Background/Objectives: Acute kidney injury (AKI) is a syndrome characterized by impaired kidney function, which is associated with reduced survival and increased morbidity. Central venous pressure (CVP) is a widely used hemodynamic parameter for assessing the volume status of patients and evaluating their response to fluid resuscitation. This systematic review aims to analyze various prospective and retrospective observational and controlled trials to determine the association between CVP and the risk of developing AKI in patients undergoing cardiac surgery. Additionally, it examines whether elevated CVP serves as an accurate predictor of AKI in this patient population. Methods: A systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, using PubMed as the primary database. The search focused on studies published after 2014 that included adult patients undergoing cardiac surgery with reported measurements of CVP and kidney function assessment. Studies conducted on animals, pediatric populations, those published before 2014, or in languages other than English were excluded from the review. Results: Through the analysis of 21 studies, a clear association between higher CVP and increased AKI risk emerged. The most critical CVP thresholds identified were 10 mmHg, 12 mmHg, 14 mmHg, and 20 mmHg, with risk increasing progressively beyond these values. CVP ≥ 10 mmHg was the most commonly reported cutoff for elevated AKI risk, showing 1.42 to 4.53 times increased odds. CVP ≥ 12 mmHg further amplified the risk, while CVP ≥ 14 mmHg was consistently associated with severe AKI and the need for RRT. The highest threshold (CVP ≥ 20 mmHg) showed the greatest risk escalation, linked to fluid overload, right heart failure, and mortality. Studies also suggest an optimal CVP range of 6–8 mmHg to minimize AKI incidence. Conclusions: Elevated CVP is an independent risk factor for the development of AKI in patients undergoing cardiac surgery. These findings suggest that CVP monitoring can play a significant role in predicting AKI and guiding perioperative management strategies.

Background/Objectives: This study aimed to investigate the hypothesis that an alveolar recruitment maneuver can restore lung compliance to initial values after laparoscopic gynecological surgery. Methods: A total of 31 patients who underwent laparoscopic gynecological surgery were enrolled. Protective mechanical ventilation was applied, and the radial artery was catheterized in all patients. An alveolar recruitment maneuver (incremental and decremental positive end-expiratory pressure) was applied ten minutes after the release of pneumoperitoneum. The respiratory mechanics and blood gas results were recorded at eight different time points: after induction of anesthesia (T1), in the lithotomy position (T2), in the Trendelenburg position (T3), 10 and 90 min after insufflation of carbon dioxide (T4 and T5), in the supine position (T6), after desufflation (T7), and 10 min after an alveolar recruitment maneuver at the end of surgery (T8). Results: Pneumoperitoneum and the Trendelenburg position caused a decline of 15 units in compliance (T7 vs. T1; p < 0.05) compared to baseline. After the alveolar recruitment maneuver, compliance increased by 17.5% compared with the mean value of compliance at time T1 (T8 vs. T1; p < 0.05). The recruitment maneuver had favorable results in patients with low initial compliance (41.5 mL/cmH₂O, IQR: 9.75 mL/cmH₂O), high Body Mass Index 30.32 kg/m² (IQR: 1.05 kg/m²), and high initial plateau airway pressure (16.5 cmH₂O, IQR: 0.75 cmH₂O). Conclusions: Lung compliance does not return to initial values after performing laparoscopic gynecological procedures. However, after the release of pneumoperitoneum, an alveolar recruitment maneuver is beneficial as it improves compliance and gas exchange.

Background/Objectives: The aim of this study is to assess whether changes in Pulse Pressure Variation (PPV) and Stroke Volume Variation (SVV) following a VtC can predict the response to fluid administration in patients undergoing surgery under general anesthesia with protective mechanical ventilation. Methods: A total of 40 patients undergoing general surgery or vascular surgery without clamping the aorta were enrolled. Protective mechanical ventilation was applied, and the radial artery was catheterized in all patients. The protocol began one hour after the induction of general anesthesia and the stabilization of hemodynamic parameters. The parameters PPV₆ and SVV₆ were recorded during ventilation with a Vt of 6 mL/kg Ideal Body Weight (IBW) (T1). Then, the Vt was increased to 8 mL/kg IBW for 3 min without changing other respiratory parameters. After the VtC, the parameters PPV₈ and SVV₈ (T2) were recorded. After the stabilization of hemodynamic parameters, volume expansion (VE) was administered with colloid fluid of 6 mL/kg IBW. Parameters before (T3) and 5 min after fluid challenge (T4) were recorded. The change in the Stroke Volume Index (SVI) before and after VE was used to indicate fluid responsiveness. Patients were classified as fluid responders (SVI ≥ 10%) or non-responders (SVI < 10%). Results: The parameter ΔPPV(6–8) demonstrated good predictive ability to predict fluid responsiveness, evidenced by an Area Under the Curve (AUC) of 0.86 [95% Confidence Interval (CI) 0.74 to 0.95, p < 0.0001]. The threshold of ΔPPV(6–8) exceeding 2% identified responders with a sensitivity of 83% (95% CI 0.45 to 1.0, p < 0.0001) and a specificity of 73% (95% CI 0.48 to 1.0, p < 0.0001). The parameter ΔSVV(6–8) also revealed good predictive ability, reflected by an AUC of 0.82 (95% CI 0.67 to 0.94, p < 0.0001). The criterion ΔSVV(6–8) greater than 2% pinpointed responders with a sensitivity of 83% (95% CI 0.71 to 1.0, p < 0.001) and a specificity of 77% (95% CI 0.44 to 1.0, p < 0.001). Conclusions: This study demonstrates that VtC possesses good predictive ability for fluid responsiveness in patients undergoing general surgery.