title: Lower body impedance for the evaluation of venovenous bypass flow.
abstract: Inferior vena cava (IVC) clamping during liver transplantation causes venous congestion in the splanchnic and IVC beds. A venovenous bypass relieves congestion and improves cardiac output (CO), but the bypass flow required for adequate drainage of the vascular beds is controversial. In this study we evaluated the bypass flow necessary to compensate for the IVC clamping. Lower body impedance (BI) is inversely related to tissue fluid content and was used to reflect congestion. A venovenous bypass was successfully applied to 59 of 62 patients. BI was measured across the left buttock and related to bypass flow, CO, bypass flow ratio (bypass flow/CO before IVC clamping; n = 62), and right femoral venous pressure (n = 8). The bypass flow was 1.7 (0.0-3.0) L.min-1 (median and range). BI decreased (delta BI; -2.2 [-10.3-1.1)] omega) as the femoral venous pressure increased (29 [21-49] mm Hg; r = -0.81; P < .05), and the femoral venous pressure correlated inversely to bypass flow (r = -0.35; P < .01). The change in CO at IVC clamping (delta CO; -2.3 [-6.3-1.6] L.min-1) related to bypass flow ratio (0.25 [0-0.51]; r = 0.57, P < .01), whereas delta BI related only minimally to bypass flow or bypass flow ratio (r = 0.37; P < .05). In conclusion the median bypass flow of 1.7 L.min-1 was too small to prevent fluid accumulation in the lower caval region, and extrapolation of data suggests that bypass flow should have approached 3.5 L.min-1 or 50% of CO in order to prevent fluid accumulation in the lower caval region. However the minimal correlation between lower BI and bypass flow indicates that bypass flow per se is not the only determinant of lower body fluid accumulation.
authors.affiliation: Department of Anesthesia, National University Hospital, Copenhagen, Denmark.
authors.forename: E
authors.initials: E
authors.lastname: Ejlersen
authors.forename: P
authors.initials: P
authors.lastname: Sode
authors.forename: C
authors.initials: C
authors.lastname: Skak
authors.forename: A
authors.initials: A
authors.lastname: Rasmussen
authors.forename: K
authors.initials: K
authors.lastname: Espersen
authors.forename: P
authors.initials: P
authors.lastname: Kirkegaard
authors.forename: N H
authors.initials: NH
authors.lastname: Secher
mesh_terms: D000328:Adult; D002307:Cardiography, Impedance; D017097:Electric Impedance; D005260:Female; D006439:Hemodynamics; D006801:Humans; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011167:Portacaval Shunt, Surgical / Q000009:adverse effects* / Q000379:methods