Assessment of superior vena cava diameter and collapsibility index in liver transplantation: a prospective observational study
Avaliação do diâmetro da veia cava superior e índice de colapsibilidade no transplante de fígado: um estudo observacional prospectivo
Maged Y. Argalious, Sven Halvorson, John Seif, Sandeep Khanna, Mi Wang, Jacek B. Cywinski
Abstract
Background
Superior Vena Cava (SVC) diameter and collapsibility index, dynamic measures of fluid responsiveness, have been successfully utilized as echocardiographic indices for fluid responsiveness in ventilated septic patients. Whether these measurements are correlated with Central Venous Pressure (CVP) measurements in liver transplant patients is unknown. We sought to assess the correlation of maximum and minimum SVC diameter and SVC collapsibility index measurements obtained intraoperatively by Transesophageal Echocardiography (TEE) with those of simultaneously recorded CVP measurements obtained through a right atrial port of a pulmonary artery catheter. The secondary aim of the study was to assess the correlation between SVC measurements and simultaneously obtained thermodilution cardiac index measurements.
Methods
Single center prospective observational trial of patients with end stage liver disease undergoing liver transplantation in an academic tertiary care center.
Results
The minimum SVC exhibited a mild significant correlation with CVP as did the maximum SVC. The correlation between the SVC collapsibility index and CVP was not significantly different from zero. In our secondary analysis, the correlation between minimum SVC diameter and cardiac index was determined to be weak but non-zero as was the correlation between the maximum SVC diameter and cardiac index. The correlation between SVC collapsibility index and cardiac index was not different from zero.
Conclusion
While statistically significant, the weak clinical correlation of intraoperative SVC measurements obtained by TEE make them unsuitable as a replacement for central venous pressure or thermodilution cardiac index measurements in liver transplant recipients.
Keywords
Resumo
Introdução
O diâmetro da veia cava superior (VCS) e o índice de colapsibilidade, medidas dinâmicas de responsividade a fluidos, foram utilizados com sucesso como índices ecocardiográficos para responsividade a fluidos em pacientes sépticos ventilados. Não se sabe se essas medidas estão correlacionadas com medidas de pressão venosa central (PVC) em pacientes com transplante de fígado. Buscamos avaliar a correlação das medidas máximas e mínimas de diâmetro da VCS e índice de colapsibilidade da VCS obtidas intraoperatoriamente por ecocardiografia transesofágica (ETE) com aquelas de medidas de PVC registradas simultaneamente obtidas por meio de uma porta atrial direita de um cateter de artéria pulmonar. O objetivo secundário do estudo foi avaliar a correlação entre medidas de VCS e medidas de índice cardíaco de termodiluição obtidas simultaneamente.
Métodos
Ensaio observacional prospectivo de centro único de pacientes com doença hepática em estágio terminal submetidos a transplante de fígado em um centro acadêmico de cuidados terciários.
Resultados
A VCS mínima exibiu uma correlação significativa leve com PVC, assim como a VCS máxima. A correlação entre o índice de colapsibilidade da VCS e a CVP não foi significativamente diferente de zero. Em nossa análise secundária, a correlação entre o diâmetro mínimo da VCS e o índice cardíaco foi determinada como fraca, mas diferente de zero, assim como a correlação entre o diâmetro máximo da VCS e o índice cardíaco. A correlação entre o índice de colapsibilidade da VCS e o índice cardíaco não foi diferente de zero.
Conclusões
Embora estatisticamente significativa, a fraca correlação clínica das medidas intraoperatórias da VCS obtidas por ETE as torna inadequadas como uma substituição para medidas de pressão venosa central ou índice cardíaco de termodiluição em receptores de transplante de fígado.
Palavras-chave
Referências
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