Optimal Hemodynamic Monitoring in Deceased Donor

Abstract

Optimal hemodynamic monitoring is important for fluid management in deceased organ donor. Recently, pulse pressure variation (PPV) and stroke volume variation (SVR) have been applied for critical patients. However, it is unclear whether these parameters can be applied for deceased donor. We compared these parameters with traditional hemodynamic parameters such as central venous pressure (CVP) and heart rate. Twelve deceased donors were evaluated using uncalibrated arterial pressure waveform analysis (FloTrac/Vigileo™). Volume replacement was done based on volume status by physical examination and CVP for 8 hours. Cardiac output (CO) was increased over 15 % in three donors (responder, 3 male, mean age 37.3 +/- 8.0 yr), and not changed in 9 donors (non-responder, 7 male and 2 female, 49.6 +/- 13.1 yr). Functional hemodynamic monitoring was done in the setting of tidal volume (8mL/kg) and minimal positive end-expiratory pressure (5 cmH2O). There were several significantly different parameters between responder and non-responder): Baseline heart rate was faster in responder (106.33 +/- 10.0 vs. 83.2 +/-12.9, p=0.018), PPV was higher in responder (24.3 +/- 11.2 vs. 9.5 +/- 2.0, p=0.003), and SVV was also higher in responder (21.7 +/- 11.5 vs. 10.2 +/- 3.2, p=0.016). After volume replacement, CO was significantly increased in responder compared to non-responder (2.2 +/- 0.63 vs. 0.2 +/- 0.57, p < 0.001), PPV was decreased in responder (-12.3 +/- 16.1 vs. 1.75 +/- 5.17, p=0.044), and SVR was also decreased (-9.67 +/- 10.1 vs. 2.67 +/- 3.93, p=0.008). However, baseline CVP was not different between two groups, and CVP was not significantly changed after volume replacement. In conclusion, both PPV and SVV were better parameter than CVP and HR in evaluating volume status and fluid therapy in deceased donor.