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Comparison of two fluid warming devices for maintaining body core temperature during living donor liver transplantation: Level 1 H-1000 vs. Fluid Management System 2000.

Han S, Choi J, Ko JS, Gwak M, Lee SK, Kim GS - Korean J Anesthesiol (2014)

Bottom Line: The degree of core temperature changes within the dissection, anhepatic and postreperfusion phase were also comparable between the two groups.The minimum intraoperative core temperature was also comparable (Level 1, 35.6℃ vs.FMS, 35.4℃, P = 0.122).

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT

Background: Rapid fluid warming has been a cardinal measure to maintain normothermia during fluid resuscitation of hypovolemic patients. A previous laboratory simulation study with different fluid infusion rates showed that a fluid warmer using magnetic induction is superior to a warmer using countercurrent heat exchange. We tested whether the simulation-based result is translated into the clinical liver transplantation.

Methods: Two hundred twenty recipients who underwent living donor liver transplantation between April 2009 and October 2011 were initially screened. Seventeen recipients given a magnetic induction warmer (FMS2000) were matched 1 : 1 with those given a countercurrent heat exchange warmer (Level-1 H-1000) based on propensity score. Matched variables included age, gender, body mass index, model for end-stage liver disease score, graft size and time under anesthesia. Core temperatures were taken at predetermined time points.

Results: Level-1 and FMS groups had comparable core temperature throughout the surgery from skin incision, the beginning/end of the anhepatic phase to skin closure. (P = 0.165, repeated measures ANOVA). The degree of core temperature changes within the dissection, anhepatic and postreperfusion phase were also comparable between the two groups. The minimum intraoperative core temperature was also comparable (Level 1, 35.6℃ vs. FMS, 35.4℃, P = 0.122).

Conclusions: A countercurrent heat exchange warmer and magnetic induction warmer displayed comparable function regarding the maintenance of core temperature and prevention of hypothermia during living donor liver transplantation. The applicability of the two devices in liver transplantation needs to be evaluated in various populations and clinical settings.

No MeSH data available.


Related in: MedlinePlus

Changes in body core temperature during transplantation of recipient given FMS or Level 1 for fluids warming (P value was calculated by means of repeated measures ANOVA).
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Figure 1: Changes in body core temperature during transplantation of recipient given FMS or Level 1 for fluids warming (P value was calculated by means of repeated measures ANOVA).

Mentions: Demographic data of 34 recipients were described in Table 1. As expected, the matched variables, including body mass index, the MELD score, graft size (graft-to-recipient weight ratio), and time under anesthesia, were comparable between Level 1 and FMS group. Along with the matched variables, the two groups were also comparable regarding the preoperative BCT, baseline BCT, duration of the dissection/anhepatic/postreperfusion phase. One recipient in FMS group was given 5 mmHg positive end-expiratory pressure. BCT dropped significantly during the anhepatic phase and gradually recovered after reperfusion (Fig. 1). BCTs were not significantly different at the start (Level 1 group 36.0℃ vs. FMS group 35.9℃ , P = 0.522) and end of the anhepatic phase (Level 1 group 35.9℃ vs. FMS group 35.4℃, P = 0.085). The minimum BCT during transplantation was also comparable between both groups (Level 1 group 35.6℃ vs. FMS group 35.4℃, P = 0.122). Repeated measures ANOVA showed that overall intraoperative BCTs of the two groups were comparable (P = 0.255). The changes in BCT within the respective operative phases were measured (Table 1). The degree of BCT drop during the anhepatic phase was comparable (Level 1 group -0.4℃ vs. FMS group -0.3℃, P = 0.150). The degree of BCT rise during the postreperfusion phase was not significantly different with a marginality (Level 1 group 0.3℃ vs. FMS group 0.6℃, P = 0.067). Detailed data on the amount of infused fluids and blood products during each transplant phase are described in Table 2, showing comparable infused volumes in the two groups. As shown in Table 3, hemodynamic parameters, including cardiac output and mean arterial pressure, were also comparable between the two groups. The maximum dose of two major vasoactive drugs which were frequently used during liver transplantation was also comparable.


Comparison of two fluid warming devices for maintaining body core temperature during living donor liver transplantation: Level 1 H-1000 vs. Fluid Management System 2000.

Han S, Choi J, Ko JS, Gwak M, Lee SK, Kim GS - Korean J Anesthesiol (2014)

Changes in body core temperature during transplantation of recipient given FMS or Level 1 for fluids warming (P value was calculated by means of repeated measures ANOVA).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4216789&req=5

Figure 1: Changes in body core temperature during transplantation of recipient given FMS or Level 1 for fluids warming (P value was calculated by means of repeated measures ANOVA).
Mentions: Demographic data of 34 recipients were described in Table 1. As expected, the matched variables, including body mass index, the MELD score, graft size (graft-to-recipient weight ratio), and time under anesthesia, were comparable between Level 1 and FMS group. Along with the matched variables, the two groups were also comparable regarding the preoperative BCT, baseline BCT, duration of the dissection/anhepatic/postreperfusion phase. One recipient in FMS group was given 5 mmHg positive end-expiratory pressure. BCT dropped significantly during the anhepatic phase and gradually recovered after reperfusion (Fig. 1). BCTs were not significantly different at the start (Level 1 group 36.0℃ vs. FMS group 35.9℃ , P = 0.522) and end of the anhepatic phase (Level 1 group 35.9℃ vs. FMS group 35.4℃, P = 0.085). The minimum BCT during transplantation was also comparable between both groups (Level 1 group 35.6℃ vs. FMS group 35.4℃, P = 0.122). Repeated measures ANOVA showed that overall intraoperative BCTs of the two groups were comparable (P = 0.255). The changes in BCT within the respective operative phases were measured (Table 1). The degree of BCT drop during the anhepatic phase was comparable (Level 1 group -0.4℃ vs. FMS group -0.3℃, P = 0.150). The degree of BCT rise during the postreperfusion phase was not significantly different with a marginality (Level 1 group 0.3℃ vs. FMS group 0.6℃, P = 0.067). Detailed data on the amount of infused fluids and blood products during each transplant phase are described in Table 2, showing comparable infused volumes in the two groups. As shown in Table 3, hemodynamic parameters, including cardiac output and mean arterial pressure, were also comparable between the two groups. The maximum dose of two major vasoactive drugs which were frequently used during liver transplantation was also comparable.

Bottom Line: The degree of core temperature changes within the dissection, anhepatic and postreperfusion phase were also comparable between the two groups.The minimum intraoperative core temperature was also comparable (Level 1, 35.6℃ vs.FMS, 35.4℃, P = 0.122).

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT

Background: Rapid fluid warming has been a cardinal measure to maintain normothermia during fluid resuscitation of hypovolemic patients. A previous laboratory simulation study with different fluid infusion rates showed that a fluid warmer using magnetic induction is superior to a warmer using countercurrent heat exchange. We tested whether the simulation-based result is translated into the clinical liver transplantation.

Methods: Two hundred twenty recipients who underwent living donor liver transplantation between April 2009 and October 2011 were initially screened. Seventeen recipients given a magnetic induction warmer (FMS2000) were matched 1 : 1 with those given a countercurrent heat exchange warmer (Level-1 H-1000) based on propensity score. Matched variables included age, gender, body mass index, model for end-stage liver disease score, graft size and time under anesthesia. Core temperatures were taken at predetermined time points.

Results: Level-1 and FMS groups had comparable core temperature throughout the surgery from skin incision, the beginning/end of the anhepatic phase to skin closure. (P = 0.165, repeated measures ANOVA). The degree of core temperature changes within the dissection, anhepatic and postreperfusion phase were also comparable between the two groups. The minimum intraoperative core temperature was also comparable (Level 1, 35.6℃ vs. FMS, 35.4℃, P = 0.122).

Conclusions: A countercurrent heat exchange warmer and magnetic induction warmer displayed comparable function regarding the maintenance of core temperature and prevention of hypothermia during living donor liver transplantation. The applicability of the two devices in liver transplantation needs to be evaluated in various populations and clinical settings.

No MeSH data available.


Related in: MedlinePlus