Liver Transplant Research Today is a free monthly online journal that collates and summarizes the latest research about Liver Transplant, including details on risks, prognosis, procedure, surgery, organ donation. | ||||||||
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Cardiac output measurement in patients undergoing liver transplantation: pulmonary artery catheter versus uncalibrated arterial pressure waveform analysis.Biais M, Nouette-Gaulain K, Cottenceau V, Vallet A, Cochard JF, Revel P, Sztark F Service d'Anesthésie Réanimation I, Hôpital Pellegrin, Place Amélie Raba-Léon, 33076 Bordeaux Cedex, France. BACKGROUND: Cardiac output (CO) and invasive hemodynamic measurements are useful during liver transplantation. The pulmonary artery catheter (PAC) is commonly used for these patients, despite the potential complications. Recently, a less invasive device (Vigileo/FloTrac) became available, which estimates CO using arterial pressure waveform analysis without external calibration. In this study, we compared CO obtained with a PAC using automatic thermodilution, instantaneous CO stat-mode (ICO(SM)), and CO obtained with the new device, arterial pressure waveform analysis (APCO) in patients undergoing liver transplantation. METHODS: Twenty sets of simultaneous measurements of APCO and ICO(SM) were determined in sedated and mechanically ventilated patients undergoing liver transplantation. Time points were as follows: after PAC insertion (T1-3), after portal clamping (T4-6), during anhepathy (T7-9), after graft reperfusion (T10-15), and in the postoperative period in the intensive care unit (T15-20). RESULTS: We enrolled 20 patients and 400 measurements were obtained. No data were rejected. Bias between ICO(SM) and APCO was 0.8 L/min, 95% limits of agreement were -1.8 to 3.5 L/min. The percentage error was 43%. Bias between ICO(SM) and APCO was correlated with systemic vascular resistance [r(2) = 0.55, P < 0.0001, y = 15.8-2.2 ln(x)] and subgroup analysis revealed an increase in the bias and in the percentage error in patients with low systemic vascular resistance (Child-Pugh grade B and C patients). There was no difference between the different surgical periods. CONCLUSIONS: Our results suggest that Vigileo/FloTrac CO monitoring data do not agree well with those of automatic thermodilution in patients undergoing liver transplantation, especially in Child-Pugh grade B and C patients with low systemic vascular resistance. Published 18 April 2008 in Anesth Analg, 106(5): 1480-6, table of contents.
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