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Utilization of bioreactance technique as indicator for preload responsiveness during living donor liver donation
1Department of Anesthesiology, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan.
Background:
Fluid restriction has been used to decrease central venous pressure as a strategy of fluid management during living donor liver donation (LDLD). However, potential risks such as hemodynamic instability are also involved during the procedure. Monitoring of preload or preload responsiveness is therefore crucial during LDLD. The aim of this study was to explore the efficiency of an innovative bioreactance method that introduced the noninvasive cardiac output monitor (NICOM, Cheetah Medical, Vancouver, Wash, United States), as surrogate indicator for preload responsiveness during LDLD.
Methods:
Twenty-six patients underwent LDLD and were enrolled in this study. Fluid was restricted until the organ was harvested. The ultrasonic cardiac output monitor (USCOM Ltd, Sydney, Australia) was applied to measure stroke volume (SV) before and after 500 mL of 6% hydroxyethyl starch 130/0.4 (Voluven, Fresenius Kabi, Friedberg, Germany) fluid challenge, and the value of SV variation (SVV) from NICOM was also recorded. Fluid responsiveness was defined if SV increased by more than 15%. Receiver operating characteristic (ROC) curve was performed.
Results:
The area under the ROC curve was 0.6023. The optimal cutoff value of SVV from NICOM was 12% during LDLD.
Conclusions:
Our study has shown that SVV measured from the bioreactance technique is a poor indicator for monitoring preload responsiveness during LDLD.
