Hemodynamics During Liver Transplantation

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doi:10.1016/j.transproceed.2007.05.002 Copyright © 2007 Elsevier Inc. All rights reserved.

Hemodynamics During Liver Transplantation

M.G. Costa, P. Chiarandini and G. Della RoccaaDepartment of Anesthesia and Intensive Care Medicine, Azienda Ospedaliera Universitaria, University of Udine, Udine, Italy. Available online 8 August 2007.

Abstract Assessing the optimal volemia in the perioperative course of liver transplantation is a challenge for the anesthesiologist. Traditional estimates of intravascular volume status, such as pulmonary artery occlusion pressure (PAOP), have been widely shown to poorly correlate with changes in cardiac output among critically ill patients. Hence, there has been recent interest in alternative, catheter-related, bedside device volume estimates using thermodilution. Continuous end diastolic volume (CEDVI) showed better correlations with cardiac performance than cardiac filling pressures in studies performed in critically ill patients. When compared with conventional pressure-derived data, preload monitoring estimated as intrathoracic blood volume index (ITBVI) with the PiCCO system based on an integrated transpulmonary thermodilution technique better reflected left ventricular filling both in critically ill patients and those who underwent liver transplantation. Moreover, in liver transplantation, the use of transoesophageal echocardiography (TEE) has been increasing for it provides rapid visualization of the dimension and function of heart chambers as well as the left ventricular end diastolic area index (EDAI) that seem to correlate with graded acute hypovolemia, although its validity as on preload index is still under discussion.

Address reprint requests to la Costa, MD, Department of Anesthesia and Intensive Care Unit, Azienda Ospedaliera Universitaria, University of Udine, P.le S.M. della Misericordia 14, 33100 Udine, Italy.

Transplantation Proceedings Volume 39, Issue 6, July-August 2007, Pages 1871-1873