MONITORIA EN CUIDADO INTENSIVO DEL PACIENTE CON ENFERMEDAD HEPATICA

DIEGO FERNANDO BAUTISTA R.

INTERNISTA INTENSIVISTA

COMO MONITOREAMOS HOY

Frederic Michard, Michael R. Pinsky and Jean-Louis Vincent. Intensive Care Med (2017) 43:440–442

COMO LO HARIAMOS EN EL FUTURO

MIENTRAS TANTO…

R. Schumann et al. Anesthesia for liver transplantation in United States academiccenters: intraoperative practice. Journal of Clinical Anesthesia (2013) 25, 542–550

UNA MIRADA A LA PRACTICA EN U.S.A

R. Schumann et al. Anesthesia for liver transplantation in United States academiccenters: intraoperative practice. Journal of Clinical Anesthesia (2013) 25, 542–550

R. Schumann et al. Anesthesia for liver transplantation in United States academiccenters: intraoperative practice. Journal of Clinical Anesthesia (2013) 25, 542–550

BIANCOFIORE G, DELLA ROCCA G. Minerva Anestesiol 2012;78:668-74

Classification of Surgical Complications A New Proposal With Evaluation in a Cohort of 6336 Patients and Results of a Survey. Annals of Surgery • Volume 240, Number 2, August 2004.

ES PELIGROSO ?

Lu SY, Matsusaki T, Abuelkasem E, Sturdevant ML, Humar A, Hilmi IA, Planinsic RM, Sakai T. Complications related to invasive hemodynamic monitors during adult liver Transplantation. ClinTransplant 2013: 27: 823–828

ES PELIGROSO ?

METODOS DE TERMODILUCION

Kumar Audimoolam Vinod, Predicting Fluid Responsiveness in AcuteLiver Failure: A Prospective Study Anesth Analg 2017;124:480–6)

Garutti Ignacio et al. Extravascular Lung Water and Pulmonary Vascular Permeability Index Measured at the End ofSurgery Are Independent Predictors of Prolonged Mechanical Ventilation in Patients Undergoing LiverTransplantation. Anesth Analg 2015;121:736–45

Garutti Ignacio et al. Extravascular Lung Water and Pulmonary Vascular Permeability Index Measured at the End ofSurgery Are Independent Predictors of Prolonged Mechanical Ventilation in Patients Undergoing LiverTransplantation. Anesth Analg 2015;121:736–45

Garutti Ignacio et al. Extravascular Lung Water and Pulmonary Vascular Permeability Index Measured at the End ofSurgery Are Independent Predictors of Prolonged Mechanical Ventilation in Patients Undergoing LiverTransplantation. Anesth Analg 2015;121:736–45

Matthieu Biais et al. Cardiac Output Measurement in Patients Undergoing LiverTransplantation: Pulmonary Artery Catheter Versus Uncalibrated Arterial Pressure WaveformAnalysis. Anesth Analg 2008;106:1480 –6

Matthieu Biais et al. Cardiac Output Measurement in Patients Undergoing Liver Transplantation: Pulmonary ArteryCatheter Versus Uncalibrated Arterial Pressure Waveform Analysis. Anesth Analg 2008;106:1480 –6

VILCHEZ MONGE. Cardiac output monitoring with pulmonary versus transpulmonarythermodilution during liver transplantation: interchangeable methods?. Minerva Anestesiol2014;80:1178-87)

VILCHEZ MONGE. Cardiac output monitoring with pulmonary versus transpulmonary thermodilutionduring liver transplantation: interchangeable methods?. Minerva Anestesiol 2014;80:1178-87)

VILCHEZ MONGE. Cardiac output monitoring with pulmonary versus transpulmonary thermodilutionduring liver transplantation: interchangeable methods?. Minerva Anestesiol 2014;80:1178-87)

Conclusion. Continuous pulmonary thermodilutionwith PAC is not an alternative monitoring methodof CO. Transpulmonary thermodilution COmonitoring with PiCCO2 shows too questionableagreement with the clinical gold standard (PACi)being in the limit of acceptance to be consideredinterchangeable during liver transplantation

CONCLUSIONS: Our results suggest that Vigileo/FloTrac CO monitoring data do not agree well with those of automatic thermodilution in patientsundergoing liver transplantation, especially in Child-Pugh grade B and C patients with low systemic vascular resistance.

Biais Matthieu et al. Anesth Analg 2008;106:1480 –6

DISPOSITIVOS DE ULTIMA GENERACION

Biais Matthieu et al, Impact of Systemic Vascular Resistance on the Accuracy of thePulsioflex Device. Anesth Analg 2017;124:487–93

Biais Matthieu et al, Impact of Systemic Vascular Resistance on the Accuracy of thePulsioflex Device. Anesth Analg 2017;124:487–93

CONCLUSIONS: In patients undergoing liver transplantation,Pulsioflex does not accurately estimate CI. Its accuracy is highlyimpacted by SVR, and it is not able to track changes in CI whenlarge variations in SVR occur.

So we use less pulmonary arterycatheters—But why?*

Vincent Jean-Louis , MD, PhD,Crit Care Med 2011 Vol. 39, No. 7

G R A C I A S