关键词: 肝移植 , 急性低氧性呼吸衰竭 , 急性呼吸窘迫综合征 , 液体管理

Abstract:

Objective Liver transplantation is an effective treatment for end-stage liver disease. However，early postoperative acute hypoxemic respiratory failure （AHRF） is one of the most critical medical complications，impeding rapid recovery. The etiology of post-liver transplantation AHRF is diverse， and the correlation betweenperioperative fluid management strategies and AHRF remains unreported in the literature. Whether specific fluid management strategies benefit AHRF patients is still unclear. This study aims to evaluate the impact of postoperative fluid management on AHRF and to analyze whether pulse index continuous cardiac output （PiCCO）-guided fluid therapy confers benefits， thereby optimizing clinical protocols. Methods Clinical data from 81 liver transplant recipients admitted to the Department of Critical Care Medicine， Renji Hospital， Shanghai Jiao Tong University School of Medicine， between December 2024 and April 2025 were retrospectively analyzed. Preoperative indicators （age，transplant type， electrocardiogram， cardiac ultrasound）， intraoperative blood loss， fluid infusion volume， peak lactatelevels， and postoperative PiCCO-based hemodynamic parameters were collected. The time to AHRF onset， etiology（infectious/non-infectious）， ICU stay， hospitalization duration， and their impacts on graft function and survival rates were evaluated. Results The incidence of postoperative AHRF was 22.2% （18/81）， with a median onset time of 3 days posttransplant. Among AHRF patients，72.2% （13/18） had non-infectious causes， and 27.8% （5/18） had infectious causes.AHRF occurrence showed no correlation with preoperative electrocardiogram or cardiac ultrasound findings， intraoperative blood loss， vasoactive drug use， peak lactate levels， postoperative portal vein velocity， hepatic artery velocity， or hepatic artery resistance index. Compared to non-AHRF patients， the AHRF group achieved comparable mean arterial pressure targets but exhibited a significantly higher fluid positive balance on postoperative day 1， elevated volume preload indicators， and increased extravascular lung water （EVLW） on days 1 and 2. The occurrence of AHRF prolonged ICU stays and total hospitalization duration. Conclusion Early postoperative AHRF in liver transplant recipients is associated with higher volume load and increased EVLW. PiCCO-guided monitoring of preload volume parameters 〔e.g.， global end-diastolic volume（GEDV）〕 facilitates optimal fluid management. Targeting GEDV at the lower limit of the normal range may represent a rational fluid management strategy. 

Key words:

Liver transplantation； , Acute hypoxemic respiratory failure； , Acute respiratory distress syndrome； , Fluid Management