Efficacy of corrected left ventricular ejection time and stroke volume in guiding volume therapy during single lung transplantation: transesophageal Doppler monitoring

Abstract

Objective To evaluate the efficacy of corrected left ventricular ejection time (LVETc) and stroke volume (SV) monitored by transesophageal Doppler in guiding volume therapy during single lung transplantation. Methods Twenty-six American Society of Anesthesiologists physical status Ⅲ or Ⅳ patients, aged 32-55 yr, with body mass index of 18.0-24.6 kg/m2, scheduled for elective single lung transplantation, were divided into 2 groups (n=13 each) using a random number table: control group (group C) and LVETc plus SV group (group LS). After implanting double lumen endobronchial tube, a transesophageal probe was inserted to monitor LVETc and SV in group LS, and Swan-Ganz catheter was inserted via the right internal jugular vein puncture to monitor CVP in group C. Fluid infusion was given according to CVP, and CVP was maintained at 6-12 cmH2O in group C. In group LS, fluid infusion was given according to LVETc and SV, LVETc was maintained at 0.35-0.40 s, and the fluctuation of SV was less than 10% of the baseline before fluid replacement.At 5 min before one-lung ventilation, 30 min of one-lung ventilation, 30 min of pulmonary artery occlusion and 30 min of pulmonary artery unclamping and at the end of operation, blood samples were collected from the radial artery for blood gas analysis, blood lactate levels were recorded, and oxygenation index was calculated.The liquid intake and output volume was recorded before pulmonary artery occlusion (from the end of one-lung ventilation until the time point before pulmonary artery occlusion), during pulmonary artery occlusion and during pulmonary artery unclamping (from removal of atrial clamp until the end of operation). The consumption of intraoperative furosemide and metaraminol was recorded.The development of pharyngeal mucosal membrane injury, esophageal perforation, hemorrhage or local hematoma was recorded after operation. Results Compared with group C, the oxygenation index was significantly increased and blood lactate concentrations were decreased at 30 min of pulmonary artery occlusion, 30 min of pulmonary artery unclamping and at the end of operation, the amount of crystalloid and colloid solution infused was increased before and during pulmonary artery occlusion and reduced during pulmonary artery unclamping, the urine output was increased in each period, and the consumption of intraoperative metaraminol was reduced in group LS (P<0.05). No postoperative esophageal perforation, bleeding or local hematoma was found in two groups, and only one patient had pharyngeal mucous membrane injury after operation in group LS. Conclusion LVETc and SV monitored by transesophageal Doppler can not only keep circulation capacity and tissue perfusion effective, but also maintain hemodynamics relatively stable during operation for patients undergoing single lung transplantation. Key words: Lung transplantation; Ventricular function, left; Stroke volume; Fluid therapy; Transesophageal, Doppler