Low central venous pressure versus acute normovolemic hemodilution versus conventional fluid management for reducing blood loss in radical retropubic prostatectomy: A randomized controlled trial

Ashraf S. Habib, Judd W. Moul, Thomas J. Polascik, Cary N. Robertson, Anthony M. Roche, William D. White, Stephen E. Hill, Israel Nosnick, Tong J. Gan

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective: To compare acute normovolemic hemodilution versus low central venous pressure strategy versus conventional fluid management in reducing intraoperative estimated blood loss, hematocrit drop and need for blood transfusion in patients undergoing radical retropubic prostatectomy under general anesthesia. Research design and methods: Patients undergoing radical retropubic prostatectomy under general anesthesia were randomized to conventional fluid management, acute normovolemic hemodilution or low central venous pressure (≤5mmHg). Treatment effects on estimated blood loss and hematocrit change were tested in multivariable regression models accounting for surgeon, prostate size, and all two-way interactions. Results: Ninety-two patients completed the study. Estimated blood loss (mean±SD) was significantly lower with low central venous pressure (706±362ml) compared to acute normovolemic hemodilution (1103±635ml) and conventional (1051±714ml) groups (p=0.0134). There was no difference between the groups in need for blood transfusion, or hematocrit drop from preoperative values. The multivariate model predicting estimated blood loss showed a significant effect of treatment (p=0.0028) and prostate size (p=0.0323), accounting for surgeon (p=0.0013). In the model predicting hematocrit change, accounting for surgeon difference (p=0.0037), the treatment effect depended on prostate size (p=0.0007) with the slope of low central venous pressure differing from the other two groups. Hematocrit was predicted to drop more with increased prostate size in acute normovolemic hemodilution and conventional groups but not with low central venous pressure. Key limitations: Limitations include the inability to blind providers to group assignment, possible variability between providers in estimation of blood loss, and the relatively small sample size that was not powered to detect differences between the groups in need for blood transfusion. Conclusions: Maintaining low central venous pressure reduced estimated blood loss compared to conventional fluid management and acute normovolemic hemodilution in patients undergoing radical retropubic prostatectomy but there was no difference in allogeneic blood transfusion between the groups.

Original languageEnglish (US)
Pages (from-to)937-943
Number of pages7
JournalCurrent Medical Research and Opinion
Volume30
Issue number5
DOIs
StatePublished - 2014

Fingerprint

Hemodilution
Central Venous Pressure
Prostatectomy
Hematocrit
Randomized Controlled Trials
Blood Transfusion
Prostate
General Anesthesia
Sample Size
Research Design
Therapeutics
Surgeons

Keywords

  • Blood loss
  • Central venous pressure
  • Fluid management
  • Hemodilution
  • Prostatectomy

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Low central venous pressure versus acute normovolemic hemodilution versus conventional fluid management for reducing blood loss in radical retropubic prostatectomy : A randomized controlled trial. / Habib, Ashraf S.; Moul, Judd W.; Polascik, Thomas J.; Robertson, Cary N.; Roche, Anthony M.; White, William D.; Hill, Stephen E.; Nosnick, Israel; Gan, Tong J.

In: Current Medical Research and Opinion, Vol. 30, No. 5, 2014, p. 937-943.

Research output: Contribution to journalArticle

Habib, Ashraf S. ; Moul, Judd W. ; Polascik, Thomas J. ; Robertson, Cary N. ; Roche, Anthony M. ; White, William D. ; Hill, Stephen E. ; Nosnick, Israel ; Gan, Tong J. / Low central venous pressure versus acute normovolemic hemodilution versus conventional fluid management for reducing blood loss in radical retropubic prostatectomy : A randomized controlled trial. In: Current Medical Research and Opinion. 2014 ; Vol. 30, No. 5. pp. 937-943.
@article{708527b8aefa4d43a3498e38926bd983,
title = "Low central venous pressure versus acute normovolemic hemodilution versus conventional fluid management for reducing blood loss in radical retropubic prostatectomy: A randomized controlled trial",
abstract = "Objective: To compare acute normovolemic hemodilution versus low central venous pressure strategy versus conventional fluid management in reducing intraoperative estimated blood loss, hematocrit drop and need for blood transfusion in patients undergoing radical retropubic prostatectomy under general anesthesia. Research design and methods: Patients undergoing radical retropubic prostatectomy under general anesthesia were randomized to conventional fluid management, acute normovolemic hemodilution or low central venous pressure (≤5mmHg). Treatment effects on estimated blood loss and hematocrit change were tested in multivariable regression models accounting for surgeon, prostate size, and all two-way interactions. Results: Ninety-two patients completed the study. Estimated blood loss (mean±SD) was significantly lower with low central venous pressure (706±362ml) compared to acute normovolemic hemodilution (1103±635ml) and conventional (1051±714ml) groups (p=0.0134). There was no difference between the groups in need for blood transfusion, or hematocrit drop from preoperative values. The multivariate model predicting estimated blood loss showed a significant effect of treatment (p=0.0028) and prostate size (p=0.0323), accounting for surgeon (p=0.0013). In the model predicting hematocrit change, accounting for surgeon difference (p=0.0037), the treatment effect depended on prostate size (p=0.0007) with the slope of low central venous pressure differing from the other two groups. Hematocrit was predicted to drop more with increased prostate size in acute normovolemic hemodilution and conventional groups but not with low central venous pressure. Key limitations: Limitations include the inability to blind providers to group assignment, possible variability between providers in estimation of blood loss, and the relatively small sample size that was not powered to detect differences between the groups in need for blood transfusion. Conclusions: Maintaining low central venous pressure reduced estimated blood loss compared to conventional fluid management and acute normovolemic hemodilution in patients undergoing radical retropubic prostatectomy but there was no difference in allogeneic blood transfusion between the groups.",
keywords = "Blood loss, Central venous pressure, Fluid management, Hemodilution, Prostatectomy",
author = "Habib, {Ashraf S.} and Moul, {Judd W.} and Polascik, {Thomas J.} and Robertson, {Cary N.} and Roche, {Anthony M.} and White, {William D.} and Hill, {Stephen E.} and Israel Nosnick and Gan, {Tong J.}",
year = "2014",
doi = "10.1185/03007995.2013.877436",
language = "English (US)",
volume = "30",
pages = "937--943",
journal = "Current Medical Research and Opinion",
issn = "0300-7995",
publisher = "Taylor and Francis Ltd.",
number = "5",

}

TY - JOUR

T1 - Low central venous pressure versus acute normovolemic hemodilution versus conventional fluid management for reducing blood loss in radical retropubic prostatectomy

T2 - A randomized controlled trial

AU - Habib, Ashraf S.

AU - Moul, Judd W.

AU - Polascik, Thomas J.

AU - Robertson, Cary N.

AU - Roche, Anthony M.

AU - White, William D.

AU - Hill, Stephen E.

AU - Nosnick, Israel

AU - Gan, Tong J.

PY - 2014

Y1 - 2014

N2 - Objective: To compare acute normovolemic hemodilution versus low central venous pressure strategy versus conventional fluid management in reducing intraoperative estimated blood loss, hematocrit drop and need for blood transfusion in patients undergoing radical retropubic prostatectomy under general anesthesia. Research design and methods: Patients undergoing radical retropubic prostatectomy under general anesthesia were randomized to conventional fluid management, acute normovolemic hemodilution or low central venous pressure (≤5mmHg). Treatment effects on estimated blood loss and hematocrit change were tested in multivariable regression models accounting for surgeon, prostate size, and all two-way interactions. Results: Ninety-two patients completed the study. Estimated blood loss (mean±SD) was significantly lower with low central venous pressure (706±362ml) compared to acute normovolemic hemodilution (1103±635ml) and conventional (1051±714ml) groups (p=0.0134). There was no difference between the groups in need for blood transfusion, or hematocrit drop from preoperative values. The multivariate model predicting estimated blood loss showed a significant effect of treatment (p=0.0028) and prostate size (p=0.0323), accounting for surgeon (p=0.0013). In the model predicting hematocrit change, accounting for surgeon difference (p=0.0037), the treatment effect depended on prostate size (p=0.0007) with the slope of low central venous pressure differing from the other two groups. Hematocrit was predicted to drop more with increased prostate size in acute normovolemic hemodilution and conventional groups but not with low central venous pressure. Key limitations: Limitations include the inability to blind providers to group assignment, possible variability between providers in estimation of blood loss, and the relatively small sample size that was not powered to detect differences between the groups in need for blood transfusion. Conclusions: Maintaining low central venous pressure reduced estimated blood loss compared to conventional fluid management and acute normovolemic hemodilution in patients undergoing radical retropubic prostatectomy but there was no difference in allogeneic blood transfusion between the groups.

AB - Objective: To compare acute normovolemic hemodilution versus low central venous pressure strategy versus conventional fluid management in reducing intraoperative estimated blood loss, hematocrit drop and need for blood transfusion in patients undergoing radical retropubic prostatectomy under general anesthesia. Research design and methods: Patients undergoing radical retropubic prostatectomy under general anesthesia were randomized to conventional fluid management, acute normovolemic hemodilution or low central venous pressure (≤5mmHg). Treatment effects on estimated blood loss and hematocrit change were tested in multivariable regression models accounting for surgeon, prostate size, and all two-way interactions. Results: Ninety-two patients completed the study. Estimated blood loss (mean±SD) was significantly lower with low central venous pressure (706±362ml) compared to acute normovolemic hemodilution (1103±635ml) and conventional (1051±714ml) groups (p=0.0134). There was no difference between the groups in need for blood transfusion, or hematocrit drop from preoperative values. The multivariate model predicting estimated blood loss showed a significant effect of treatment (p=0.0028) and prostate size (p=0.0323), accounting for surgeon (p=0.0013). In the model predicting hematocrit change, accounting for surgeon difference (p=0.0037), the treatment effect depended on prostate size (p=0.0007) with the slope of low central venous pressure differing from the other two groups. Hematocrit was predicted to drop more with increased prostate size in acute normovolemic hemodilution and conventional groups but not with low central venous pressure. Key limitations: Limitations include the inability to blind providers to group assignment, possible variability between providers in estimation of blood loss, and the relatively small sample size that was not powered to detect differences between the groups in need for blood transfusion. Conclusions: Maintaining low central venous pressure reduced estimated blood loss compared to conventional fluid management and acute normovolemic hemodilution in patients undergoing radical retropubic prostatectomy but there was no difference in allogeneic blood transfusion between the groups.

KW - Blood loss

KW - Central venous pressure

KW - Fluid management

KW - Hemodilution

KW - Prostatectomy

UR - http://www.scopus.com/inward/record.url?scp=84899063097&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84899063097&partnerID=8YFLogxK

U2 - 10.1185/03007995.2013.877436

DO - 10.1185/03007995.2013.877436

M3 - Article

C2 - 24351100

AN - SCOPUS:84899063097

VL - 30

SP - 937

EP - 943

JO - Current Medical Research and Opinion

JF - Current Medical Research and Opinion

SN - 0300-7995

IS - 5

ER -