Predicting Fluid Responsiveness in Acute Liver Failure: A Prospective Study

TY - JOUR

T1 - Predicting Fluid Responsiveness in Acute Liver Failure

T2 - A Prospective Study

AU - Audimoolam, Vinod Kumar

AU - McPhail, Mark J W

AU - Willars, Chris

AU - Bernal, William

AU - Wendon, Julia A

AU - Cecconi, Maurizio

AU - Auzinger, Georg

PY - 2017/2

Y1 - 2017/2

N2 - BACKGROUND: The profound hemodynamic changes seen in acute liver failure (ALF) resemble the hyperdynamic state found in the later stages of septic shock. Vasopressor support frequently is required after initial volume therapy. Markers of preload dependency have not been studied in this patient group. Dynamic maneuvers such as passive leg raising or end-expiratory hold, which have shown good predictive accuracy in a general intensive care unit population, cannot be considered safe in this cohort because of the concerns of intracranial hypertension.METHODS: Mechanically ventilated patients with ALF admitted to a tertiary specialist intensive care unit in shock and multiorgan failure were enrolled. Markers of fluid responsiveness derived from transpulmonary thermodilution, pulse contour analysis, and echocardiography were compared between responders (cardiac index ≥15%) and nonresponders to a colloid fluid challenge (5 mL/kg predicted body weight). The ability to predict fluid responsiveness of stroke volume variation, pulse pressure variation (PPV), and respiratory change in peak (delta V peak) left ventricular outflow tract velocity for preload dependency were analyzed.RESULTS: Thirty-five patients (mean ± SD age, 38 [14] years, 13 male, 22 female]) were assessed after a single fluid challenge. Ten patients (29%) were fluid responders. Changes in cardiac index and stroke volume index in the cohort of 35 patients were correlated (R = 0.726 [99% confidence interval, 0.401-0.910]; P < .001). PPV predicted fluid responsiveness (area under the receiver operating characteristic curve [AUROC], 0.752 [95% confidence interval, 0.565-0.889]; P = .005; cutoff >9%). The AUROC for stroke volume variation was 0.678 ([95% confidence interval, 0.499-0.825]; P = .084; cutoff >11%). The AUROC for [delta] V peak before fluid bolus was 0.637 (95% confidence interval, 0.413-0.825; P = .322).CONCLUSIONS: PPV based on pulse contour analysis predicted fluid responsiveness in ALF.

AB - BACKGROUND: The profound hemodynamic changes seen in acute liver failure (ALF) resemble the hyperdynamic state found in the later stages of septic shock. Vasopressor support frequently is required after initial volume therapy. Markers of preload dependency have not been studied in this patient group. Dynamic maneuvers such as passive leg raising or end-expiratory hold, which have shown good predictive accuracy in a general intensive care unit population, cannot be considered safe in this cohort because of the concerns of intracranial hypertension.METHODS: Mechanically ventilated patients with ALF admitted to a tertiary specialist intensive care unit in shock and multiorgan failure were enrolled. Markers of fluid responsiveness derived from transpulmonary thermodilution, pulse contour analysis, and echocardiography were compared between responders (cardiac index ≥15%) and nonresponders to a colloid fluid challenge (5 mL/kg predicted body weight). The ability to predict fluid responsiveness of stroke volume variation, pulse pressure variation (PPV), and respiratory change in peak (delta V peak) left ventricular outflow tract velocity for preload dependency were analyzed.RESULTS: Thirty-five patients (mean ± SD age, 38 [14] years, 13 male, 22 female]) were assessed after a single fluid challenge. Ten patients (29%) were fluid responders. Changes in cardiac index and stroke volume index in the cohort of 35 patients were correlated (R = 0.726 [99% confidence interval, 0.401-0.910]; P < .001). PPV predicted fluid responsiveness (area under the receiver operating characteristic curve [AUROC], 0.752 [95% confidence interval, 0.565-0.889]; P = .005; cutoff >9%). The AUROC for stroke volume variation was 0.678 ([95% confidence interval, 0.499-0.825]; P = .084; cutoff >11%). The AUROC for [delta] V peak before fluid bolus was 0.637 (95% confidence interval, 0.413-0.825; P = .322).CONCLUSIONS: PPV based on pulse contour analysis predicted fluid responsiveness in ALF.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Cardiac Output/physiology

KW - Cohort Studies

KW - Critical Care/methods

KW - Female

KW - Fluid Therapy/methods

KW - Humans

KW - Liver Failure, Acute/therapy

KW - Male

KW - Middle Aged

KW - Multiple Organ Failure/physiopathology

KW - Predictive Value of Tests

KW - Prospective Studies

KW - Respiration, Artificial

KW - Shock/physiopathology

KW - Stroke Volume/physiology

KW - Thermodilution

KW - Treatment Outcome

U2 - 10.1213/ANE.0000000000001585

DO - 10.1213/ANE.0000000000001585

M3 - Article

C2 - 27984249

SN - 0003-2999

VL - 124

SP - 480

EP - 486

JO - Anesthesia and Analgesia

JF - Anesthesia and Analgesia

IS - 2

ER -