Hemodynamic Response to a Rapid Fluid Challenge in End-Stage Liver Disease .

Song,  Jang Ho; Hwang,  Kyu Sam; Shim,  Heung Rak; Gwak,  Mi Jeung; Lee,  Su Keoung; Choi,  Kyu Taek

doi:2002.42.3.318

Clinical Research Article

Korean Journal of Anesthesiology 2002;42(3):318-324.
DOI: https://doi.org/10.4097/kjae.2002.42.3.318

Hemodynamic Response to a Rapid Fluid Challenge in End-Stage Liver Disease .

Jang Ho Song, Kyu Sam Hwang, Heung Rak Shim, Mi Jeung Gwak, Su Keoung Lee, Kyu Taek Choi

Department of Anesthesiology, Asan Medical Center, College of Medicine, University of Ulsan, Korea

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.

Key Words: Fluid challenge; hemodynamics; transplantation; liver