A randomized comparison between pulse pressure variation and central venous pressure in patients undergoing renal transplantation

Abstract

Background and Aims: Intraoperative fluid management is important in renal transplant recipients with end-stage renal disease. Conventionally, central venous pressure (CVP) has been used to guide perioperative fluid administration but with high incidence of poor graft outcome. There is a requirement of reliable parameter to guide the fluid therapy in these patients so as to minimize the perioperative complications and improve the outcome. Hence, this study was conducted. Material and Methods: This prospective study included 75 patients of chronic kidney disease undergoing renal transplantation. Patients were divided into two groups. Group A (control group): Intraoperative fluids were guided by CVP; Group B: Intraoperative fluids were guided by pulse pressure variation (PPV). Primary outcome measure of this study was incidence of delayed graft functioning, i.e., need of hemodialysis within 7 days of renal transplant. Secondary outcome measures were incidence of perioperative hypotension, post-transplant pulmonary edema, tissue edema, and lactic acidosis. Results: Total amount of fluid before reperfusion was significantly greater in the control group (P = 0.005). However, the total amount of fluid required at the end of surgery was comparable. Delayed graft functioning was seen only in CVP group, although it was not statistically significant. The postoperative tissue edema was more in CVP group (P = 0.03). The postoperative nausea and vomiting, pulmonary edema, and mechanical ventilation were more in CVP group but not statistically significant. Increase in lactate value was more in CVP group. Conclusion: Perioperative fluid guidance by PPV is better than central venous pressure in renal transplant patients.

Clinical outcomes of a prospective randomized comparison of bioreactance monitoring versus pulse‐contour analysis in a stroke‐volume based goal‐directed fluid resuscitation protocol in brain‐dead organ donors

“…[18][19][20][21] Static measurements of cardiac function, for example, central venous pressure and pulmonary artery occlusion pressure, have been shown to be poor predictors of fluid responsiveness. 22,23 Many studies have demonstrated that the optimal way to resuscitate a critically ill patient in shock is by using a dynamic method to determine fluid responsiveness, such as increasing the SV by >10% with a fluid bolus or passive leg raising. [8][9][10][11][12]14 Optimizing SV and CO by using a dynamic assessment of fluid responsiveness has been shown to have improved clinical outcomes in the ICU and in the OR.…”

“…Multiple studies have shown that only 50% of critically ill hypotensive patients are fluid‐responsive, and one study demonstrated that only 48% of BD donors are fluid‐responsive 18–21 . Static measurements of cardiac function, for example, central venous pressure and pulmonary artery occlusion pressure, have been shown to be poor predictors of fluid responsiveness 22,23 . Many studies have demonstrated that the optimal way to resuscitate a critically ill patient in shock is by using a dynamic method to determine fluid responsiveness, such as increasing the SV by >10% with a fluid bolus or passive leg raising 8–12,14 .…”

Pulse Pressure Variance (PPV)-Guided Fluid Management in Adult Patients Undergoing Supratentorial Tumor Surgeries: A Randomized Controlled Trial

“…[11][12][13][23][24][25] Akin to our study, estimation of fluids by GDFT has led to a lesser intraoperative fluid requirement than conventional CVP-guided regimen in studies on renal transplant recipients. [26][27][28] De Cassai et al used PPV to guide fluid management to achieve adequate urine output and found it to be as effective as liberal fluid therapy. 26 Another randomized controlled trial (RCT) reported decreased intraoperative crystalloid requirement using PPV as compared to CVPguided fluid therapy with similar outcomes.…”

Current Commonly Used Dynamic Parameters and Monitoring Systems for Perioperative Goal-Directed Fluid Therapy: A Review

“…Although CVP is traditionally used as a static parameter to assess fluid responsiveness, multiple studies showed that it is unreliable [28]. In contrast, dynamic parameters were shown to estimate fluid responsiveness and status with reasonable accuracy [29][30][31][32].…”