TY - JOUR
T1 - What is the optimal anesthetic monitoring regarding immediate and short-term outcomes after liver transplantation?—A systematic review of the literature and expert panel recommendations
AU - the ERAS4OLT.org Working Group: Marinos Zachiotis, Patras, Greece, Lelia Jeilani, London, UK, Claus Niemann, San Francisco, CA, USA, Joerg-Matthias Pollok, London, UK, Marina Berenguer, Valencia, Spain, Pascale Tinguely, London, UK, London,UK.
AU - Fernandez, Thomas M.A.
AU - Schofield, Nick
AU - Krenn, Claus G.
AU - Rizkalla, Nicole
AU - Spiro, Michael
AU - Raptis, Dimitri Aristotle
AU - De Wolf, Andre M.
AU - Merritt, William T.
N1 - Publisher Copyright:
© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
PY - 2022/10
Y1 - 2022/10
N2 - Background: Liver transplant centers vary in approach to intraoperative vascular accesses, monitoring of cardiac function and temperature management. Evidence is limited regarding impact of selected modalities on postoperative outcomes. Objectives: To review the literature and provide expert panel recommendations on optimal intraoperative arterial blood pressure (BP), central venous pressure (CVP), and vascular accesses, monitoring of cardiac function and intraoperative temperature management regarding immediate and short-term outcomes after orthotopic liver transplant (OLT). Methods: Systematic review following PRISMA guidelines and recommendations using the GRADE approach derived from an international expert panel. Recommendations made for: (1) Vascular accesses, arterial BP and CVP monitoring, (2) cardiac function monitoring, and (3) Intraoperative temperature management (CRD42021239908). Results: Of 2619 articles screened 16 were included. Studies were small, retrospective, and observational. Vascular access studies demonstrated low rates of insertion complications. TEE studies demonstrated low rates of esophageal hemorrhage. One study found lower hospital-LOS and 30-day mortality in patients monitored with both PAC and TEE. Other monitoring studies were heterogenous in design and outcomes. Temperature studies showed increased blood transfusion and ventilation times in hypothermic groups. Conclusions: Recommendations were made for; routine arterial and CVP monitoring as a minimum standard of practice, consideration of discrepancy between peripheral and central arterial BP in patients with hemodynamic instability and high vasopressor requirements, and routine use of high flow cannulae while monitoring for extravasation and hematoma formation. Availability and expertise in PAC and/or TEE monitoring is strongly recommended particularly in hemodynamic instability, portopulmonary HT and/or cardiac dysfunction. TEE use is recommended as an acceptable risk in patients with treated esophageal varices and is an effective diagnostic tool for emergency cardiovascular collapse. Maintenance of intraoperative normothermia is strongly recommended.
AB - Background: Liver transplant centers vary in approach to intraoperative vascular accesses, monitoring of cardiac function and temperature management. Evidence is limited regarding impact of selected modalities on postoperative outcomes. Objectives: To review the literature and provide expert panel recommendations on optimal intraoperative arterial blood pressure (BP), central venous pressure (CVP), and vascular accesses, monitoring of cardiac function and intraoperative temperature management regarding immediate and short-term outcomes after orthotopic liver transplant (OLT). Methods: Systematic review following PRISMA guidelines and recommendations using the GRADE approach derived from an international expert panel. Recommendations made for: (1) Vascular accesses, arterial BP and CVP monitoring, (2) cardiac function monitoring, and (3) Intraoperative temperature management (CRD42021239908). Results: Of 2619 articles screened 16 were included. Studies were small, retrospective, and observational. Vascular access studies demonstrated low rates of insertion complications. TEE studies demonstrated low rates of esophageal hemorrhage. One study found lower hospital-LOS and 30-day mortality in patients monitored with both PAC and TEE. Other monitoring studies were heterogenous in design and outcomes. Temperature studies showed increased blood transfusion and ventilation times in hypothermic groups. Conclusions: Recommendations were made for; routine arterial and CVP monitoring as a minimum standard of practice, consideration of discrepancy between peripheral and central arterial BP in patients with hemodynamic instability and high vasopressor requirements, and routine use of high flow cannulae while monitoring for extravasation and hematoma formation. Availability and expertise in PAC and/or TEE monitoring is strongly recommended particularly in hemodynamic instability, portopulmonary HT and/or cardiac dysfunction. TEE use is recommended as an acceptable risk in patients with treated esophageal varices and is an effective diagnostic tool for emergency cardiovascular collapse. Maintenance of intraoperative normothermia is strongly recommended.
KW - LiDCO
KW - PiCCO
KW - cardiac output or hemodynamic monitoring
KW - central venous access
KW - hyperthermia
KW - hypothermia
KW - liver transplantation
KW - monitoring
KW - or FloTrac
KW - pulmonary artery catheter
KW - thermoregulation
KW - transesophageal echocardiography
KW - venous or arterial access
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U2 - 10.1111/ctr.14643
DO - 10.1111/ctr.14643
M3 - Review article
C2 - 35262975
AN - SCOPUS:85139768974
SN - 0902-0063
VL - 36
JO - Clinical Transplantation
JF - Clinical Transplantation
IS - 10
M1 - e14643
ER -