Prevention of Postoperative Pulmonary Edema on the Ward by Application of a Central Venous Pressure Rule§

Objective: to demonstrate the efficacy of a Central Venous Pressure rule and algorithm in the elimination of postoperative pulmonary edema after major surgery. Background: Pulmonary edema in the postoperative period after major surgery is a life-threatening complication, usually due to fluid overload. Analysis of its pathogenesis in our patients during the period 1981 - 1988 led to the formulation of the central venous pressure (CVP) rule in 1990. The purpose of this study was to examine whether this rule had proven to be efficient in preventing pulmonary edema without causing complications related to fluid restriction. Methods: A retrospective study was performed in our Department about the prevalence of pulmonary edema, venous thrombosis and renal insufficiency during the postoperative period in patients undergoing major abdominal surgery. Any postoperative CVP value above +5 cmH2O led to a slowdown of supportive IV fluid lasting until a pressure of � +5 cm H2O was reached, unless the measurement was proven to be wrong or another cause for the high CVP value could be di- agnosed. During the first period between January 1981 and December 1988, 415 patients were cared for without applica- tion of the CVP rule. During the period between January 1992 and August 2002, 682 patients had postoperative care ac- cording to the CVP rule. The results in both periods were compared. Results: Whereas during the first period 12 cases of pulmonary edema were deplored, no pulmonary edema did occur dur- ing the second period. No significant difference in prevalence of venous thrombosis or renal insufficiency was found. Conclusions: The CVP rule is a safe and very efficient method to prevent fluid overload and pulmonary edema on a surgi- cal ward after major abdominal surgery. Training in correct CVP measurement through the central venous catheter and good collaboration between doctors and nursing staff is a prerequisite for success.