Hemodynamic monitoring during liver transplantation: A state of the art review

Abstract

Orthotopic liver transplantation can be marked by significant hemodynamic instability requiring the use of a variety of hemodynamic monitors to aide in intraoperative management. Invasive blood pressure monitoring is essential, but the accuracy of peripheral readings in comparison to central measurements has been questioned. When discrepancies exist, central mean arterial pressure, usually measured at the femoral artery, is considered more indicative of adequate perfusion than those measured peripherally. The traditional pulmonary artery catheter is less frequently used due to its invasive nature and known limitations in measuring preload but still plays an important role in measuring cardiac output (CO) when required and in the management of portopulmonary hypertension. Pulse wave analysis is a newer technology that uses computer algorithms to calculate CO, stroke volume variation (SVV) and pulse pressure variation (PPV). Although SVV and PPV have been found to be accurate predicators of fluid responsiveness, CO measurements are not reliable during liver transplantation. Transesophageal echocardiography is finding an increasing role in the real-time monitoring of preload status, cardiac contractility and the diagnosis of a variety of pathologies. It is limited by the expertise required, limited transgastric views during key portions of the operation, the potential for esophageal varix rupture and difficulty in obtaining quantitative measures of CO in the absence of tricuspid regurgitation.

A Novel Parameter Derived From Photoplethysmographic Pulse Wave to Predict Risk of Postreperfusion Syndrome

“…The increase of SSI values might be ascribed to the signi cantly increased HR and SVR, resulting from the compensatory barore ex for the sudden reduced preload and hypotension. Clamping of the IVC reduced 50% venous return and cardiac output, together with increased systemic vascular resistance and heart rate [11,16,17]. The similar change of the hemodynamics had also been reported in the healthy awake volunteers while changing to head-up tilt position [9,17].…”

Robust and scalable manifold learning via landmark diffusion for long-term medical signal processing

“…It is a challenging surgical procedure, and significant medical resource, experience and dedication are needed. During the surgery, the clamping of major vessels and the subsequent vascular anastomosis bring huge impacts on the recipient's circulation system [39]. As a better understanding of the cardiovascular dynamics during the procedure may help optimize the intraoperative management, commercial monitoring instruments based on real-time arterial blood pressure (ABP) waveform analysis has been introduced.…”

Management of Patients with Liver Transplantation in ICU

“…The assessment of the intravascular volume is of vital importance given that volume status can be affected by contradictory factors such hypovolemia or hypervolemia, both detrimental for graft and patient survival. Restoring volume status, a continually dynamic parameter, and achieving optimal CO are crucial in order to maintain the delicate balance between preload optimization and avoidance of pulmonary edema [13].…”