Randomized Controlled Trial
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Sep 27, 2022; 14(9): 1037-1048
Published online Sep 27, 2022. doi: 10.4240/wjgs.v14.i9.1037
Effect of cardiac output - guided hemodynamic management on acute lung injury in pediatric living donor liver transplantation
Xiao-Jing Dou, Qing-Ping Wang, Wei-Hua Liu, Yi-Qi Weng, Ying Sun, Wen-Li Yu
Xiao-Jing Dou, Qing-Ping Wang, Wei-Hua Liu, Yi-Qi Weng, Ying Sun, Wen-Li Yu, Department of Anesthesiology, Tianjin First Central Hospital, Tianjin 300192, China
Author contributions: Dou XJ contributed to acquisition of data, data analysis, and wrote the manuscript; Yu WL provided substantial contribution to the conception and design of the study and corrected the manuscript; Wang QP, Liu WH, Weng YQ, and Sun Y collected the data.
Institutional review board statement: This study was approved by the Ethics Committee of Tianjin First Center Hospital in China (Approval Number: 2019N180KY).
Clinical trial registration statement: The clinical trial registration number is ChiCTR1900026016.
Informed consent statement: Informed consent was obtained from eligible guardians.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Data would be shared under proper request for the corresponding author.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wen-Li Yu, Doctor, PhD, Chief Doctor, Department of Anesthesiology, Tianjin First Central Hospital, No. 24 Fukang Road, Tianjin 300192, China. yzxyuwenli@163.com
Received: March 18, 2022
Peer-review started: March 18, 2022
First decision: May 12, 2022
Revised: May 25, 2022
Accepted: August 14, 2022
Article in press: August 14, 2022
Published online: September 27, 2022
Processing time: 188 Days and 8.1 Hours
Abstract
BACKGROUND

Acute lung injury (ALI) after liver transplantation (LT) may lead to acute respiratory distress syndrome, which is associated with adverse postoperative outcomes, such as prolonged hospital stay, high morbidity, and mortality. Therefore, it is vital to maintain hemodynamic stability and optimize fluid management. However, few studies have reported cardiac output-guided (CO-G) management in pediatric LT.

AIM

To investigate the effect of CO-G hemodynamic management on early postoperative ALI and hemodynamic stability during pediatric living donor LT.

METHODS

A total of 130 pediatric patients scheduled for elective living donor LT were enrolled as study participants and were assigned to the control group (65 cases) and CO-G group (65 cases). In the CO-G group, CO was considered the target for hemodynamic management. In the control group, hemodynamic management was based on usual perioperative care guided by central venous pressure, continuous invasive arterial pressure, urinary volume, etc. The primary outcome was early postoperative ALI. Secondary outcomes included other early postoperative pulmonary complications, readmission to the intense care unit (ICU) for pulmonary complications, ICU stay, hospital stay, and in-hospital mortality.

RESULTS

The incidence of early postoperative ALI was 27.7% in the CO-G group, which was significantly lower than that in the control group (44.6%) (P < 0.05). During the surgery, the incidence of postreperfusion syndrome was lower in the CO-G group (P < 0.05). The level of intraoperative positive fluid transfusions was lower and the rate of dobutamine use before portal vein opening was higher, while the usage and dosage of epinephrine during portal vein opening and vasoactive inotropic score after portal vein opening were lower in the CO-G group (P < 0.05). Compared to the control group, serum inflammatory factors (interleukin-6 and tumor necrosis factor-α), cardiac troponin I, and N-terminal pro-brain natriuretic peptide were lower in the CO-G group after the operation (P < 0.05).

CONCLUSION

CO-G hemodynamic management in pediatric living-donor LT decreases the incidence of early postoperative ALI due to hemodynamic stability through optimized fluid management and appropriate administration of vasopressors and inotropes.

Keywords: Cardiac output; Hemodynamic management; Child; Liver transplantation; Acute lung injury; Reperfusion injury

Core Tip: This is the first randomized controlled trial to evaluate the effect of cardiac output (CO)-guided hemodynamic therapy in pediatric liver recipients. In this study, hemodynamic parameters, including CO, stroke volume index, stroke volume variation, and the maximum increase in the speed of intraventricular pressure (dp/dtmax) obtained through the pressure recording analytical method monitoring were used to guide intraoperative hemodynamic management. The incidence of postoperative acute liver injury was significantly lower in the interventional group. Moreover, the inflammatory factors (interleukin-6 and tumor necrosis factor-α), cardiac troponin I, and N-terminal pro-brain natriuretic peptide levels decreased faster in the intervention group.