title: Haemodynamic Optimization by Oesophageal Doppler and Pulse Power Wave Analysis in Liver Surgery: A Randomised Controlled Trial.
abstract: Liver surgery is still associated with a high rate of morbidity and mortality. We aimed to compare different haemodynamic treatments in liver surgery. In a prospective, blinded, randomised, controlled pilot trial patients undergoing liver resection were randomised to receive haemodynamic management guided by conventional haemodynamic parameters or by oesophageal Doppler monitor (ODM, CardioQ-ODM) or by pulse power wave analysis (PPA, LiDCOrapid) within a goal-directed algorithm adapted for liver surgery. The primary endpoint was stroke volume index before intra-operative start of liver resection. Secondary endpoints were the haemodynamic course during surgery and postoperative pain levels. Due to an unbalance in the extension of the surgical procedures with a high rate of only minor procedures the conventional group was dropped from the analysis. Eleven patients in the ODM group and 10 patients in the PPA group were eligible for statistical analysis. Stroke volume index before start of liver resection was 49 (37; 53) ml/m2 and 48 (41; 56) ml/m2 in the ODM and PPA group, respectively (p=0.397). The ODM guided group was haemodynamically stable as shown by ODM and PPA measurements. However, the PPA guided group showed a significant increase of pulse-pressure-variability (p=0.002) that was not accompanied by a decline of stroke volume index displayed by the PPA (p=0.556) but indicated by a decline of stroke volume index by the ODM (p<0.001). The PPA group had significantly higher postoperative pain levels than the ODM group (p=0.036). In conclusion, goal-directed optimization by ODM and PPA showed differences in intraoperative cardiovascular parameters indicating that haemodynamic optimization is not consistent between the two monitors.
  
  
  BACKGROUND
  ISRCTN.com ISRCTN64578872.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - University Medicine Berlin, Berlin, Germany.
authors.forename: Aarne
authors.initials: A
authors.lastname: Feldheiser
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - University Medicine Berlin, Berlin, Germany.
authors.forename: Velizara
authors.initials: V
authors.lastname: Pavlova
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - University Medicine Berlin, Berlin, Germany.
authors.forename: Karin
authors.initials: K
authors.lastname: Weimann
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - University Medicine Berlin, Berlin, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Hunsicker
authors.affiliation: Department of General-, Visceral- and Transplantation Surgery, Charité - University Medicine Berlin, Campus Virchow-Klinikum, Berlin, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Stockmann
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - University Medicine Berlin, Berlin, Germany.
authors.forename: Mandy
authors.initials: M
authors.lastname: Koch
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - University Medicine Berlin, Berlin, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Giebels
authors.affiliation: Charité - University Medicine Berlin and SOSTANA GmbH Berlin, Berlin, Germany.
authors.forename: Klaus-Dieter
authors.initials: KD
authors.lastname: Wernecke
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - University Medicine Berlin, Berlin, Germany.
authors.forename: Claudia D
authors.initials: CD
authors.lastname: Spies
mesh_terms: D000368:Aged; D015150:Echocardiography, Doppler; D004947:Esophagus / Q000000981:diagnostic imaging*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007430:Intraoperative Care; D008099:Liver / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D010149:Postoperative Pain / Q000188:drug therapy; D063177:Pulse Wave Analysis; D013997:Time Factors
chemical_list: D009020:Morphine