Document Detail

Evaluation of the pulse pressure variation index as a predictor of fluid responsiveness during orthotopic liver transplantation.
MedLine Citation:
PMID:  19454548     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The pulse pressure variation (PPV) index has been shown to be a reliable predictor of fluid responsiveness (FR) in a variety of clinical settings. However, it has not been formally evaluated in the setting of orthotopic liver transplantation (OLT). METHODS: Fifteen (n=15) patients undergoing OLT were enrolled in this study. All patients were monitored with a modified pulmonary artery catheter which measured the cardiac output on a semi-continuous basis. A fluid challenge (FC) with 350 ml of colloid was attempted during the following stages of surgery: hepatectomy (TH), anhepatic phase (TA), early post-reperfusion [(TE)--during the first 30 min], late post-reperfusion [(TL)--after hepatic artery anastomosis], and at the beginning of abdominal closure (TC). PPV and stroke volume index (SVI) were recorded at baseline and 5 min after the FC. Each individual FC which raised the SVI more than 10% from baseline was classified as responsive (R); otherwise, it was considered non-responsive (NR). RESULTS: Forty-one FCs were performed, with 14 (34%) classified as responsive and 27 (66%) as non-responsive. The baseline PPV did not differ significantly between the R and NR groups, showing considerable overlap of its values throughout the procedure [R vs NR; TH: 20% (inter-quartile range 7-32) vs 7% (5-14); TA: 10% (7-14) vs 19% (12-21), and TE+TL: 7% (5-11) vs 9% (7-16)]. CONCLUSIONS: Under the conditions of this study, the PPV index was not shown to be a reliable predictor of FR during OLT. Further studies are warranted to elucidate the role of this and other dynamic indexes in this specific setting.
G Gouvêa; R Diaz; L Auler; R Toledo; J M Martinho
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Publication Detail:
Type:  Evaluation Studies; Journal Article     Date:  2009-05-19
Journal Detail:
Title:  British journal of anaesthesia     Volume:  103     ISSN:  1471-6771     ISO Abbreviation:  Br J Anaesth     Publication Date:  2009 Aug 
Date Detail:
Created Date:  2009-07-14     Completed Date:  2009-08-13     Revised Date:  2009-11-17    
Medline Journal Info:
Nlm Unique ID:  0372541     Medline TA:  Br J Anaesth     Country:  England    
Other Details:
Languages:  eng     Pagination:  238-43     Citation Subset:  IM    
Liver Transplantation Unit, Bonsucesso General Hospital (HGB), Rio de Janeiro, Brazil.
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MeSH Terms
Blood Pressure*
Blood Pressure Determination / methods
Cardiac Output
Fluid Therapy / methods*
Intraoperative Care / methods
Liver Transplantation*
Middle Aged
Monitoring, Intraoperative / methods*
Comment In:
Br J Anaesth. 2009 Dec;103(6):896-7; author reply 897-9   [PMID:  19918025 ]

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