RESPONSE OF PATIENTS WITH CIRRHOSIS WHO HAVE UNDERGONE PARTIAL-HEPATECTOMY TO TREATMENT AIMED AT ACHIEVING SUPRANORMAL OXYGEN DELIVERY AND CONSUMPTION

Background. This study was undertaken to evaluate the response to ther apy aimed at achieving supranormal cardiac and oxygen transport variab les (cardiac index > than 4.5 L/min/m(2), oxygen delivery > 600 ml/min /m(2), and oxygen consumption > 170 ml/min/m(2)) in patients with cirr hosis who have undergone partial hepatectomy and to assess the relatio nship between those parameters and outcome, Methods. Thirty-four conse cutive patients underwent elective hepatectomy for hepatocellular carc inoma. The postoperative outcomes and hemodynamic and oxygen transport values in 16 patients (groups) who maintained supranormal values were compared with those in 18 Patients (group N) treated to maintain norm al hemodynamic values. Patients in group S received volume expansion a nd then, if necessary dobutumine (3 to 15 mu g/kg/min) to increase car diac index oxygen delivery and oxygen consumption simultaneously durin g the first 12 hours. Results. The hemodynamic targets were reached by 56% ro of patients in group S during the first 12 hours and 31% durin g the nest 12 hours. Postoperative blood lactate levels at 12 and 24 h ours were lower in group S than in group N, and total bilirubin concen trations, hepatic venous oxygen saturation, and arterial ketone body r atio, useful markers of postoperative liver function, also showed more favorable changes in group S than in group N. Postoperative morbidity and mortality rates were not significantly different in the two group s, but the incidence of hyperbulirubinemia and liver failure was much lower in group S than in group iii. Conclusions. These results suggest that fluid therapy aimed at achieving a supranormal pattern by 12 hou rs after hepatectomy improved the systemic oxygen demand-supply dynami cs and hepatic hemodynamics, decreasing the incidence of postoperative hyperbilirubinemia and liver failure in patients with liver cirrhosis .