Changes in Hepatic Blood Flow and Liver Function during Closed Abdominal Hyperthermic Intraperitoneal Chemotherapy following Cytoreduction Surgery

Article Article scientifique Article Changes in Hepatic Blood Flow and Liver Function during Closed Abdominal Hyperthermic Intraperitoneal Chemotherapy following Cytoreduction Surgery eng 2018-03-12 2018 author Dupont Stéphanie Bernadette M 0000-0001-8820-4750 Geneva University Hospitals, Geneva, Switzerland. 911554 author Schiffer Eduardo 0000-0002-7415-4315 Geneva University Hospitals, Geneva, Switzerland. 33705 Département d'anesthésiologie, pharmacologie et soins intensifs (APSIC) author White Jamie Marion 0000-0003-2184-7270 Geneva University Hospitals, Geneva, Switzerland. 963492 author Diaper John R A Geneva University Hospitals, Geneva, Switzerland. author Licker Marc Geneva University Hospitals, Geneva, Switzerland. 133428 Département d'anesthésiologie, pharmacologie et soins intensifs (APSIC) author Masouye Philippe Charles Geneva University Hospitals, Geneva, Switzerland. 84906 8063097 10.1155/2018/8063097 29721013 1687-6121 PMC5867686 https://onlinelibrary.wiley.com/doi/10.1155/2018/8063097 Background: The increase in intra-abdominal pressure (IAP) during closed abdominal hyperthermic intraperitoneal chemotherapy (HIPEC) leads to major haemodynamic changes and potential organ dysfunction. We investigated these effects on hepatic blood flow (HBF) and liver function in patients undergoing HIPEC following cytoreductive surgery and fluid management guided by dynamic preload indices. Methods: In this prospective observational clinical study including 15 consecutive patients, we evaluated HBF by transesophageal echocardiography and liver function by determination of the indocyanine green plasma disappearance rate (ICG-PDR). Friedman's two-way analysis of variance by ranks and Wilcoxon signed-rank test were performed for statistical analysis. Results: During HIPEC, HBF was markedly reduced, resulting in the loss of any pulsatile Doppler flow signal in all but one patient. The ICG-PDR, expressed as median (interquartile 25-75), decreased from 23 (20-30) %/min to 18 (12.5-19) %/min (p < 0.001). Despite a generous crystalloid infusion rate (27 (22-35) ml/kg/h), cardiac index decreased during the increased IAP period, inferior vena cava diameter decreased, stroke volume variation and pulse pressure variation increased, lung compliance dropped, and there was an augmentation in plateau pressure. All changes were significant (p < 0.001) and reversed to baseline values post HIPEC. Conclusion: Despite optimizing intravenous fluids during closed abdominal HIPEC, we observed a marked decrease in HBF and liver function. Both effects were transient and limited to the period of HIPEC but could influence the choice between closed or open abdominal cavity procedure for HIPEC and should be considered in similar clinical situations of increased IAP. Dewey 617 63 Département d'anesthésiologie, pharmacologie, soins intensifs et urgences 229 false 218 Dysfonctions cardio-pulmonaires et cérébrales 278 Gastroenterology research and practice 2018 d4d232f8-8552-4240-9eee-003d347f4de7 Article (Published version) Public Article-scientifique-from-europePmc.pdf 1450663 application/pdf CC BY-4.0 295aa05ad495e95f0795aa1fe2c6fd5b2a3892eff1d48d285dfe9af24285f9d0 openAccess Faculté de médecine / Section de médecine clinique / Département d'anesthésiologie, pharmacologie, soins intensifs et urgences

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Changes in Hepatic Blood Flow and Liver Function during Closed Abdominal Hyperthermic Intraperitoneal Chemotherapy following Cytoreduction Surgery	Gastroenterology research and practice			2018	29	156

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Dupont, Stéphanie Bernadette M