Haemodynamic Optimization by Oesophageal Doppler and Pulse Power Wave Analysis in Liver Surgery: A Randomised Controlled Trial

PLoS One. 2015 Jul 17;10(7):e0132715. doi: 10.1371/journal.pone.0132715. eCollection 2015.


Liver surgery is still associated with a high rate of morbidity and mortality. We aimed to compare different haemodynamic treatments in liver surgery. In a prospective, blinded, randomised, controlled pilot trial patients undergoing liver resection were randomised to receive haemodynamic management guided by conventional haemodynamic parameters or by oesophageal Doppler monitor (ODM, CardioQ-ODM) or by pulse power wave analysis (PPA, LiDCOrapid) within a goal-directed algorithm adapted for liver surgery. The primary endpoint was stroke volume index before intra-operative start of liver resection. Secondary endpoints were the haemodynamic course during surgery and postoperative pain levels. Due to an unbalance in the extension of the surgical procedures with a high rate of only minor procedures the conventional group was dropped from the analysis. Eleven patients in the ODM group and 10 patients in the PPA group were eligible for statistical analysis. Stroke volume index before start of liver resection was 49 (37; 53) ml/m2 and 48 (41; 56) ml/m2 in the ODM and PPA group, respectively (p=0.397). The ODM guided group was haemodynamically stable as shown by ODM and PPA measurements. However, the PPA guided group showed a significant increase of pulse-pressure-variability (p=0.002) that was not accompanied by a decline of stroke volume index displayed by the PPA (p=0.556) but indicated by a decline of stroke volume index by the ODM (p<0.001). The PPA group had significantly higher postoperative pain levels than the ODM group (p=0.036). In conclusion, goal-directed optimization by ODM and PPA showed differences in intraoperative cardiovascular parameters indicating that haemodynamic optimization is not consistent between the two monitors.

Trial registration: ISRCTN.com ISRCTN64578872.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Echocardiography, Doppler*
  • Esophagus / diagnostic imaging*
  • Female
  • Hemodynamics* / drug effects
  • Humans
  • Intraoperative Care
  • Liver / diagnostic imaging*
  • Liver / surgery*
  • Male
  • Middle Aged
  • Morphine / administration & dosage
  • Morphine / therapeutic use
  • Pain, Postoperative / drug therapy
  • Pulse Wave Analysis*
  • Time Factors


  • Morphine

Associated data

  • ISRCTN/ISRCTN64578872

Grant support

This research was an investigator-initiated pilot study. Support to perform the study was provided from Charité - Universitätsmedizin Berlin. Material but not financial support to perform the study was offered by the LiDCO Group Plc. The implementation of the ODM technology in the department was supported by Deltex Medical by an unrestricted grant unrelated to this study. However, both companies had no input into, or control over, study design, data collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.