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Transoesophageal echo-Doppler vs. thermodilution cardiac output measurement during hepatic vascular exclusion in liver transplantation

Published online by Cambridge University Press:  01 June 2008

C. Boucaud ,
Y. Bouffard ,
J. Dumortier ,
N. Gaillac ,
P. Sagnard ,
M. C. Graber ,
M. Adham  and
O. Boillot
C. Boucaud*
Affiliation:
Hôpital Edouard Herriot, Hospices Civils de Lyon, Anesthesiology and Intensive Care Department, Lyon, France Hôpital Edouard Herriot, Hospices Civils de Lyon, Liver Transplant Unit, Lyon, France
Y. Bouffard
Affiliation:
Hôpital Edouard Herriot, Hospices Civils de Lyon, Anesthesiology and Intensive Care Department, Lyon, France Hôpital Edouard Herriot, Hospices Civils de Lyon, Liver Transplant Unit, Lyon, France
J. Dumortier
Affiliation:
Hôpital Edouard Herriot, Hospices Civils de Lyon, Liver Transplant Unit, Lyon, France
N. Gaillac
Affiliation:
Hôpital Edouard Herriot, Hospices Civils de Lyon, Anesthesiology and Intensive Care Department, Lyon, France
P. Sagnard
Affiliation:
Hôpital Edouard Herriot, Hospices Civils de Lyon, Anesthesiology and Intensive Care Department, Lyon, France Hôpital Edouard Herriot, Hospices Civils de Lyon, Liver Transplant Unit, Lyon, France
M. C. Graber
Affiliation:
Hôpital Edouard Herriot, Hospices Civils de Lyon, Anesthesiology and Intensive Care Department, Lyon, France Hôpital Edouard Herriot, Hospices Civils de Lyon, Liver Transplant Unit, Lyon, France
M. Adham
Affiliation:
Hôpital Edouard Herriot, Hospices Civils de Lyon, Liver Transplant Unit, Lyon, France
O. Boillot
Affiliation:
Hôpital Edouard Herriot, Hospices Civils de Lyon, Liver Transplant Unit, Lyon, France
*
Correspondence to: Catherine Boucaud, Hôpital Edouard Herriot, 3 Place d’Arsonval, 69437 Lyon, Cedex 3, France. E-mail: Catherine.boucaud@chu-lyon.fr; Tel: +33 472116269; Fax: +33 472116783
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Summary

Background and objective

Continuous monitoring of cardiac output during liver transplantation is essential to evaluate the patient’s haemodynamic tolerance to acute volume variations. The aim of this study was to compare the cardiac output values obtained with a transoesophageal echo-Doppler and those obtained with a continuous thermodilution cardiac output pulmonary artery catheter.

Methods

Twenty adult patients were prospectively studied during a 5 min hepatic vascular exclusion test performed at the end of the dissection phase. Echo-Doppler and continuous thermodilution cardiac output, mean arterial pressure and end-tidal CO2 were measured before and at the end of the test.

Results

Before the test, echo-Doppler cardiac output was 7.0 ± 2.7 L min−1 and thermodilution was 9.4 ± 3.1 L min−1, (R = 0.85, P < 0.001). The end test values were, respectively, 3.5 ± 2.7 and 7.8 ± 3.5 L min−1 (R = 0.23, P = 0.34). Bland and Altman analysis showed a bias of −2.2 before the test, which increased to −4.4 at the end of the test. Mean arterial pressure decreased from 85.5 ± 15 to 66.8 ± 16 mmHg, end-tidal CO2 from 31.4 ± 2.3 to 23.8 ± 2.7 mmHg.

Conclusion

Echo-Doppler cardiac output values are different from those measured by thermodilution cardiac output in these patients. Echo-Doppler cardiac output monitoring seems to detect the output changes, which can occur during acute haemodynamic changes more rapidly than thermodilution cardiac output in the course of liver transplantation.

Keywords

CARDIAC OUTPUTTHERMODILUTIONECHOCARDIOGRAPHY DOPPLERLIVER TRANSPLANTATION
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 6 , June 2008 , pp. 485 - 489
Copyright
Copyright © European Society of Anaesthesiology 2008

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