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Intraoperative fluid management during orthotopic liver transplantation.

Publication ,  Journal Article
Schroeder, RA; Collins, BH; Tuttle-Newhall, E; Robertson, K; Plotkin, J; Johnson, LB; Kuo, PC
Published in: J Cardiothorac Vasc Anesth
August 2004

OBJECTIVE: To assess clinical safety of a low central venous pressure (CVP) fluid management strategy in patients undergoing liver transplantation. DESIGN: Retrospective record review comparing 2 transplant centers, one using the low CVP method and the other using the normal CVP method. SETTING: University-based, academic, tertiary care centers. PARTICIPANTS: Patients undergoing orthotopic cadaveric liver transplantation. INTERVENTIONS: Each center practiced according to its own standard of care. Center 1 maintained an intraoperative CVP <5 mmHg using fluid restriction, nitroglycerin, forced diuresis, and morphine. If pressors were required to maintain systolic arterial pressure >90 mmHg, phenylephrine or norepinephrine was used. At center 2, CVP was kept 7 to 10 mmHg and mean arterial pressure >75 mmHg with minimal use of vasoactive drugs. MEASUREMENTS AND MAIN RESULTS: Data collected included United Network for Organ Sharing status, surgical technique, intraoperative transfusion rate, preoperative and peak postoperative creatinine, time spent in intensive care unit and hospital, incidence of death, and postoperative need for hemodialysis. Principal findings include an increased rate of transfusion in the normal CVP group but increased rates of postoperative renal failure (elevated creatinine and more frequent need for dialysis) and 30-day mortality in the low CVP group. CONCLUSIONS: Despite success in lowering blood transfusion requirements in liver resection patients, a low CVP should be avoided in patients undergoing liver transplantation.

Duke Scholars

Published In

J Cardiothorac Vasc Anesth

DOI

ISSN

1053-0770

Publication Date

August 2004

Volume

18

Issue

4

Start / End Page

438 / 441

Location

United States

Related Subject Headings

  • Vasodilator Agents
  • Vasoconstrictor Agents
  • Postoperative Complications
  • Nitroglycerin
  • Morphine
  • Monitoring, Intraoperative
  • Middle Aged
  • Male
  • Liver Transplantation
  • Intraoperative Care
 

Citation

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Chicago
ICMJE
MLA
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Schroeder, R. A., Collins, B. H., Tuttle-Newhall, E., Robertson, K., Plotkin, J., Johnson, L. B., & Kuo, P. C. (2004). Intraoperative fluid management during orthotopic liver transplantation. J Cardiothorac Vasc Anesth, 18(4), 438–441. https://doi.org/10.1053/j.jvca.2004.05.020
Schroeder, Rebecca A., Bradley H. Collins, Elizabeth Tuttle-Newhall, Kerri Robertson, Jeffrey Plotkin, Lynt B. Johnson, and Paul C. Kuo. “Intraoperative fluid management during orthotopic liver transplantation.J Cardiothorac Vasc Anesth 18, no. 4 (August 2004): 438–41. https://doi.org/10.1053/j.jvca.2004.05.020.
Schroeder RA, Collins BH, Tuttle-Newhall E, Robertson K, Plotkin J, Johnson LB, et al. Intraoperative fluid management during orthotopic liver transplantation. J Cardiothorac Vasc Anesth. 2004 Aug;18(4):438–41.
Schroeder, Rebecca A., et al. “Intraoperative fluid management during orthotopic liver transplantation.J Cardiothorac Vasc Anesth, vol. 18, no. 4, Aug. 2004, pp. 438–41. Pubmed, doi:10.1053/j.jvca.2004.05.020.
Schroeder RA, Collins BH, Tuttle-Newhall E, Robertson K, Plotkin J, Johnson LB, Kuo PC. Intraoperative fluid management during orthotopic liver transplantation. J Cardiothorac Vasc Anesth. 2004 Aug;18(4):438–441.
Journal cover image

Published In

J Cardiothorac Vasc Anesth

DOI

ISSN

1053-0770

Publication Date

August 2004

Volume

18

Issue

4

Start / End Page

438 / 441

Location

United States

Related Subject Headings

  • Vasodilator Agents
  • Vasoconstrictor Agents
  • Postoperative Complications
  • Nitroglycerin
  • Morphine
  • Monitoring, Intraoperative
  • Middle Aged
  • Male
  • Liver Transplantation
  • Intraoperative Care