Fluid Responsiveness Is Associated with Successful Weaning after Liver Transplant Surgery
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Bioreactance Monitoring
2.3. Study Procedures
2.3.1. Hemodynamic Monitoring
2.3.2. Spontaneous Breathing Trial
2.3.3. Passive Leg Raising
2.4. Statistical Methods
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variable | Value |
---|---|
Demographics | n = 15 |
Age (years) | 62 {54, 65} |
Sex (female) | 53% |
Height (cm) | 165 {158, 173} |
Weight (kg) | 74 {56, 75} |
Body mass index | 25 {21, 26} |
Clinical condition at admission | |
APACHE II | 14 {10, 18} |
MELD | 21 {14, 23} |
SOFA | 6 {6, 10} |
Norepinephrine (mcg/kg/min) (6 pts) | 0.004 {0.000, 0.220} |
Fluid balance (m/L) | 4480 {3697, 5723} |
Laboratory | |
Lactate (mmol/L) | 3.2 {1.7, 5.1} |
Hemoglobin (g/dL) | 9.7 {8.6, 10.5} |
Albumin (g/dL) | 3.4 {2.7, 4.2} |
Na (mEq/L) | 142 {138, 143} |
K (mEq/L) | 4.3 {3.9, 4.4} |
BUN (mg/dL) | 20 {13, 26} |
Creatinine (mg/dL) | 0.9 {0.7, 1.2} |
(a) | ||||||||||||||
FLUID-RESPONSIVE | ||||||||||||||
HR (lpm) | p | SAP (mmHg) | p | DAP (mmHg) | p | MAP (mmHg) | p | RR (bpm) | p | SaO2 (%) | p | pCO2 (mmHg) | p | |
PLR start (T1) | 77 {70, 85} | 0.971 | 115 {108, 123} | 0.436 | 47 {47, 60} | 0.075 | 94 {90, 99} | 0.280 | 20 {17, 21} | 0.218 | 100 {99, 100} | 0.232 | ||
PLR end (T1) | 77 {72, 85} | 120 {105, 152} | 65 {52, 72} | 103 {90, 128} | 20 {15, 21} | 98 {96, 100} | ||||||||
PLR start (T2) | 79 {69, 88} | 0.887 | 112 {104, 123} | 0.551 | 55 {47, 65} | 0.054 | 92 {85, 104} | 0.514 | 22 {18, 22} | 0.143 | 100 {98, 100} | 0.912 | ||
PLR end (T2) | 78 {67, 85} | 115 {108, 130} | 68 {57, 70} | 100 {84, 115} | 18 {16, 21} | 99 {96, 100} | ||||||||
SBT start (T3) | 80 {69, 90} | 0.932 | 114 {104, 132} | 0.908 | 52 {49, 67} | 0.219 | 73 {68, 85} | 0.319 | 20 {19, 22} | 0.198 | 98 {96, 100} | 0.413 | 41 {37, 45} | 0.195 |
SBT end (T3) | 75 {70, 91} | 116 {103, 130} | 62 {53, 70} | 78 {73, 88} | 18 {14, 21} | 97 {96, 98} | 37 {33, 39} | |||||||
FLUID-UNRESPONSIVE | ||||||||||||||
HR (lpm) | p | SAP (mmHg) | p | DAP (mmHg) | p | MAP (mmHg) | p | RR (bpm) | p | SaO2 (%) | p | pCO2 (mmHg) | p | |
PLR start (T1) | 71 {67, 77} | 0.527 | 119 {104, 142} | 0.189 | 64 {59, 66} | 0.206 | 99 {85, 116} | 0.401 | 21 {18, 22} | 0.244 | 99 {98, 100} | 0.279 | ||
PLR end (T1) | 73 {61, 78} | 136 {114, 151} | 68 {64, 73} | 111 {94, 127} | 16 {13, 19} | 98 {96, 99} | ||||||||
PLR start (T2) | 76 {72, 76} | 0.268 | 120 {115, 132} | 0.050 | 62 {61, 67} | 0.127 | 105 {99, 116} | 0.127 | 16 {14, 19} | 0.658 | 100 {98, 100} | 0.609 | ||
PLR end (T2) | 74 {67, 75} | 150 {149, 158} | 81 {74, 82} | 128 {127, 137} | 18 {17, 20} | 99 {94, 100} | ||||||||
SBT start (T3) | 70 {67, 73} | 0.827 | 123 {119, 146} | 0.275 | 59 {57, 67} | 0.121 | 80 {80, 93} | 0.184 | 16 {14, 19} | 0.513 | 97 {96, 98} | 0.822 | 39 {38, 43} | 0.202 |
SBT end (T3) | 71 {66, 74} | 149 {148, 165} | 77 {75, 77} | 106 {105, 112} | 15 {11, 18} | 97 {97, 98} | 37 {33, 39} | |||||||
(b) | ||||||||||||||
FLUID-RESPONSIVE | ||||||||||||||
CI (L/min/m2) | p | SVI (mL/m2) | p | SVV (%) | p | CVP (mmHg) | p | SvO2 (%) | p | TFC (1/Ω) | p | |||
PLR start (T1) | 2.8 {2.7, 3.0} | 0.003 | 37 {33, 43} | 0.005 | 21 {15, 22} | 0.035 | 9 {8, 10} | 0.529 | 74 {73, 74} | 0.971 | 110 {78, 120} | 0.912 | ||
PLR end (T1) | 4.0 {3.6, 4.7} | 55 {49, 55} | 13 {13, 16} | 9 {8, 10} | 73 {68, 75} | 113 {75, 116} | ||||||||
PLR start (T2) | 3.1 {2.8, 3.6} | 0.005 | 40 {38, 44} | 0.001 | 16 {14, 21} | 0.039 | 9 {8, 10} | 0.681 | 74 {70, 75} | 0.876 | 94 {72, 115} | 0.059 | ||
PLR end (T2) | 3.9 {3.6, 4.7} | 53 {45, 55} | 13 {13, 15} | 9 {7, 9} | 71 {70, 73} | 99 {75, 113} | ||||||||
SBT start (T3) | 3.1 {2.8, 3.7} | 0.045 | 42 {32, 48} | 0.024 | 14 {12, 18} | 0.713 | 10 {9, 12} | 0.266 | 72 {70, 75} | 0.06 | 89 {72, 116} | 0.755 | ||
SBT end (T3) | 3.7 {3.4, 4.1} | 53 {46, 56} | 15 {12, 16} | 9 {7, 10} | 69 {66, 71} | 92 {74, 114} | ||||||||
FLUID-UNRESPONSIVE | ||||||||||||||
CI (L/min/m2) | p | SVI (mL/m2) | p | SVV (%) | p | CVP (mmHg) | p | SvO2 (%) | p | TFC (1/Ω) | p | |||
PLR start (T1) | 3.5 {3.1, 4.0} | 0.878 | 47 {43, 51} | 0.574 | 14 {8, 16} | 0.721 | 9 {8, 11} | 0.645 | 71 {69, 74} | 0.628 | 66 {55, 84} | 0.994 | ||
PLR end (T1) | 3.5 {3.1, 4.2} | 50 {46, 53} | 13 {9, 14} | 9 {5, 12} | 74 {70, 74} | 66 {56, 87} | ||||||||
PLR start (T2) | 3.1 {2.4, 3.4} | 0.658 | 41 {35, 45} | 0.513 | 15 {15, 24} | 0.544 | 9 {8, 10} | 0.105 | 71 {70, 73} | 0.784 | 69 {60, 71} | 0.918 | ||
PLR end (T2) | 3.2 {2.5, 3.5} | 43 {36, 47} | 13 {12, 23} | 8 {7, 9} | 70 {69, 72} | 69 {58, 72} | ||||||||
SBT start (T3) | 3.2 {2.7, 3.2} | 0.268 | 42 {38, 44} | 0.275 | 16 {12, 19} | 0.827 | 9 {8, 11} | 0.993 | 77 {76, 78} | 0.05 | 51 {50, 58} | 0.513 | ||
SBT end (T3) | 3.5 {2.9, 3.7} | 49 {43, 50} | 14 {12, 19} | 9 {8, 11} | 72 {72, 73} | 52 {51, 58} |
(a) | ||||
Fluid balance (postoperative) (mL) | p | Fluid balance (before SBT) (mL) | p | |
Fluid-responsive | 5230 {3698, 5723} | 0.674 | 4476 {3697, 5722} | 0.281 |
Fluid-unresponsive | 4167 {3755, 5583} | 2997 {−146, 5747} | ||
(b) | ||||
Plasma volume status (postoperative) (%) | p | Plasma volume status (before SBT) (%) | p | |
Fluid-responsive | 17 {14, 22} | 0.156 | 17 {10, 20} | 0.226 |
Fluid-unresponsive | 9 {5, 13} | 8 {3, 14} |
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Castro, R.; Born, P.; Muñoz, F.; Guzmán, C.; Kattan, E.; Hernandez, G.; Bakker, J. Fluid Responsiveness Is Associated with Successful Weaning after Liver Transplant Surgery. J. Pers. Med. 2024, 14, 429. https://doi.org/10.3390/jpm14040429
Castro R, Born P, Muñoz F, Guzmán C, Kattan E, Hernandez G, Bakker J. Fluid Responsiveness Is Associated with Successful Weaning after Liver Transplant Surgery. Journal of Personalized Medicine. 2024; 14(4):429. https://doi.org/10.3390/jpm14040429
Chicago/Turabian StyleCastro, Ricardo, Pablo Born, Felipe Muñoz, Camila Guzmán, Eduardo Kattan, Glenn Hernandez, and Jan Bakker. 2024. "Fluid Responsiveness Is Associated with Successful Weaning after Liver Transplant Surgery" Journal of Personalized Medicine 14, no. 4: 429. https://doi.org/10.3390/jpm14040429