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

Table 1 Comparative summary table of hemodynamic monitors in orthotopic liver transplantation

Monitor	Benefits and uses	Limitations
Invasive blood pressure monitoring	Beat-to-beat monitoring of blood pressure	Peripheral arteries possibly underestimate the central mean arterial pressure especially during reperfusion or use or high dose vasopressors
Pulmonary artery catheter	Accurately determines cardiac output via intermittent thermodilution	Invasive
	Directly measures PA pressures	Static pressure measurements are imperfect indicators of fluid status or stroke volume
Arterial pulse wave analysis - CO	Less invasive option to calculate CO	Does not reliably calculate CO in advanced cirrhosis or during OLT
Arterial pulse wave analysis - SVV	Predicts fluid responsiveness in OLT population	Requires sinus rhythm
		Requires patient does not make any spontaneous respiratory efforts
		Most accurate during tidal volumes of 8-12 mL/kg
Transesophageal echocardiography	Direct assessment of cardiac filling	Requires advanced training
	Monitors myocardial ischemia and strain	Limited views intraoperatively
	Potentially can diagnose pulmonary embolisms, shunts, effusions, and valvular pathologies	Risk of esophageal varix rupture or esophageal injury

CO: Cardiac output; SVV: Stroke volume variation; OLT: Orthotopic liver transplantation; PA: Pulmonary artery.