Egyptian Journal of Anaesthesia (Apr 2018)
Internal jugular vein distensibility in assessment of fluid responsiveness in donors of living donor liver transplantation
Abstract
Background: The concept of brain death is still not acceptable nor implemented in Egypt. Donor safety in liver transplantation is on the top of our priorities. Purpose: The purpose of this study is to evaluate the effectiveness of using IJV distensibility as a reliable method for intraoperative assessment of fluid responsiveness. Methods: A prospective observational study was conducted in Ain Shams university specialized hospitals. 40 donor candidates for right lobe hepatectomy for living donor liver transplantation were enrolled. During period of hypovolemia (T0) left IJV scanned and measured. After a given fluid bolus in the form of ringer acetate 5 ml/kg. ultrasonic and hemodynamic measurements were reassessed 10 min (T 10) after the fluid resuscitation. Results: Highly significant changes in MABP, HR, and CVP (p < 0.01) were detected after fluid resuscitation, regarding the IJV distensibility it showed a highly significant reduction from baseline (T0) to post-resuscitation expansion (P = 0.0001). Baseline (T0) measurements showed no significant correlation between IJV distensibility and hemodynamic parameters (P ≥ 0.05). Post-resuscitation values (T10) showed no significance correlation between HR and IJV distensibility (P = 0.772). On the other side it showed a highly significance negative correlation between MABP, CVP and IJV distensibility (r = −0.390, P = 0.013) and (r = −0.332∗, p = 0.036) respectively. The correlation between the percentages of change of IJV distensibility and hemodynamic parameters showed highly significant negative correlation between IJV distensibility and MABP (r = −0.359, P = 0.023) also with CVP (r = −0.464, P = 0.017). No difference was found regarding the HR (P = 0.336). Conclusion: Organ transplantation centers with experience, CVP monitoring may not be necessary in highly selective patient population. IJV distensibility, a non-invasive and safe method can be used to guide fluid replacement in healthy donor. Keywords: Living donor, Liver transplantation, IJV distensibility