Evaluation of the pulse pressure variation index as a predictor of fluid responsiveness during orthotopic liver transplantation.
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.
Gouvêa
G
G
Liver Transplantation Unit, Bonsucesso General Hospital (HGB), Rio de Janeiro, Brazil. glaubergouvea@ibest.com.br
Diaz
R
R
Auler
L
L
Toledo
R
R
Martinho
J M
JM
D000328:Adult; D000368:Aged; D001794:Blood Pressure; D001795:Blood Pressure Determination / Q000379:methods; D002302:Cardiac Output; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*