Validity of mini-fluid challenge for predicting fluid responsiveness following liver transplantation

Ahmed Mukhtar,Mai Ahmed,Akram El Adawy,Mostafa Abdo,Gihan Obayah,Amr Hussein,Ahmed Hasanin,Jean Louis Teboul,Maha Awad,Hisham Abul Dahab,Amr Abdelaal,Amr Elfouly,Mohamed Elayashy

doi:10.1186/s12871-019-0728-4

Ahmed Mukhtar, Mai Ahmed + Show 11 more

Open Access

https://doi.org/10.1186/s12871-019-0728-4

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Abstract

BackgroundMini-fluid challenge is a well tested and effective tool to predict fluid responsiveness under various clinical conditions. However, mini-fluid challenge has never been tested in patients with end-stage liver disease. This study investigated whether infusion of 150 ml albumin 5% can predict fluid responsiveness in cirrhotic patients following liver transplant.MethodsFifty patients receiving living donor liver transplant were included in the analysis. Mini-fluid challenge composed of 150 ml of albumin 5% administered over 1 min in three consecutive 50-ml fluid boluses. An additional 350 ml was then infused at a constant rate over 15 min (for a total of 500 ml). Stroke volume (SV) was measured as the product of the subaortic velocity time integral (VTI) and left ventricular outflow tract (LVOT) area. Fluid responsiveness was defined as an increase in SV by ≥15% after the infusion.ResultsFifty patients were enrolled in the study. Fourteen patients were classified with Child A, 15 patients with Child B, and 21 patients with Child C cirrhosis. Thirty four patients were fluid responders and 16 patients were fluid non-responders. After 150 ml of albumin 5%, the SV increased significantly in our cohort. The area under receiver operating curve (AUROC) was 0.7 (95% confidence interval [CI] 0.5–0.8, P = 0.005). In subgroup analysis, the SV increased significantly after mini fluid challenge in the Child A group (P = 0.017) but not Child B or C groups (P = 0.3 and 0.29, respectively). The AUROC for mini-fluid challenge in the Child A group was 0.86 (95% confidence interval [CI] 0.6–0.9, P = 0.0004), while mini-fluid challenge failed to discriminate between responders and non-responders in Child B and C groups.ConclusionA mini-fluid challenge of 150 ml albumin 5% can predict fluid responsiveness in liver transplant patients with fair sensitivity and specifiicty. Subgroup analyis revealed that minifluid challenge can predict fluid responsiveness in patients with Child A cirrhosis but not patients with Child B or C cirrhosis.Trial registrationNCT03396159. (Prospective registered). Initial registration date was 10/01/2018.

Highlights

Mini-fluid challenge is a well tested and effective tool to predict fluid responsiveness under various clinical conditions
Model for End-Stage Liver Disease (MELD) score was significantly lower in the Child A group compared to both Child B and C groups (Table 1)
The area under receiver operating curve (AUROC) was 0.7 (95% confidence interval [CI] 0.5–0.8, P = 0.005). and the optimum cut-off value for predicting fluid responsiveness was ≥10%

Summary

Introduction

Mini-fluid challenge is a well tested and effective tool to predict fluid responsiveness under various clinical conditions. Mini-fluid challenge has never been tested in patients with end-stage liver disease. This study investigated whether infusion of 150 ml albumin 5% can predict fluid responsiveness in cirrhotic patients following liver transplant. Fluid therapy is the cornerstone of hemodynamic management for unstable patients. Several methods have been suggested to detect fluid responsiveness Of these methods, some that depend on heart−lung interactions have been shown to be effective during intraoperative management of liver transplantation patients. During the postoperative period, these methods are not feasible in patients with spontaneous breathing activity. In these cases, mini-fluid challenge has emerged as an alternative for preload challenge [3]

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