Effect of cardiac output - guided hemodynamic management on acute lung injury in pediatric living donor liver transplantation

Table 1 Patient demographic and perioperative data

Variables	Control group (n = 65)	CO-G group (n = 65)	P value
Age, mo	7.5 (5.9, 9.6)	7.0 (6.0, 8.5)	0.390
Gender (boy/girl), n	31/34	33/32	0.726
Weight of receptor, kg	7.5 (6.5, 9.0)	7.4 (6.5, 8.0)	0.383
Mass of graft, g	220.5 ± 40.7	218.8 ± 39.5	0.736
GRWR, %	3.10 ± 0.76	3.03 ± 0.76	0.631
Pretransplant PELD score	16.5 ± 3.2	17.2 ± 3.5	0.549
Pretransplant INR, IU	1.77 ± 0.86	1.91 ± 0.67	0.300
Pretransplant PTA, %	57.5 ± 20.7	51.4 ± 20.2	0.095
Pretransplant PT, s	20.2 ± 9.9	21.5 ± 8.7	0.454
Pretransplant WBC, 109/L	13.3 ± 6.3	12.2 ± 5.6	0.331
Pretransplant hemoglobin, g/L	90.4 ± 13.6	86.8 ± 12.8	0.116
Pretransplant platelets, 1012/L	194.3 ± 87.0	207.3 ± 72.1	0.355
Pretransplant albumin, g/L	34.1 ± 4.4	35.6 ± 5.9	0.088
Pretransplant total bilirubin, μmol/L	271.6 ± 128.3	282.9 ± 122.4	0.607
Pretransplant creatinine, μmol/L	12.7 ± 3.5	11.8 ± 3.0	0.099
Graft cold ischemia time, min	65.9 ± 25.7	60.2 ± 14.8	0.081
Anhepatic time, min	44.4 ± 11.5	47.1 ± 15.8	0.267
Operation time, min	545.0 ± 44.9	559.5 ± 49.6	0.083
Mechanical ventilation after operation, h	3.00 (2.25, 4.50)	2.75 (2.00, 3.88)	0.789

Data are expressed as number (%), mean ± SD, or median (interquartile range), as appropriate. CO-G: Cardiac output-guided; GRWR: Graft-to-recipient body weight ratio; PELD: Pediatric end-stage liver disease; INR: International Normalized Ratio; PTA: Prothrombin activity; PT: Prothrombin time; WBC: White blood cell.

Table 2 Results for primary outcome and secondary outcomes

	Control group (n = 65)	CO-G group (n = 65)	P value
Primary outcomes
ALI, n (%)	29 (44.6)	18 (27.7)	0.045
Others
Pneumonia, n (%)	12 (18.5)	8 (12.3)	0.634
Atelectasis, n (%)	18 (27.7)	12 (18.5)	0.687
ARDS, n (%)	6 (9.2)	4 (6.2)	0.742
Refractory heart failure, n (%)	3 (4.6)	1 (1.5)	0.612
Readmission to ICU for pulmonary complications, n (%)	3 (4.6)	2 (3.1)	1.000
ICU stay, d	2 (2, 3)	2 (2, 3)	0.200
Hospital stay, d	28 (22, 39)	27 (20, 37)	0.450
In-hospital mortality, n (%)	2 (3.1)	0	0.476

Data are expressed as number (%), mean ± SD, or median (interquartile range), as appropriate. CO-G: Cardiac output-guided; ALI: Acute lung injury; ARDS: Acute respiratory distress syndrome; ICU: Intensive care unit.

Table 3 Hemodynamic parameters and hemodynamic management

	Control group (n = 65)	CO-G group (n = 65)	P value
Preoperative hemodynamic parameters
HR, bpm/min	110 ± 12	108 ± 11	0.325
MAP, mmHg	60.3 ± 8.0	61.6 ± 9.5	0.382
CVP, cmH2O	6.08 ± 1.37	5.79 ± 1.44	0.241
Intraoperative hemodynamic parameters
HRH, bpm/min	123 ± 15	125 ± 18	0.317
HRL, bpm/min	82 ± 8	86 ± 8	0.003
MAPH, mmHg	72.3 ± 8.8	71.7 ± 10.4	0.531
MAPL, mmHg	34.9 ± 5.5	43.3 ± 7.4	< 0.001
CVPH, cmH2O	11.64 ± 2.1	9.46 ± 1.66	< 0.001
CVPL, cmH2O	4.17 ± 1.49	3.55 ± 1.34	0.013
Intraoperative hemodynamic events
PRS, n (%)	35 (53.8)	22 (33.8)	0.022
Malignant ventricular arrhythmia, n (%)	3 (5)	2 (3.1)	1.000
Cardiac arrest, n (%)	1 (1.5)	0	1.000
Intraoperative hemodynamic management
Intraoperative blood transfusions, U	2.5 (2, 3)	2.0 (1.5, 2.5)	0.821
Intraoperative frozen plasma transfusions, mL	0 (0, 200)	0 (0, 110)	0.751
Intraoperative fluid transfusions, mL	1222.7 ± 381.9	865.5 ± 153.1	< 0.001
Intraoperative bleeding volume, mL	300 (200, 500)	300 (200, 400)	0.543
Intraoperative urinary volume, mL	300 (277.5, 400)	400 (200, 510)	0.416
Positive fluid balance, mL	1021.4 ± 467.9	598.8 ± 320.7	< 0.001
VIS before portal vein opening	2 (2, 5)	3 (2, 6.25)	0.565
During portal vein opening
Bolus injection of epinephrine, n (%)	30 (46.2)	18 (27.7)	0.029
Bolus dosage of epinephrine, μg	3 (2, 5)	2.5 (1.75, 4.25)	0.030
VIS after portal vein opening	3 (2, 7)	2 (2, 3)	0.049

Data are expressed as number (%), mean ± SD, or median (interquartile range), as appropriate. CO-G: Cardiac output-guided; HR: Heart rate; MAP: Mean arterial blood pressure; CVP: Central venous pressure; HR_H: Intraoperative maximum heart rate; HR_L: Intraoperative minimum heart rate; MAP_H: Intraoperative maximum mean arterial blood pressure; MAP_L: Intraoperative minimum mean arterial blood pressure; CVP_H: Intraoperative maximum central venous pressure; CVP_L: Intraoperative minimum central venous pressure; PRS: Postreperfusion syndrome; VIS: Vasoactive inotropic score.

Table 4 Changes in serum interleukin-6, tumor necrosis factor-α, troponin I, and N-terminal pro-brain natriuretic peptide levels at every time point

		IL-6 (pg/mL)	TNF-α (pg/mL)	cTnI (ug/L)	NT-proBNP (ng/L)
Control group (n = 65)	T0	78.9 ± 23.2	87.5 ± 25.6	0.032 ± 0.015	556.6 ± 251.2
	T1	170.4 ± 42.3b	175.3 ± 43.1b	0.383 ± 0.166b	1012.4 ± 568.8b
	T2	126.2 ± 33.6b	129.5 ± 35.2b	0.182 ± 0.067b	866.0 ± 283.6b
	T3	80.7 ± 23.2	92.8 ± 26.8	0.030 ± 0.011	667.4 ± 247.7
CO-G group (n = 65)	T0	80.6 ± 22.5	83.2 ± 23.8	0.029 ± 0.012	562.2 ± 195.8
	T1	145.5 ± 34.5a,b	156.7 ± 36.1a,b	0.255 ± 0.128a,b	876.7 ± 268.2a,b
	T2	108.6 ± 24.9a,b	115.5 ± 25.6a,b	0.116 ± 0.070a,b	594.0 ± 163.3a,b
	T3	78.6 ± 21.9	86.2 ± 22.6	0.028 ± 0.011	462.6 ± 154.5a,b

^aP < 0.05, compared with control group.

^bP < 0.05, compared with T₀.

Data are expressed as number (%) or mean ± SD. T₀ before induction of general anesthesia, T₁ at the end of surgery, T₂ 1 d after surgery, T₃ 3 d after surgery. CO-G: Cardiac output-guided; IL-6: Interleukin-6; TNF-α: Tumor necrosis factor-α; cTnI: Cardiac troponin I; NT-pro-BNP: N-terminal pro-brain natriuretic peptide.