Intraoperative fluid management during orthotopic liver transplantation

Objective: To assess clinical safety of a low central venous pressure (CVP) fluid management strategy in patients undergoing liver transplantation. Design: Retrospective record review comparing 2 transplant centers, one using the low CVP method and the other using the normal CVP method. Setting: Uni...

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Bibliographic Details
Published in:Journal of cardiothoracic and vascular anesthesia 2004-08, Vol.18 (4), p.438-441
Main Authors: Schroeder, Rebecca A., Collins, Bradley H., Tuttle-Newhall, Elizabeth, Robertson, Kerri, Plotkin, Jeffrey, Johnson, Lynt B., Kuo, Paul C.
Format: Article
Language:English
Subjects:
Adrenergic alpha-Agonists - therapeutic use
Blood Loss, Surgical - prevention & control
Blood Pressure - drug effects
Blood Transfusion
Central Venous Pressure
complications
Creatinine - blood
Diuresis
Female
fluid management
hemodynamics
Humans
Hypovolemia
intraoperative
Intraoperative Care
Liver Transplantation
Male
Middle Aged
Monitoring, Intraoperative
Morphine - therapeutic use
mortality
Nitroglycerin - therapeutic use
Postoperative Complications
renal failure
Vasoconstrictor Agents - therapeutic use
Vasodilator Agents - therapeutic use
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Summary:Objective: To assess clinical safety of a low central venous pressure (CVP) fluid management strategy in patients undergoing liver transplantation. Design: Retrospective record review comparing 2 transplant centers, one using the low CVP method and the other using the normal CVP method. Setting: University-based, academic, tertiary care centers. Participants: Patients undergoing orthotopic cadaveric liver transplantation. Interventions: Each center practiced according to its own standard of care. Center 1 maintained an intraoperative CVP 90 mmHg, phenylephrine or norepinephrine was used. At center 2, CVP was kept 7 to 10 mmHg and mean arterial pressure >75 mmHg with minimal use of vasoactive drugs. Measurements and Main Results: Data collected included United Network for Organ Sharing status, surgical technique, intraoperative transfusion rate, preoperative and peak postoperative creatinine, time spent in intensive care unit and hospital, incidence of death, and postoperative need for hemodialysis. Principal findings include an increased rate of transfusion in the normal CVP group but increased rates of postoperative renal failure (elevated creatinine and more frequent need for dialysis) and 30-day mortality in the low CVP group. Conclusions: Despite success in lowering blood transfusion requirements in liver resection patients, a low CVP should be avoided in patients undergoing liver transplantation.
ISSN:1053-0770
1532-8422
DOI:10.1053/j.jvca.2004.05.020