Retrospective analysis of central venous catheters in elective intracranial surgery - Is there any benefit?

Autoři: Benjamin Löser aff001;  Olga Recio Ariza aff002;  Alexander März aff001;  Anastassia Löser aff003;  Jörn Grensemann aff004;  Martin Petzoldt aff002;  Daniel A. Reuter aff001;  Frank Weber aff005;  Änne Glass aff005;  Sebastian A. Haas aff001
Působiště autorů: Department of Anaesthesiology, Center of Anaesthesiology and Intensive Care Medicine, University Medicine Rostock, Rostock, Germany aff001;  Department of Anaesthesiology, Center of Anaesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany aff002;  Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany aff003;  Department of Intensive Care Medicine, Center of Anaesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany aff004;  Institute for Biostatistics and Informatics in Medicine and Ageing Research, University Medicine Rostock, Rostock, Germany aff005
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article



It remains unclear whether the use of central venous catheters (CVC) improves a patient's clinical outcome after elective intracranial supratentorial procedures.


This two-armed, single-center retrospective study sought to compare patients undergoing elective intracranial surgery with and without CVCs. Standard anaesthesia procedures were modified during the study period resulting in the termination of obligatory CVC instrumentation for supratentorial procedures. Peri-operative adverse events (AEs) were evaluated as primary endpoint.


The data of 621 patients in total was analysed in this study (301 with and 320 without CVC). Patient characteristics and surgical procedures were comparable between both study groups. A total of 132 peri-operative AEs (81 in the group with CVC vs. 51 in the group without CVC) regarding neurological, neurosurgical, cardiovascular events and death were observed. CVC patients suffer from AEs almost twice as often as non CVC patients (ORadjusted = 1.98; 95%CI[1.28–3.06]; p = 0.002). Complications related to catheter placement (pneumothorax and arterial malpuncture) were observed in 1.0% of the cases. The ICU treatment period in patients with CVC was 22 (19;24) vs. 21 (19;24) hours (p = 0.413). The duration of hospital stay was also similar between groups (9 (7;13) vs. 8 (7;11) days, p = 0.210). The total time of ventilation (350 (300;440) vs. 335 (281;405) min, p = 0.003) and induction time (40 (35;50) vs. 30 (25;35) min, p<0.001) was found to be prolonged significantly in the group with CVCs. There were no differences found in post-operative inflammatory markers as well as antibiotic treatment.


The data of our retrospective study suggests that patients undergoing elective neurosurgical procedures with CVCs do not demonstrate any additional benefits in comparison to patients without a CVC.

Klíčová slova:

Anesthesia – Blood pressure – Catheters – Instrumentation – Jugular vein – Surgical and invasive medical procedures – Veins – White blood cells


1. Raad I. Intravascular-catheter-related infections. Lancet. 1998;351: 893–8. doi: 10.1016/S0140-6736(97)10006-X 9525387

2. Kellner P, Schleusener V, Bauerfeind F, Soukup J. Influence of different infracardial positions of central venous catheters in hemodynamic monitoring using the transpulmonal thermodilution method. J Clin Monit Comput. 2016;30: 629–40. doi: 10.1007/s10877-015-9762-z 26341509

3. Saugel B, Scheeren TWL, Teboul J-L. Ultrasound-guided central venous catheter placement: a structured review and recommendations for clinical practice. Crit Care. 2017;21: 225. doi: 10.1186/s13054-017-1814-y 28844205

4. McGee DC, Gould MK. Preventing complications of central venous catheterization. N Engl J Med. 2003;348: 1123–33. doi: 10.1056/NEJMra011883 12646670

5. Merrer J, Jonghe B de, Golliot F, Lefrant JY, Raffy B, Barre E, et al. Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial. JAMA. 2001;286: 700–7. doi: 10.1001/jama.286.6.700 11495620

6. Guilbert M-C, Elkouri S, Bracco D, Corriveau MM, Beaudoin N, Dubois MJ, et al. Arterial trauma during central venous catheter insertion: Case series, review and proposed algorithm. J Vasc Surg. 2008;48: 918–25. doi: 10.1016/j.jvs.2008.04.046 18703308

7. Patel AR, Patel AR, Singh S, Singh S, Khawaja I. Central Line Catheters and Associated Complications: A Review. Cureus. 2019;11: e4717. doi: 10.7759/cureus.4717 31355077

8. Shawyer A, Chippington S, Quyam S, Schulze-Neick I, Roebuck D. Phrenic nerve injury after image-guided insertion of a tunnelled right internal jugular central venous catheter. Pediatr Radiol. 2012;42: 875–7. doi: 10.1007/s00247-011-2269-y 22057361

9. Kornbau C, Lee KC, Hughes GD, Firstenberg MS. Central line complications. Int J Crit Illn Inj Sci. 2015;5: 170–8. doi: 10.4103/2229-5151.164940 26557487

10. Vincent J-L, Michard F, Saugel B. Intensive care medicine in 2050: towards critical care without central lines. Intensive Care Med. 2018;44: 922–4. doi: 10.1007/s00134-018-5205-x 29777262

11. Matta BF, Menon DK, Smith M. Principles of paediatric neurosurgery. In: Core topics in Neuroanaesthesia and Neurointensive Care. Cambridge University Press. New York; 2011. p. 212.

12. Engelhard K. Neuroanesthesia. Anaesthesist. 2016; 65:151–60. doi: 10.1007/s00101-015-0121-8 26696267

13. Cottrell JE, Young WL. Pediatric Neuroanesthesia and Critical Care. In: Cottrell and Young’s Neuroanesthesia. MOSBY/Elsevier. Philadelphia; 2010. p. 332.

14. Mills SJ, Tomlinson AA. The use of central venous cannulae in neuroanaesthesia. Anaesthesia. 2001;56: 465–70. doi: 10.1046/j.1365-2044.2001.01524-5.x 11350335

15. Kostaras X, Cusano F, Kline GA, Roa W, Easaw J. Use of dexamethasone in patients with high-grade glioma: a clinical practice guideline. Curr Oncol. 2014;21: e493–503. doi: 10.3747/co.21.1769 24940109

16. Isert P. Control of carbon dioxide levels during neuroanaesthesia: current practice and an appraisal of our reliance upon capnography. Anaesth Intensive Care. 1994;22: 435–41. doi: 10.1177/0310057X9402200419 7978209

17. McIntyre LA, Hébert PC, Fergusson D, Cook DJ, Aziz A. A survey of Canadian intensivists' resuscitation practices in early septic shock. Crit Care. 2007;11: R74. doi: 10.1186/cc5962 17623059

18. Kastrup M, Markewitz A, Spies C, Carl M, Erb J, Grosse J, Schirmer U. Current practice of hemodynamic monitoring and vasopressor and inotropic therapy in post-operative cardiac surgery patients in Germany: results from a postal survey. Acta Anaesthesiol Scand. 2007;51: 347–58. doi: 10.1111/j.1399-6576.2006.01190.x 17096667

19. Marik PE, Monnet X, Teboul J-L. Hemodynamic parameters to guide fluid therapy. Ann Intensive Care. 2011;1: 1. doi: 10.1186/2110-5820-1-1 21906322

20. Cepeda MS, Boston R, Farrar JT, Strom BL. Comparison of logistic regression versus propensity score when the number of events is low and there are multiple confounders. Am J Epidemiol. 2003; 158:280–7. doi: 10.1093/aje/kwg115 12882951

21. Walley KR. Use of central venous oxygen saturation to guide therapy. Am J Respir Crit Care Med. 2011; 184:514–20. doi: 10.1164/rccm.201010-1584CI 21177882

Článek vyšel v časopise


2019 Číslo 12
Nejčtenější tento týden