Pressure versus volume indices to guide fluid infusion early after living donor liver transplantation: A prospective randomized controlled trial

Background: Fluid resuscitation in early post-operative (PO) period after liver transplantation (LT) can be very detrimental for both graft and patient's outcome. Central venous pressure (CVP) was commonly used to guide fluid resuscitation after LT; yet, volumetric indices like stroke volume (SV) or right ventricular end diastolic volume (RVEDV) have gained more support recently. We tested the hypothesis that use of any of the three parameters to guide fluid therapy in the early PO period after living donor liver transplantation (LDLT) will not elaborate any changes in fluid volumes infused or graft and patient outcome. Patients and methods: Sixty patients undergoing LDLT allocated based on the parameter guiding the fluid therapy in the first 72 h in ICU into one of three groups, G-CVP (control), G-SV and GRV groups 20 patients each using CVP, SVI and RVEDVI respectively to guide fluid therapy. Based on the guiding parameter assessed every 4 h, fluid therapy was administered as 500 ml boluses followed by reassessment of the guiding parameter for further fluid infusion. Fluids infused over three days in the ICU were used as a primary outcome. Hemodynamics, graft and renal functions, and graft and patient outcome were recorded as secondary objectives. Results: CVP and PCWP were significantly higher in G-SV and G-RV compared to the CVP group while other hemodynamic parameters did not show significant differences between the groups. Fluid volume infused and urine output were significantly higher in G-SV and G-RV compared to G-CVP group. Laboratory and survival data did not differ among the studied groups. Conclusion: The use of the CVP to guide fluid infusion after LT is a safe and effective alternative to more logistically demanding techniques as SV and RVEDVI without any negative impact on patient hemodynamic or metabolic homeostasis. (C) 2012 Egyptian Society of Anesthesiologists. Production and hosting by Elsevier B.V.