Central venous pressure monitor and esophageal Doppler monitor: Comparison of preload measurements during cytoreductive surgery

Intraoperative fluid volume optimization is paramount to tissue perfusion and oxygen transportation to the cells. Invasive central venous pressure (CVP) monitoring is the “Gold Standard” tool for early detection of intraoperative fluid deficits from surgical interventions resulting in massive intravascular fluid disruptions. Accuracy of CVP measurement is subject to error from improper equipment use, improper placement of the monitoring catheter, and certain patient positions. Traditionally the esophageal echo Doppler monitor (EEDM) measurements have not been directly compared to CVP measurements. This retrospective chart review grossly examines the graphic trending of concurrent data from CVP and the EEDM measurements of aortic blood flow (ABF) and aortic stroke volume (SVa). In a retrospective medical record review, examination of these variables was conducted in a sample of cytoreductive surgery patients. From January 1–May 21, 2001, post-anesthesia care unit (PACU) admission records of 15 potential participants (monitored with CVP and EEDM) were identified at a 550-bed southeastern hospital in the United States. One participant was removed from the study, as the medical record could not be located. Of the remaining 14, 11 participants received heated intraoperative intraperitoneal chemotherapy (HIIC), however 3 of this 11 had their EEDM discontinued for undocumented reasons. Clinician documentation of frequent EEDM probe disruption occurred during tumor resection near the stomach and diaphragms. Data were complete in 8 records during the HIIC phase. Graphic trends of data revealed similar patterns in CVP and ABF values. The SVa pattern trends differed from CVP and ABF patterns, probably because these data reflect beat-to-beat changes while CVP and ABF values reflect values averaged over longer time periods. Other observations included early extubation in 5 of 8 HIIC participants. Critical electrolyte disturbances (potassium, magnesium, calcium, and phosphorous) and coagulopathies persisted into the postoperative period. PACU chest x-ray reports were unchanged in 7 participants, bi-basilar atalectasis occurred in 4 participants, pulmonary effusion was present in 1 participant, and 1 participant experienced pulmonary congestion. In conclusion, the observation a of potential correlation between CVP and ABF and the promise of cost-effective improvement in patient care (i.e., early extubation) warrants future controlled research for statistical verification of these findings.