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The influence of intraoperative fluid management on postoperative pulmonary complications in liver-transplant patients

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ABSTRACT
Background. Fluid management is one of the key elements for a successful liver transplantation (LT). Perioperative pulmonary complications can contribute significantly to the morbidity and mortality of the patients. The objective of this study was to assess the influence of intraoperative fluid management on postoperative pulmonary complications.
Methods. We retrospectively analyzed 40 consecutive patients who underwent liver transplantation
at Fundeni Clinical Institute, Bucharest, between January 2014 and April 2014. The patients were divided into two groups, based on whether they developed pulmonary complications (group 1) or not (group 2). Analysis of data included perioperative variables, such as volume of intraoperative blood and fluid transfusion, intraoperative blood loss, fluid balance, duration of surgery, postoperative pulmonary complications. Radiographic analysis was standardized in order to assess the presence of pulmonary complications.
Results. Our study included 26 men (65%) and 14 women (35%). Mean (±SD) age was 49.5 (±13.4)
years. 23 patients (57.5%) developed pulmonary complications after LT. The study revealed that intraoperative fluid administration exceeded 100 ml/kg in patients with pulmonary complications compared to those without pulmonary complications (p=0.02). Plasma transfusion in group 1 was higher than in group 2 (p=0.05) and group 1 received more crystalloid solutions than group 2 (p=0.04). We found that intraoperative fluid balance >45 ml/kg correlates with postoperative pulmonary complications (p=0.01), longer Post Anaesthesia Care Unit (PACU) stay (p=0.01) and longer extubation time (p=0.04). The Meld and Meld Na scores were not significantly different between the two groups (p=0.26).
Conclusion. Excessive intraoperative fluid transfusion was associated with postoperative pulmonary complications, prolonged PACU stay and extubation time.
Key words: liver transplantation, fluid management, pulmonary complications.

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Lavinia Nicoleta Jipa, Gabriela Droc and Mircea Diculescu

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