0.04). In a multivariate model, the negative association between CVP and outcome persisted after correction for hemodynamic variables, including ejection fraction and MAP. Conclusions: Elevated CVP results in lower brain saturation and is associated with worse outcome in post-CA patients. This pilot study provides support that venous cerebral congestion as indicated by high CVP may be detrimental for post-CA patients.
Keywords: post-cardiac arrest; central venous pressure; cerebral perfusion; outcome
Document URI: http://hdl.handle.net/1942/21515
ISSN: 1466-609X
e-ISSN: 1364-8535
DOI: 10.1186/s13054-016-1297-2
ISI #: 000375771300001
Rights: © 2016 Ameloot et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Category: A1
Type: Journal Contribution
Validations: ecoom 2017
Appears in Collections:Research publications

Files in This Item:
File Description SizeFormat 
art%3A10.1186%2Fs13054-016-1297-2.pdfpublished version747.95 kBAdobe PDFView/Open
Show full item record

SCOPUSTM   
Citations

18
checked on Sep 3, 2020

WEB OF SCIENCETM
Citations

18
checked on May 21, 2022

Page view(s)

52
checked on May 20, 2022

Download(s)

84
checked on May 20, 2022

Google ScholarTM

Check

Altmetric


Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.