Clinical trial NCT02818218: SVC and Its Relationship to CVP Measurements in Liver Transplantation
Official title: SVC Diameter and Collapsibility Index and Its Relationship to Central Venous Pressure Measurements in Patients Undergoing Liver Transplantation
Study type: OBSERVATIONAL
Overall status: ACTIVE_NOT_RECRUITING
Conditions: Liver Failure
Lead sponsor: The Cleveland Clinic
Sponsor class: OTHER
First posted: 2016-06-29
Enrollment: 100
Sex: ALL
Minimum age (years): 18
Maximum age (years): 80
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: PROBABILITY_SAMPLE
Study population: Adult patients undergoing liver transplantation surgery (cadaveric and living related)

Brief summary: Consecutive patients undergoing liver transplant surgery will be included in the study. Before surgical incision, during the preanhepatic phase, during the anhepatic phase, during the postanhepatic phase and following closure of the deep fascial layer of the anterior abdominal wall simultaneous measurement of SVC diameter, SBC collapsibility index and CVP will be recorded.

Detailed description: Central venous pressure (CVP) measured invasively through a central venous catheter in the internal jugular vein or through a right atrial port of a pulmonary artery catheter is commonly used during liver transplant surgery. CVP measurements at the SVC-RA junction are a function of circulating blood volume, right ventricle function, intrathoracic pressure. CVP measurements can also be affected by the presence of tricuspid regurgitation. Because central venous pressure measurements are determined by several factors and do not predict the response to subsequent fluid bolus administration, they are considered "static measures" and are poor indicators of fluid responsiveness.

Given the entirely intrathoracic location of the superior vena cava (SVC), its diameter and collapsibility with positive pressure ventilation it is a potentially attractive method of non-invasively estimating CVP.

SVC diameter and collapsibility index, dynamic measures of fluid responsiveness have been successfully utilized as echocardiographic indices for fluid responsiveness in ventilated septic patients. Whether SVC collapsibility is correlated with CVP measurements in liver transplant patients is not known.

Consecutive patients undergoing liver transplant surgery will be included in the study. Before surgical incision, during the preanhepatic phase, during the anhepatic phase, during the postanhepatic phase and following closure of the deep fascial layer of the anterior abdominal wall simultaneous measurement of SVC diameter, SBC collapsibility index and CVP will be recorded.

Eligibility criteria: Inclusion Criteria:

* 18 years of age
* undergoing liver transplantation surgery (cadaveric and living related)

Exclusion Criteria:

* Contraindication to Transesophageal echocardiography

Primary outcomes:
measure: Superior vena cava (SVC) diameter
timeFrame: during surgery
Secondary outcomes:
measure: Change in Superior vena cava (SVC) diameter
timeFrame: during surgery
measure: Change in Superior vena cava (SVC) collapsibility index
timeFrame: during surgery
measure: Superior vena cava (SVC) collapsibility index
timeFrame: during surgery
measure: Correlation between SVC measurements and cardiac output/cardiac index
timeFrame: during surgery
Other outcomes:
Locations:
city: Cleveland
country: United States
facility: Cleveland Clinic Foundation
state: Ohio
Study officials:
affiliation: Chair of Department
name: Daniel Sessler, M.D.
role: STUDY_CHAIR
References: