Comparison of femoral and radial arterial pressures for goal directed fluid therapy in undergoing liver transplantation recipients?

Purpose: The aim of this study is to compare measured femoral and radial arterial pressure differences and the results of goal-directed of fluid management in guidance of these different pressure sites. Material and Method: Thirty-six consecutive patients, aged between 18-65 years, undergone orthotopic liver transplantation due to end stage liver disease were included in this study. After standard anesthesia induction, same size catheters (4F) (Pulsiocath®; Pulsion Medical System, Munich, Germany) was placed to left femoral and radial artery. Triple lumen catheter (20 cm, 7F) was placed to right internal jugular or subclavian vein by Seldinger technique. Systolic arterial pressure (SAP), diastolic arterial pressure (DAP) and mean arterial pressure (MAP) measured concurrent from femoral and radial artery in appointed time periods were recorded. Cardiac output (CO), stroke volume index (SVI), volumetric preload parameters (global end-diastolic volume index [GEDI] ), fluid response evaluation parameters (stroke volume variation [SVV] , pulse pressure variation [PPV] ), cardiac index (CI)) and extra vascular lung water index (EVLWI) values was recorded at each measurement. Fluid treatments and vasoconstrictor agent administration, if necessary, of patients were adjusted according to included arterial measurements. Hemodynamic goal was based on keeping mean arterial pressure over 65 mmHg. Patients with mean arterial pressure less than 65 mmHg, fluid replacement (if SVV>10) or vasoconstrictor agents (if SVV<10, norepinephrine: 0,1micg/kg/min) were administered. Fluid replacement was 54 administered with colloids (%4 succinyl gelatin and %20 albumin if patients albumin was <2g/dl) in case of blood loss and with crystalloid solutions (isolyte-S) in case of no blood loss. Results: The values of creatinine was statistically significant different in both groups in Z1 values compared to Z0 values. Systolic arterial pressures were higher in femoral group than in the radial group at anhepatic period. There was no statistically significant difference according the amount of fluid used, amount of vasoconstrictive/inotropic agent, mean of the lenght of stay in intensive care unit and ELWI values. Conclusion: In our study, we compared femoral and radial artery monitorization in liver transplantation surgery; we found systolic arterial pressure higher in femoral artery group at anhepatic period and although there was not statistically significant, amount of used vasoconstrictive/inotropic agents was lower in femoral group. We think that this is important to prevent end-organ damage.