Cardiac output-based fluid optimization for kidney transplant recipients: a proof-of-concept trial

Corbella, Davide; Toppin, Patrick Jason; Ghanekar, Anand; Ayach, Nour; Schiff, Jeffrey; Rensburg, Adrian Van; McCluskey, Stuart A.

doi:10.1007/s12630-018-1118-y

Cited by 19 publications

(6 citation statements)

References 26 publications

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“…Two previous studies investigated a goal-directed fluid therapy during KT: 15 , 20 both Cavaleri et al 15 and Corbella et al 20 applied a Stroke Volume (SV) optimization protocol with different objectives. Cavaleri 15 aimed to show a reduction in early complications after KT using a FloTrac TM /EV1000 monitor, while Corbella 19 aimed to evaluate if the use of esophageal doppler monitoring would alter the amount of fluids given during KT.…”

Section: Discussionmentioning

confidence: 99%

Pulse pressure variation guided fluid therapy during kidney transplantation: a randomized controlled trial

Cassai

Bond

Marini

et al. 2020

Brazilian Journal of Anesthesiology (English Edition)

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Section: Discussionmentioning

confidence: 99%

Pulse pressure variation guided fluid therapy during kidney transplantation: a randomized controlled trial

Cassai

Bond

Marini

et al. 2020

Brazilian Journal of Anesthesiology (English Edition)

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“…Apparently, there is increasing interest in advanced hemodynamic monitoring in pediatric kidney transplantation. Especially, esophageal doppler monitoring seems to gain popularity in this field. Although it is still difficult to show an unambiguous impact on outcome, monitoring the effect of fluids, and vasopressor support on CO makes sense as a cornerstone in hemodynamic management.…”

Section: Discussionmentioning

confidence: 99%

“…25 Apparently, there is increasing interest in advanced hemodynamic monitoring in pediatric kidney transplantation. Especially, esophageal doppler monitoring 26 seems to gain popularity in this field. Although it is still difficult to…”

Section: Alternative Co-monitoringmentioning

confidence: 99%

Cardiac output‐guided hemodynamic therapy for adult living donor kidney transplantation in children under 20 kg: A pilot study

Voet

Nusmeier

Lerou

et al. 2019

Pediatric Anesthesia

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Background A living‐donor (adult) kidney transplantation in young children requires an increased cardiac output to maintain adequate perfusion of the relatively large kidney. To achieve this, protocols commonly advise liberal fluid administration guided by high target central venous pressure. Such therapy may lead to good renal outcomes, but the risk of tissue edema is substantial. Aims We aimed to evaluate the safety and feasibility of the transpulmonary thermodilution technique to measure cardiac output in pediatric recipients. The second aim was to evaluate whether a cardiac output‐guided hemodynamic therapy algorithm could induce less liberal fluid administration, while preserving good renal results and achieving increased target cardiac output and blood pressure. Methods In twelve consecutive recipients, cardiac output was measured with transpulmonary thermodilution (PiCCO device, Pulsion). The algorithm steered administration of fluids, norepinephrine and dobutamine. Hemodynamic values were obtained before, during and after transplantation. Results are given as mean (SD) [minimum‐maximum]. Results Age and weight of recipients was 3.2 (0.97) [1.6‐4.9] yr and 14.1 (2.4) [10.4‐18] kg, respectively. No complications related to cardiac output monitoring occurred. After transplantation, cardiac index increased with 31% (95% CI = 15%‐48%). Extravascular lung water and central venous pressure did not change. Fluids given decreased from 158 [124‐191] mL kg−1 in the first 2 patients to 80 (18) [44‐106] mL kg−1 in the last 10 patients. The latter amount was 23 mL kg−1 less (95% CI = 6‐40 mL kg−1) than in one recent study, but similar to that in another. After reperfusion, all patients received norepinephrine (maximum dose 0.45 (0.3) [0.1‐0.9] mcg kg−1 min−1). Patient and graft survivals were 100% with excellent kidney function at 6 months post‐transplantation. Conclusion Transpulmonary thermodilution‐cardiac output monitoring appeared to be safe and feasible. Using the cardiac output‐guided algorithm led to excellent renal results with a trend toward less fluids in favor of norepinephrine.

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“…The use of OD did not improve immediate graft function; however, the number of postoperative complications caused by fluid overload was limited [ 103 ]. Another study reported that OD did not alter the volume of fluid administered or the rate of complications in this group of patients [ 111 ].…”

Section: Intraoperative Carementioning

confidence: 99%

Anaesthetic Approach to Enhanced Recovery after Surgery for Kidney Transplantation: A Narrative Review

Jaszczuk

Natarajan

Papalois

2022

JCM

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Enhanced recovery after surgery (ERAS) protocols are designed to reduce medical complications, the length of hospital stays (LoS), and healthcare costs. ERAS is considered safe and effective for kidney transplant (KTx) surgery. KTx recipients are often frail with multiple comorbidities. As these patients follow an extensive diagnostic pathway preoperatively, the ERAS protocol can ideally be implemented at this stage. Small singular changes in a long perioperative pathway can result in significant positive outcomes. We have investigated the current evidence for an ERAS pathway related to anaesthetic considerations in renal transplant surgery for adult recipients.

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Cardiac output-based fluid optimization for kidney transplant recipients: a proof-of-concept trial

Abstract: www.clinicaltrials.gov (NCT02512731). Registered 31 July 2015.

Cited by 19 publications

References 26 publications

Pulse pressure variation guided fluid therapy during kidney transplantation: a randomized controlled trial

Pulse pressure variation guided fluid therapy during kidney transplantation: a randomized controlled trial

Cardiac output‐guided hemodynamic therapy for adult living donor kidney transplantation in children under 20 kg: A pilot study

Anaesthetic Approach to Enhanced Recovery after Surgery for Kidney Transplantation: A Narrative Review

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