Feasibility of using head up patient position in maintaining low central venous pressure and restricting the need for pharmacological agents during major hepatectomy.

Backgrounds/Aims Head-up position is used with fluid restriction and medications to achieve low central venous pressure (LCVP). We evaluated application of head-up position for its effectiveness, safety and potential to reduce need for complex drug interventions in achieving LCVP during hepatectomy.

Methods This prospective study included 50 patients undergoing major hepatectomies from 2019 to 2024. CVP was measured in supine, 10 cm and 20 cm head-up positions during liver resection. We assessed relationship between supine CVP and head-up positions with the need for supplemental pharmacological intervention using regression analysis. Additionally, we evaluated correlation between LCVP fluctuation, blood loss, and head-up position.

Results Mean blood loss was 204.6 ± 29.2 mL, with no incidents of air embolism, hemodynamic instability, renal dysfunction, blood transfusion, or 90-day mortality. Mean CVP values were 7.370 ± 4.094 mmHg in supine, 3.360 ± 4.304 mmHg at head-up 10 cm, and -0.780 ± 4.663 mmHg at head-up 20 cm positions, demonstrating a progressive reduction with each position (p < 0.001). High adjusted R2 identified supine CVP as significant predictor of CVP at head-up positions, indicating strong linear relationship (p < 0.001). LCVP was achieved in 47/50 patients using 20 cm head-up position, while in 3/50 patients with supine CVP > 10 mmHg, additional medications were required. Correlation between blood loss and LCVP fluctuation (ρ = 0.169) was insignificant (p = 0.240), while that between head-up position and LCVP fluctuation (ρ = 0.383) was significant (p = 0.006).

Conclusions LCVP can be effectively achieved using a 20 cm head-up position, with the potential to limit drug usage in the majority of patients.