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BJA Advance Access originally published online on May 19, 2009
British Journal of Anaesthesia 2009 103(2):238-243; doi:10.1093/bja/aep123
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© The Author [2009]. Published by Oxford University Press on behalf of The Board of Directors of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournal.org

Evaluation of the pulse pressure variation index as a predictor of fluid responsiveness during orthotopic liver transplantation

G. Gouvêa*, R. Diaz, L. Auler, R. Toledo and J. M. Martinho

Liver Transplantation Unit, Bonsucesso General Hospital (HGB), Rio de Janeiro, Brazil

* Corresponding author. E-mail: glaubergouvea{at}ibest.com.br

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.

Keywords: fluids, i.v.; liver, transplantation; measurement techniques, thermodilution; monitoring, arterial pressure


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