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Intraoperative fluid management during orthotopic liver transplantation.
- Source :
-
Journal of cardiothoracic and vascular anesthesia [J Cardiothorac Vasc Anesth] 2004 Aug; Vol. 18 (4), pp. 438-41. - Publication Year :
- 2004
-
Abstract
- Objective: To assess clinical safety of a low central venous pressure (CVP) fluid management strategy in patients undergoing liver transplantation.<br />Design: Retrospective record review comparing 2 transplant centers, one using the low CVP method and the other using the normal CVP method.<br />Setting: University-based, academic, tertiary care centers.<br />Participants: Patients undergoing orthotopic cadaveric liver transplantation.<br />Interventions: Each center practiced according to its own standard of care. Center 1 maintained an intraoperative CVP <5 mmHg using fluid restriction, nitroglycerin, forced diuresis, and morphine. If pressors were required to maintain systolic arterial pressure >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.<br />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.<br />Conclusions: Despite success in lowering blood transfusion requirements in liver resection patients, a low CVP should be avoided in patients undergoing liver transplantation.
- Subjects :
- Adrenergic alpha-Agonists therapeutic use
Blood Pressure drug effects
Blood Transfusion
Central Venous Pressure
Creatinine blood
Diuresis
Female
Humans
Hypovolemia
Male
Middle Aged
Monitoring, Intraoperative
Morphine therapeutic use
Nitroglycerin therapeutic use
Postoperative Complications
Vasoconstrictor Agents therapeutic use
Vasodilator Agents therapeutic use
Blood Loss, Surgical prevention & control
Intraoperative Care
Liver Transplantation
Subjects
Details
- Language :
- English
- ISSN :
- 1053-0770
- Volume :
- 18
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Journal of cardiothoracic and vascular anesthesia
- Publication Type :
- Academic Journal
- Accession number :
- 15365923
- Full Text :
- https://doi.org/10.1053/j.jvca.2004.05.020