PiCCO Monitoring During Liver Transplantation for Pediatric Patients
Zeynep Ersoy1, Aycan Ozdemirkan1, Pinar Zeyneloglu1, Arash Pirat1, Adnan Torgay1, Zeynep Kayhan1, Mehmet Haberal2.
1Anesthesiology, Baskent University, Ankara, Turkey; 2Transplantation, Baskent University, Ankara, Turkey
Introduction: Anesthetic management of pediatric liver transplant recipients (PLTR) is based on fluid management, adhering to hemodynamic goals and managing associated comorbidities. The PiCCO (pulse contour cardiac output) system gives validated intermittent cardiac output measurements by transpulmonary thermodilution and is less invasive than pulmonary artery catheterization. Monitoring the cardiopulmonary system of PLTR during surgery using PiCCO system is reflective of ongoing hemodynamic response to intraoperative maneuvers. We compare the intraoperative and postoperative parameters with hemodynamic volumetric parameters monitored by PiCCO system in PLTR during surgery.
Materials and Methods: In a retrospective analysis of PLTR from Sept 2014 to Oct 2017, demographic, laboratory and perioperative data were collected. Transpulmonary thermodilutions were performed at different times of surgery: beginning of surgery (To); before hepatectomy and after selective vascular exclusion (Tanhepatic); new hepatic phase (Tend). Hemodynamic volumetric parameters monitored by the PiCCO system were mean arterial pressure (MAP), cardiac index (CI), intrathoracic blood volume index (ITBVI), extravascular lung water index (EVLWI), systemic vascular resistance index (SVRI) and stroke volume variability (SVV).
Results: 41 PLTR (aged 4 mo to 17 y) underwent hemodynamic monitoring with PiCCO during LT. Measurements including CI, CVP and MAP were significantly lower during Tanhepatic phase when compared to To and Tend phases (p<.05 for all, Table). Patients whose mean Tend EVLWI measurements were >7 mL/kg; greater amounts of intraoperative blood transfused (p=.027), higher graft recipient body weight ratio (GRWR) (p=.016) and longer anesthesia times (p=.046) were seen. The mean Tend SVV measurements were >10 in patients who had a higher GRWR (p=.033). More blood transfusion was needed and higher GRWR was observed in patients with GEDV <650ml/m2 (p=.000). Patients with a mean Tend CI measurement <3L/min/m2 received more colloid transfusion and had longer anesthesia time during LT.
Conclusion: PiCCO monitoring enables flow and dynamic parameters which predict fluid responsiveness and help to make critical decisions to restore hemodynamic stability during pediatric LT.
| To | Tanhepatic | Tend | |
| Mean arterial pressure (mmHg) | 59.3±11.0* | 53.1±11.5** | 57.0±10.1 |
| Central venous pressure (mmHg) | 10.7±3.83• | 9.03±4.01•• | 10.8±4.24 |
| Cardiac index (L•min-1•m-2) | 5.3±2.27◘ | 5.2±4.23◘◘ | 7.4±3.07 |
| Extravascular lung water index (mL/kg) | 14.5±9.89 | 13.5±7.63 | 10±12.7 |
| Stroke volume variability (%) | 11.76±4.53 | 10.4±5.77 | 11.07±5.18 |
* p=.015 compared with Tanhepatic, ** p=.008 compared with Tend value
• p=.019 compared with Tanhepatic, •• p=.021 compared with Tend value
◘p=.005,◘◘p=.021 compared with Tend value
