The effect of pulse pressure variation compared with central venous pressure on intraoperative fluid management during kidney transplant surgery: a randomized controlled trial

Kannan, Gowtham; Loganathan, Sekar; Kajal, Kamal; Hazarika, Amarjyoti; Sethi, Sameer; Sen, Indu; Subramanyam, Rajeev; Singh, Sarbpreet

doi:10.1007/s12630-021-02130-y

Cited by 7 publications

(6 citation statements)

References 20 publications

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“…Dynamic variables based on the heart–lung interaction appear to be good predictors of fluid responsiveness in adults 7 ; however, there is no consensus on their usefulness in children. Respiration induces changes in the cardiac SV centrally which are transmitted peripherally by the change in the arterial BP.…”

Section: Discussionmentioning

confidence: 99%

“…4,5 Considering the short intravascular stay of crystalloids, liberal fluid administration to maintain higher central venous pressure may not be an ideal strategy in patients with dilated cardiomyopathy. 6 Dynamic variables based on the heart-lung interaction appear to be good predictors of fluid responsiveness in adults 7 ; however, there is no consensus on their usefulness in children. Respiration induces changes in the cardiac SV centrally which are transmitted peripherally by the change cases-anesthesia-analgesia.org…”

Section: Discussionmentioning

confidence: 99%

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Pediatric Renal Transplant With Dilated Cardiomyopathy: A Stepwise Hemodynamic Management—A Case Report

Garg,

Kayina,

Kajal

et al. 2023

A&A Practice

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Here we have described the anesthetic management of a 10-year-old patient having uremia-induced dilated cardiomyopathy for a living-related adult to pediatric renal transplant. Maintaining optimal hemodynamics, especially during the reperfusion phase, is crucial for maintaining graft perfusion. However, dilated cardiomyopathy limits indiscriminate fluid administration as it may cause congestive heart failure and pulmonary edema. We have described the fluid therapy algorithm based on the plethysmography variability index and velocity time integral at the left ventricular outflow tract, which was able to limit excessive fluid administration and maintain adequate perfusion pressures.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pediatric Renal Transplant With Dilated Cardiomyopathy: A Stepwise Hemodynamic Management—A Case Report

Garg,

Kayina,

Kajal

et al. 2023

A&A Practice

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“…[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.…”

Section: Discussionmentioning

confidence: 99%

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

Gopal,

Srivastava,

Singh

et al. 2023

Asian J Neurosurg

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Objective Appropriate fluid management in neurosurgery is critical due to the risk of secondary brain injury. Determination of volume status is challenging with static variables being unreliable. Goal-directed fluid therapy with dynamic variables allows reliable determination of fluid responsiveness and promises better outcomes. We aimed to compare the intraoperative fluid requirement between conventional central venous pressure (CVP)-guided and pulse pressure variance (PPV)-guided fluid management in supratentorial tumor surgeries. Materials and Methods This prospective, randomized, double-blind, single-center trial was conducted with 72 adults undergoing supratentorial tumor surgery in a supine position. Patients were divided into two groups of 36 patients each receiving CVP- and PPV-guided fluid therapy. The CVP-guided group received boluses to target CVP greater than 8 mm Hg along with hourly replacement of intraoperative losses and maintenance fluids. The PPV-guided group received boluses to target PPV less than 13% in addition to maintenance fluids. Total intraoperative fluids administered and the incidence of hypotension was recorded along with the brain relaxation score. Postoperatively, serum lactate levels, periorbital and conjunctival edema, as well as postoperative nausea and vomiting were assessed. Statistical Analyses All statistical analyses were performed with Statistical Package for Social Sciences, version-20 (SPSS-20, IBM, Chicago, Illinois, United States). To compare the means between the two groups (CVP vs. PPV), independent samples t-test was used for normal distribution data and Mann–Whitney U test for nonnormal distribution data. The chi-square test or Fischer's exact test was used for categorical variables. Results The CVP group received significantly more intraoperative fluids than the PPV group (4,340 ± 1,010 vs. 3,540 ± 740 mL, p < 0.01). Incidence of hypotension was lower in the PPV group (4 [11.1%] vs. 0 [0%], p = 0.04). Brain relaxation scores, serum lactate levels, periorbital and conjunctival edema, and incidence of postoperative nausea and vomiting were comparable between the groups. Conclusion The requirement for intraoperative fluids was less in PPV-guided fluid management with better hemodynamic stability, adequate brain conditions, and no compromise of perfusion.

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“…Secondary outcomes including intraoperative hemodynamics, serum lactate, serum creatinine, need for post-operative dialysis, and DGF were not different between groups. 45…”

Section: Kidney Transplantationmentioning

confidence: 99%

“…Secondary outcomes including intraoperative hemodynamics, serum lactate, serum creatinine, need for post-operative dialysis, and DGF were not different between groups. 45 Blood transfusion in the postoperative period and its relation to venous thromboembolism (VTE) was studied in a retrospective cohort study of 1258 patients. 46 Red blood cells (RBCs) transfused on POD 1 or later were correlated with an increased incidence of VTE, deep vein thrombosis (DVT), and pulmonary embolism (PE).…”

Section: Perioperative Fluid and Bloodmentioning

confidence: 99%

Abdominal Organ Transplantation: Noteworthy Literature in 2022

Nolasco

Igwe

Sakai

2023

Semin Cardiothorac Vasc Anesth

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This review highlights noteworthy literature published in 2022 pertinent to anesthesiologists and critical care physicians caring for patients undergoing abdominal organ transplantation. We begin by exploring the impacts that the COVID-19 pandemic has had across the field of abdominal organ transplantation, including the successful use of grafts procured from COVID-19-infected donors. In pancreatic transplantation, we highlight several studies on dexmedetomidine and ischemia-reperfusion injury, equity in transplantation, and medical management, as well as studies comparing pancreatic transplantation to islet cell transplantation. In our section on intestinal transplantation, we explore donor selection. Kidney transplantation topics include cardiovascular risk management, obesity, and intraoperative management, including fluid resuscitation, dexmedetomidine, and sugammadex. The liver transplantation section focuses on clinical trials, systematic reviews, and meta-analyses published in 2022 and covers a wide range of topics, including machine perfusion, cardiovascular issues, renal issues, and coagulation/transfusion.

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The effect of pulse pressure variation compared with central venous pressure on intraoperative fluid management during kidney transplant surgery: a randomized controlled trial

Cited by 7 publications

References 20 publications

Pediatric Renal Transplant With Dilated Cardiomyopathy: A Stepwise Hemodynamic Management—A Case Report

Pediatric Renal Transplant With Dilated Cardiomyopathy: A Stepwise Hemodynamic Management—A Case Report

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

Abdominal Organ Transplantation: Noteworthy Literature in 2022

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