Utility of uncalibrated femoral stroke volume variation as a predictor of fluid responsiveness during the anhepatic phase of liver transplantation.
We evaluated the value of the stroke volume variation (SVV) calculated with the Vigileo monitor, which recently has been increasingly advocated for fluid management, as a predictor of fluid responsiveness during the anhepatic phase of liver transplantation (LT). We also compared SVV to the central venous pressure (CVP) and pulmonary arterial occlusion pressure (PAOP) in patients. Thirty-three adult recipients scheduled for elective living donor LT were enrolled in this study. Twenty minutes after the start of the anhepatic phase, the CVP, PAOP, approximate inferior vena caval pressure, femoral SVV, and cardiac output values were measured before and 12 minutes after fluid loading. Fluid loading was performed with a 6% hydroxyethyl starch solution (10 mL/kg). The responders were defined as patients whose cardiac index increased ≥ 15% after fluid loading. Receiver operating characteristic (ROC) analysis showed that only femoral SVV (area under the curve = 0.894, P = 0.0001) could be used to predict fluid responsiveness during the anhepatic phase of LT. The area under the ROC curve for femoral SVV was 0.894 (P = 0.0001), and it was significantly larger than those for CVP (area under the curve = 0.576, P = 0.004) and PAOP (area under the curve = 0.670, P = 0.021). Femoral SVV >8% identified the responders with a sensitivity of 89% and a specificity of 80%. Our results suggest that femoral SVV derived with the Vigileo monitor would be useful for fluid management during the anhepatic phase in LT recipients.
Department of Anesthesiology and Pain Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea.
Young Hee
YH
Shin
Justin Sangwook
JS
Ko
Mi Sook
MS
Gwak
Gaab Soo
GS
Kim
Jong Hwan
JH
Lee
Suk-Koo
SK
Lee
D000328:Adult; D000368:Aged; D002496:Central Venous Pressure; D016009:Chi-Square Distribution; D017558:Elective Surgical Procedures; D005260:Female; D005263:Femoral Artery / Q000502:physiology*; D005440:Fluid Therapy; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage*; D007430:Intraoperative Care; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D010952:Plasma Substitutes / Q000008:administration & dosage*; D011237:Predictive Value of Tests; D011651:Pulmonary Artery / Q000502:physiology; D012372:ROC Curve; D056910:Republic of Korea; D013318:Stroke Volume; D014682:Vena Cava, Inferior / Q000502:physiology
D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes