Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Fluid Responsiveness Associates with Successful Weaning After Liver Transplant Surgery

Ricardo Castro
* ORCID logo ,
Pablo Born
,
Felipe Muñoz
,
Camila Guzmán
,
Eduardo Kattan
ORCID logo ,
Glenn Hernandez
,
Jan Bakker
Version 1 : Received: 18 March 2024 / Approved: 19 March 2024 / Online: 19 March 2024 (11:21:01 CET)

A peer-reviewed article of this Preprint also exists.

Castro, R.; Born, P.; Muñoz, F.; Guzmán, C.; Kattan, E.; Hernandez, G.; Bakker, J. Fluid Responsiveness Is Associated with Successful Weaning after Liver Transplant Surgery. J. Pers. Med. 2024, 14, 429. Castro, R.; Born, P.; Muñoz, F.; Guzmán, C.; Kattan, E.; Hernandez, G.; Bakker, J. Fluid Responsiveness Is Associated with Successful Weaning after Liver Transplant Surgery. J. Pers. Med. 2024, 14, 429.

Abstract

A positive fluid balance may evolve to fluid overload and associate with organ dysfunctions, weaning difficulties, and increased mortality in ICU patients. We explored whether individualized fluid management, assessing fluid-responsiveness via passive leg-raising maneuver (PLR) before spontaneous breathing trial (SBT) associated with less extubation failure in ventilated patients with high fluid balance, admitted to the ICU after liver transplantation (LT). We recruited 15 LT patients in 2023. Postoperative fluid balance was +4476 [3697,5722] mL. PLRs were conducted at ICU admission (T1) and pre-SBT (T2). Cardiac index (CI) changes were recorded before and after SBT (T3). Seven patients were fluid responsive at T1, and 12 at T2. No significant differences occurred in hemodynamic, respiratory, and perfusion parameters between fluid-responsive and fluid-unresponsive patients at any time. Fluid-responsive patients at T1 and T2 increased their CI during SBT from 3.1 [2.8,3.7] to 3.7 [3.4,4.1] mL/min/m2 (p= 0.045). All fluid-responsive patients at T2 were extubated after SBT and consolidated extubation. Two out of three of fluid-unresponsive patients experienced weaning difficulties. We concluded that fluid-responsive patients post-LT may start weaning earlier and achieve successful extubation despite high postoperative fluid balance. This highlights the profound impact of personalized assessment of cardiovascular state on critical surgical patients.

Keywords

fluid overload; fluid responsiveness; passive leg raising; spontaneous breathing trial

Subject

Medicine and Pharmacology, Cardiac and Cardiovascular Systems

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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