Intraoperative hemodynamic monitoring during organ transplantation: what is new?
OBJECTIVE
To highlight the recent developments in hemodynamic monitoring during liver and lung transplantation.


RESULTS
Even though a consensus on intraoperative hemodynamic monitoring is still lacking, the most frequently monitoring tool used is the pulmonary artery catheter (PAC). The filling pressures are widely accepted as not being able to accurately define cardiac preload. On the contrary, the use of transesophageal echocardiography (TEE), although it is operator dependent and requires a prolonged training, is increasing during the intraoperative period to directly evaluate the cardiovascular function. New frontiers have been opened by the transpulmonary thermodilution: intrathoracic blood volume has been shown to have a better correlation with preload than the filling pressures. The advanced modified PAC permits evaluation of the right heart function and preload. Recently, right ventricular end diastolic volume has been shown to correlate better with preload than the filling pressures and also the left ventricular end diastolic area.


CONCLUSIONS
The PAC still represents the most used intraoperative hemodynamic monitoring technique. TEE is increasing in popularity. Recent studies demonstrate that volumetric monitoring conducted with transpulmonary thermodilution and advanced volumetric PAC give good definition of preload and should be implemented in clinical practice.
Della Rocca
Giorgio
G
Clinic of Anesthesia and Intensive Care Medicine, Department of Surgical Science, Medical School, University of Udine, P.le S. M. Misericordia, Udine 15-33100, Italy. giorgio.dellarocca@uniud.it
Brondani
Anita
A
Costa
Maria Gabriella
MG
D001794:Blood Pressure; D001810:Blood Volume; D002407:Catheterization, Swan-Ganz / Q000639:trends; D017548:Echocardiography, Transesophageal / Q000639:trends; D006439:Hemodynamics; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects; D016040:Lung Transplantation / Q000009:adverse effects; D016343:Monitoring, Intraoperative / Q000639:trends*; D011237:Predictive Value of Tests; D013815:Thermodilution / Q000639:trends; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right