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Cardiac output during liver transplantation
S Colbert1, D M O'Hanlon, J Duranteau
1Department of Anesthesia and Intensive Care, Hôpital Paul Brousse, Villejuif, France.
Summary
Oesophageal Doppler monitoring (ODM) for cardiac output measurement showed considerable differences compared to the gold standard thermodilution technique in liver transplant patients. Its use is not recommended due to large measurement variability.
Area of Science:
- Anesthesiology
- Cardiovascular Physiology
- Surgical Monitoring
Background:
- Cardiac output measurement is crucial in major surgeries.
- Pulmonary artery catheter thermodilution is the current gold standard.
- Thermodilution has limitations in clinical practice.
Purpose of the Study:
- To compare oesophageal Doppler monitoring (ODM) with thermodilution for cardiac output measurement.
- To evaluate ODM accuracy during orthotopic liver transplantation.
- To assess the reliability of ODM in critical surgical phases.
Main Methods:
- Prospective randomized controlled study.
- Compared oesophageal Doppler monitor (ODM) with thermodilution.
- 18 patients undergoing orthotopic liver transplantation.
- Measurements during dissection, anhepatic, and reperfusion phases.
Main Results:
- Strong correlation between ODM and thermodilution (r = 0.714; P < 0.00001).
- Bland-Altman analysis revealed a small mean difference (0.07 l.min-1) but large precision (> 2 l.min-1 in one third of measurements).
- No consistent differences observed in individual patients.
Conclusions:
- Oesophageal Doppler monitoring provides cardiac output measurements significantly different from thermodilution.
- The precision of ODM is insufficient for reliable clinical use in this context.
- ODM is not recommended for cardiac output monitoring during orthotopic liver transplantation.