Hemodynamic Response to a Rapid Fluid Challenge in End-Stage Liver Disease .
10.4097/kjae.2002.42.3.318
- Author:
Jang Ho SONG
1
;
Kyu Sam HWANG
;
Heung Rak SHIM
;
Mi Jeung GWAK
;
Su Keoung LEE
;
Kyu Taek CHOI
Author Information
1. Department of Anesthesiology, Asan Medical Center, College of Medicine, University of Ulsan, Korea
- Publication Type:Original Article
- Keywords:
Fluid challenge;
hemodynamics;
transplantation;
liver
- MeSH:
Arterial Pressure;
Hemodynamics*;
Humans;
Liver Diseases*;
Liver*;
Oximetry;
Stroke;
Stroke Volume;
Thermodilution;
Transplantation
- From:Korean Journal of Anesthesiology
2002;42(3):318-324
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: Patients with end-stage liver disease have a hyperdynamic circulatory state complicated by a high right ventricular end-diastolic volume index (RVEDVI) and a low ventricular performance. These changes often make if difficult to evaluate volume status and preload. In this study, we analyzed hemodynamic profiles after a rapid fluid challenge in the recipients of a liver transplant. METHODS: Hemodynamic responses were evaluated before and after 200 ml of a 5% albumin challenge in forty patients, recipients of a liver transplant with a Swan-Ganz right-heart ejection fraction oximetry thermodilution cathether. Patients were divided into two groups, group A (responders, n=12, >or= 10% increase in stroke volume index (SVI) after fluid challenge) and group B (non-responders, n = 28, decrease or < 10% increase in SVI after fluid challenge). We analyzed hemodynamic data obtained from the two groups before and after the fluid challenge. RESULTS: Group B had a lower baseline right ventricular ejection fraction (REF) (49.9+/-5.9% vs 42.8+/-5.7%), a higher RVEDVI (120.8+/-19.4 ml/m2 vs 143.6+/-26.3 ml/m2), and a higher right ventricular end-systolic volume index (RVESVI) (60.8+/-14.0 ml/m2 vs 82.8+/-20.5 ml/m2) than group A. In group B, the cardic index (CI) and right ventricular stroke work index (RVSWI) were not increased after the fluid challenge. There was a mild decrease in the mean arterial pressure (MAP) in group B after the fluid challenge. There was a moderate negative correlation between the fluid-induced change in SVI and the baseline RVEDVI in all patients (r =-0.40, P<0.05). CONCLUSIONS: Our study suggests that there is no improvement of hemodynamic profiles after a rapid fluid challenge in many patients with end-stage liver disease, especially those with a high RVEDVI.
