1
|
Mihatsch LL, Friederich P. The influence of sex, age, and body height on the pulmonary vascular permeability index - a prospective observational study. Sci Rep 2024; 14:22001. [PMID: 39322748 PMCID: PMC11424636 DOI: 10.1038/s41598-024-72967-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 09/12/2024] [Indexed: 09/27/2024] Open
Abstract
The pulmonary vascular permeability index (PVPI) is a quotient of the extravascular lung water (EVLW) and the pulmonary blood volume (PBV). In acute respiratory distress syndrome (ARDS), the alveolar-capillary membrane integrity is disrupted. The result is a disproportionate increase of EVLW compared to the PBV and, hence, an increase in PVPI. Thus, PVPI has repetitively been discussed to extend the definition of ARDS. Besides sex, the influence of other anthropometric variables on PVPI has not been studied so far. However, since it is known that EVLW depends on body height and sex, we hypothesize that PVPI depends on anthropometric variables as well. This prospective single-center observational study included 1533 TPTD measurements of 251 non-critically ill patients (50.6% men) undergoing elective neuro-, thoracic, or abdominal surgery at the Munich Clinic Bogenhausen of the Technical University of Munich. Multivariate regressions were used to measure the influence of sex, age, and body height on PVPI. In all patients, PVPI was significantly higher in women (P < 0.001), with 34.4% having a PVPI > 2 compared to 15.9% of men. Mean PVPI significantly decreased with height (P < 0.001) and age (P < 0.001). Multivariate regressions allowed the calculation of mean reference surfaces. The 95th percentile surface for PVPI was > 3 for small and young women and well above 2 for all but tall and elderly men. In patients who underwent (lung reduction) thoracic surgery, the PVPI before and after surgery did not differ significantly (P = 0.531), and post-surgical PVPI did not correlate with the amount of lung resected (P = 0.536). Hence, we conclude that PVPI may be independent of the extent of lung volume reduction. However, PVPI is heavily dependent on sex, age, and body height. Anthropometric variables thus have a significant impact on the likelihood of misclassified abnormal PVPI. This warrants further studies since an increased PVPI, e.g. in the context of an ARDS, may be overlooked if anthropometric variables are not considered. We suggest reference surfaces based on the 95th-percentile corrected for sex, age, and height as a novel approach to normalize PVPI.
Collapse
Affiliation(s)
- Lorenz L Mihatsch
- Technical University of Munich, TUM School of Medicine and Health, Munich, Germany.
- Department of Anaesthesiology, Critical Care Medicine and Pain Therapy, Munich Clinic Bogenhausen, Academic Teaching Hospital of Technical University of Munich, Munich, Germany.
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany.
| | - Patrick Friederich
- Technical University of Munich, TUM School of Medicine and Health, Munich, Germany
- Department of Anaesthesiology, Critical Care Medicine and Pain Therapy, Munich Clinic Bogenhausen, Academic Teaching Hospital of Technical University of Munich, Munich, Germany
| |
Collapse
|
2
|
Kwon H, Jo YH, Lee JH, Hwang JE, Park I, Kim S, Jang DH, Kim D, Chang H. MONITORING OF PULMONARY EDEMA USING ULTRASOUND RADIOFREQUENCY SIGNAL. Shock 2023; 59:118-124. [PMID: 36377364 DOI: 10.1097/shk.0000000000002048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
ABSTRACT Objectives: Excessive accumulation of extravascular lung water impairs respiratory gas exchange and results in respiratory distress. Real-time radiofrequency signals of ultrasound can continuously and quantitatively monitor excessive lung water. This study aims to evaluate the availability of continuous real-time quantitative pulmonary edema monitoring using ultrasound radiofrequency signals and compare it with Pa o2 (partial pressure of arterial oxygen)/F io2 (fraction of inspired oxygen) (PF) ratio, conventional lung ultrasound, and the Hounsfield unit of chest computed tomography. Methods: Male Yorkshire pigs (40.5 ± 0.5 kg) were anesthetized and mechanically ventilated. A balanced crystalloid was administered to induce hydrostatic pulmonary edema. Three different infusion rates of 2, 4, and 6 mL/kg per minute were tested to determine the infusion rate for the appropriate swine model. The chest computed tomography and ultrasonography with radiofrequency signals were taken every 5 min during the full inspiration. The ultrasonography scans with radiofrequency signals were measured at the intercostal space where the line crossing the two armpits and the right anterior axillary line intersected. Results: The infusion rate of fluid for the pulmonary edema model was determined to be 6 mL/kg per minute, and a total of four pigs were tested at an injection rate of 6 mL/kg. The adjusted R2 values of regression analysis between the radiofrequency signal and computer tomography Hounsfield score were 0.990, 0.993, 0.988, and 0.993 (all P values <0.05). All radiofrequency signal changes preceded changes in PF ratio or lung ultrasound changes. The area under the receiver operating characteristic curve of the radiofrequency signal for predicting PF ratio <300 was 0.88 (95% confidence interval, 0.82-0.93). Conclusion: We evaluated ultrasound radiofrequency signals to assess pulmonary edema in a swine model that can worsen gradually and showed that quantitative ultrasound radiofrequency signal analysis could assess pulmonary edema and its progression before PF ratio or lung ultrasound changes.
Collapse
Affiliation(s)
| | | | | | | | | | - Seonghye Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Dong-Hyun Jang
- Department of Emergency Medicine, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, Republic of Korea
| | - Doyun Kim
- Department of Emergency Medicine, Incheon Sarang Hospital, Incheon, Republic of Korea
| | - Hyunglan Chang
- Department of Emergency Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| |
Collapse
|
3
|
Li X, Wang X, Guan Z. New onset atrial fibrillation during orthotopic liver transplantation induced by iced saline injection for transpulmonary thermodilution: a case report. J Int Med Res 2022; 50:3000605221132711. [PMID: 36268764 PMCID: PMC9597047 DOI: 10.1177/03000605221132711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Transpulmonary thermodilution is often used to measure extravascular lung water
during liver transplantation. Here, the case of new onset atrial fibrillation
during orthotopic liver transplantation, which may have been induced by iced
saline injection for transpulmonary thermodilution measurement, is described. A
52-year-old male patient underwent orthotopic liver transplantation due to
alcoholic cirrhosis combined with portal hypertension. During dissection of the
recipient liver, transpulmonary thermodilution was performed. At 3 minutes
following iced saline injected, atrial fibrillation occurred, the ventricular
rate increased to more than 120 beats per min, and blood pressure dropped to
75/50 mmHg. Massive haemorrhage, inferior vena cava clamping, electrolyte
disorder, acid-base balance disorder, and hypothermia were all ruled out, and
iced saline injection was suspended. Hemodynamic stability was maintained with
phenylephrine and lanatocide C (cedilanid), and chemical cardioversion was
performed using amiodarone. During the reperfusion phase, transient hemodynamic
instability was managed by norepinephrine. The neohepatic phase was uneventful.
Atrial fibrillation lasted for 5 days and reversed to sinus rhythm
automatically. The patient was hemodynamically stable during this period, and
recovery was smooth with no thromboembolic events. In conclusion, atrial
fibrillation may be induced by iced saline injection for transpulmonary
thermodilution measurement during orthotopic liver transplantation.
Collapse
Affiliation(s)
- Xin Li
- Department of Anaesthesiology, the First Affiliated Hospital of
Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Xu Wang
- Department of Anaesthesiology, Qinghai Provincial People’s
Hospital, Xining, Qinghai Province, China
| | - Zheng Guan
- Department of Anaesthesiology, the First Affiliated Hospital of
Xi’an Jiaotong University, Xi’an, Shaanxi Province, China,Zheng Guan, Department of Anaesthesiology,
the First Affiliated Hospital of Xi’an Jiaotong University, 277 Yanta West Road,
Xi’an, Shaanxi Province 710061, China.
| |
Collapse
|
4
|
Fernandez TMA, Schofield N, Krenn CG, Rizkalla N, Spiro M, Raptis DA, De Wolf AM, Merritt WT. What is the optimal anesthetic monitoring regarding immediate and short-term outcomes after liver transplantation?-A systematic review of the literature and expert panel recommendations. Clin Transplant 2022; 36:e14643. [PMID: 35262975 PMCID: PMC10077907 DOI: 10.1111/ctr.14643] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/28/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Liver transplant centers vary in approach to intraoperative vascular accesses, monitoring of cardiac function and temperature management. Evidence is limited regarding impact of selected modalities on postoperative outcomes. OBJECTIVES To review the literature and provide expert panel recommendations on optimal intraoperative arterial blood pressure (BP), central venous pressure (CVP), and vascular accesses, monitoring of cardiac function and intraoperative temperature management regarding immediate and short-term outcomes after orthotopic liver transplant (OLT). METHODS Systematic review following PRISMA guidelines and recommendations using the GRADE approach derived from an international expert panel. Recommendations made for: (1) Vascular accesses, arterial BP and CVP monitoring, (2) cardiac function monitoring, and (3) Intraoperative temperature management (CRD42021239908). RESULTS Of 2619 articles screened 16 were included. Studies were small, retrospective, and observational. Vascular access studies demonstrated low rates of insertion complications. TEE studies demonstrated low rates of esophageal hemorrhage. One study found lower hospital-LOS and 30-day mortality in patients monitored with both PAC and TEE. Other monitoring studies were heterogenous in design and outcomes. Temperature studies showed increased blood transfusion and ventilation times in hypothermic groups. CONCLUSIONS Recommendations were made for; routine arterial and CVP monitoring as a minimum standard of practice, consideration of discrepancy between peripheral and central arterial BP in patients with hemodynamic instability and high vasopressor requirements, and routine use of high flow cannulae while monitoring for extravasation and hematoma formation. Availability and expertise in PAC and/or TEE monitoring is strongly recommended particularly in hemodynamic instability, portopulmonary HT and/or cardiac dysfunction. TEE use is recommended as an acceptable risk in patients with treated esophageal varices and is an effective diagnostic tool for emergency cardiovascular collapse. Maintenance of intraoperative normothermia is strongly recommended.
Collapse
Affiliation(s)
- Thomas M A Fernandez
- Department of Anesthesia and Perioperative Medicine, Auckland City Hospital, Auckland, New Zealand.,Department of Anesthesia, University of Auckland, Auckland, New Zealand
| | - Nick Schofield
- Department of Anesthesia and Intensive Care Medicine, Royal Free Hospital, London, UK
| | - Claus G Krenn
- Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Nicole Rizkalla
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Michael Spiro
- Department of Anesthesia and Intensive Care Medicine, Royal Free Hospital, London, UK.,Clinical Service of HPB Surgery and Liver Transplantation, Royal Free Hospital, London, UK
| | - Dimitri Aristotle Raptis
- Clinical Service of HPB Surgery and Liver Transplantation, Royal Free Hospital, London, UK.,Division of Surgery & Interventional Science, University College London, London, UK
| | - Andre M De Wolf
- Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - William T Merritt
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA.,Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | -
- Department of Anesthesia and Perioperative Medicine, Auckland City Hospital, Auckland, New Zealand
| |
Collapse
|
5
|
Wen H, He R, Wang H, Zhao S, Zheng J, Wu J, Xie M. Effects of small molecule inhibitor SW033291 on hepatic ischemia-reperfusion injury in mice. Biochem Biophys Res Commun 2022; 615:70-74. [DOI: 10.1016/j.bbrc.2022.05.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 05/13/2022] [Indexed: 11/09/2022]
|
6
|
Bodys-Pełka A, Kusztal M, Boszko M, Główczyńska R, Grabowski M. Non-Invasive Continuous Measurement of Haemodynamic Parameters-Clinical Utility. J Clin Med 2021; 10:jcm10214929. [PMID: 34768449 PMCID: PMC8584279 DOI: 10.3390/jcm10214929] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/15/2021] [Accepted: 10/20/2021] [Indexed: 11/16/2022] Open
Abstract
The evaluation and monitoring of patients’ haemodynamic parameters are essential in everyday clinical practice. The application of continuous, non-invasive measurement methods is a relatively recent solution. CNAP, ClearSight and many other technologies have been introduced to the market. The use of these techniques for assessing patient eligibility before cardiac procedures, as well as for intraoperative monitoring is currently being widely investigated. Their numerous advantages, including the simplicity of application, time- and cost-effectiveness, and the limited risk of infection, could enforce their further development and potential utility. However, some limitations and contradictions should also be discussed. The aim of this paper is to briefly describe the new findings, give practical examples of the clinical utility of these methods, compare them with invasive techniques, and review the literature on this subject.
Collapse
Affiliation(s)
- Aleksandra Bodys-Pełka
- 1st Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.B.-P.); (M.K.); (M.B.); (M.G.)
- Doctoral School, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Maciej Kusztal
- 1st Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.B.-P.); (M.K.); (M.B.); (M.G.)
| | - Maria Boszko
- 1st Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.B.-P.); (M.K.); (M.B.); (M.G.)
| | - Renata Główczyńska
- 1st Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.B.-P.); (M.K.); (M.B.); (M.G.)
- Correspondence: ; Tel.: +48-5992-616
| | - Marcin Grabowski
- 1st Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (A.B.-P.); (M.K.); (M.B.); (M.G.)
| |
Collapse
|
7
|
Partain KN, Mpody C, Rodgers B, Kenney B, Tobias JD, Nafiu OO. Prolonged Postoperative Mechanical Ventilation (PPMV) in children undergoing abdominal operations: An analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. J Pediatr Surg 2021; 56:1114-1119. [PMID: 33745739 DOI: 10.1016/j.jpedsurg.2021.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Prolonged postoperative mechanical ventilation (PPMV) increases length of stay, hospitalization costs, and postoperative complications. Independent risk factors associated with PPMV are not well-known for children. METHOD We identified children (<18 years) in the ACS NSQIP-P database who underwent a general surgical abdominal operation. We excluded children with preoperative ventilator dependence and mortality within 48 h of surgery. PPMV was defined as cumulative postoperative mechanical ventilation exceeding 72 h. A multivariable logistic regression model identified independent predictors of PPMV. RESULTS We identified 108,392 children who underwent a general surgical abdominal operation in the ACS NSQIP-P database from 2012 to 2017. We randomly divided the population into a derivation cohort of 75,874(70%) and a validation cohort of 32,518(30%). In the derivation cohort, we identified PPMV in 1,643(2.2%). In the multivariable model, the strongest independent predictor of PPMV was neonatal age (OR:20.66; 95%CI:16.44-25.97). Other independent risk factors for PPMV were preoperative inotropic support (OR:10.56; 95%CI:7.56-14.77), an operative time longer than 150 min (OR:4.30; 95%CI:3.72-4.52), and an American Society of Anesthesiologists classification >3 (OR:12.16; 95%CI:10.75-13.75). CONCLUSION Independent preoperative risk factors for PPMV in children undergoing a general surgical operation were neonatal age, preoperative ionotropic support, duration of operation, and ASA classification >3.
Collapse
Affiliation(s)
- Kristin N Partain
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Christian Mpody
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Brandon Rodgers
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Brian Kenney
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Joseph D Tobias
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Olubukola O Nafiu
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.
| |
Collapse
|
8
|
Seibel A, Zechner PM, Berghold A, Holter M, Braß P, Michels G, Leister N, Gemes G, Donauer R, Giebler RM, Sakka SG. B-Lines for the assessment of extravascular lung water: Just focused or semi-quantitative? Acta Anaesthesiol Scand 2020; 64:953-960. [PMID: 32236940 DOI: 10.1111/aas.13586] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/25/2020] [Accepted: 03/18/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND B-lines as typical artefacts of lung ultrasound are considered as surrogate measurement for extravascular lung water. However, B-lines develop in the sub-pleural space and do not allow assessment of the whole lung. Here, we present data from the first observational multi-centre study focusing on the correlation between a B-lines score and extravascular lung water in critically ill patients suffering from a variety of diseases. PATIENTS AND METHODS In 184 adult patients, 443 measurements were obtained. B-lines were counted and expressed in a score which was compared to extravascular lung water, measured by single-indicator transpulmonary thermodilution. Appropriate correlation coefficients were calculated and receiver operating characteristics (ROC-) curves were plotted. RESULTS Overall, B-lines score was correlated with body weight-indexed extravascular lung water characterized by r = .59. The subgroup analysis revealed a correlation coefficient in patients without an infection of r = .44, in those with a pulmonary infection of r = .75 and in those with an abdominal infection of r = .23, respectively. Using ROC-analysis the sensitivity and specificity of B-lines for detecting an increased extravascular lung water (>10 mL/kg) was 63% and 79%, respectively. In patients with a P/F ratio <200 mm Hg, sensitivity and specificity to predict an increased extravascular lung water was 71% and 93%, respectively. CONCLUSIONS Assessment of B-lines does not accurately reflect actual extravascular lung water. In presence of an impaired oxygenation, B-lines may reliably indicate increased extravascular lung water as cause of the oxygenation disorders.
Collapse
Affiliation(s)
- Armin Seibel
- Department of Anaesthesiology, Intensive and Emergency Medicine Diakonie Klinikum Jung‐Stilling Siegen Germany
| | - Peter M. Zechner
- Department of Cardiology and Intensive Care Medicine LKH Graz II Graz Austria
| | - Andrea Berghold
- Institute for Medical Informatics, Statistics and Documentation Medical University of Graz Graz Austria
| | - Magdalena Holter
- Institute for Medical Informatics, Statistics and Documentation Medical University of Graz Graz Austria
| | - Patrick Braß
- Department of Anaesthesiology and operative Intensive Care Medicine Helios‐Klinikum Krefeld Krefeld Germany
| | - Guido Michels
- Department of Acute and Emergency Care St.-Antonius-Hospital gGmbH Eschweiler Germany
| | - Nicolas Leister
- Department of Anaesthesiology and Intensive Care Medicine University Hospital of Cologne Cologne Germany
| | - Geza Gemes
- Department of Anaesthesiology and Intensive Care Medicine Krankenhaus der Barmherzigen Brüder Graz Austria
| | - Reinmar Donauer
- Department of Anaesthesiology and Intensive Care Medicine LKH Graz II Graz Austria
| | - Reiner M. Giebler
- Department of Anaesthesiology, Intensive and Emergency Medicine Diakonie Klinikum Jung‐Stilling Siegen Germany
| | - Samir G. Sakka
- Department of Anaesthesiology and operative Intensive Care Medicine Medical Centre Merheim University Witten/Herdecke Witten Germany
- Department of Intensive Care Medicine Gemeinschaftsklinikum Mittelrhein gGmbHAcademic teaching hospital of the Johannes Gutenberg University Mainz Koblenz Germany
| |
Collapse
|
9
|
Vilchez-Monge AL, Garutti I, Jimeno C, Zaballos M, Jimenez C, Olmedilla L, Piñeiro P, Duque P, Salcedo M, Asencio JM, Lopez-Baena JA, Maruszewski P, Bañares R, Perez-Peña JM. Intraoperative Troponin Elevation in Liver Transplantation Is Independently Associated With Mortality: A Prospective Observational Study. Liver Transpl 2020; 26:681-692. [PMID: 31944566 DOI: 10.1002/lt.25716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/09/2020] [Indexed: 01/09/2023]
Abstract
Intraoperative factors implicated in postoperative mortality after liver transplantation (LT) are poorly understood. Because LT is a particularly demanding procedure, we hypothesized that intraoperative myocardial injury may be frequent and independently associated with early postoperative outcomes. We aimed to determine the association between intraoperative high-sensitivity troponin (hsTn) elevation during LT and 30-day postoperative mortality. A total of 203 adult patients undergoing LT were prospectively included in the cohort and followed during 1 year. Advanced hemodynamic parameters and serial high-sensitivity troponin T (hsTnT) measurements were assessed at 6 intraoperative time points. The optimal hsTnT cutoff level for intraoperative troponin elevation (ITE) was identified. Patients were classified into 2 groups according to the presence of ITE. Independent impact of ITE on survival was assessed through survival curves and multivariate Cox regression analysis. Intraoperative cardiac function was compared between groups. Troponin levels increased early during surgery in the ITE group. Troponin values at abdominal closure were associated with 30-day mortality (area under the receiver operating caracteristic curve, [AUROC], 0.73; P = 0.005). Patients with ITE showing values of hsTnT ≥61 ng/L at abdominal closure presented higher 30-day mortality (29.6% versus 3.4%; P < 0.001). ITE was independently associated with 30-day mortality (hazard ratio, 3.8; 95% confidence interval, 1.1-13.8; P = 0.04) and with worse overall intraoperative cardiac function. The hsTnT upper reference limit showed no discriminant capacity during LT. Intraoperative myocardial injury identified by hsTn elevation is frequently observed during LT, and it is associated with myocardial dysfunction and short-term mortality. Determinations of hsTn may serve as a valuable intraoperative monitoring tool during LT.
Collapse
Affiliation(s)
- Almudena L Vilchez-Monge
- Department of Anesthesiology and Intensive Care, Hospital General Universitario Gregorio Marañon, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Ignacio Garutti
- Department of Anesthesiology and Intensive Care, Hospital General Universitario Gregorio Marañon, Madrid, Spain.,Instituto de Investigación Sanitaria of Hospital General Universitario Gregorio Marañon (IiSGM), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Concepción Jimeno
- Department of Anesthesiology and Intensive Care, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Matilde Zaballos
- Department of Anesthesiology and Intensive Care, Hospital General Universitario Gregorio Marañon, Madrid, Spain.,Instituto de Investigación Sanitaria of Hospital General Universitario Gregorio Marañon (IiSGM), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Consuelo Jimenez
- Department of Anesthesiology and Intensive Care, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Luis Olmedilla
- Department of Anesthesiology and Intensive Care, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Patricia Piñeiro
- Postoperative Care Unit, Hospital General Universitario Gregorio Marañon, Madrid, Spain.,Department of Anesthesiology and Intensive Care, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Patricia Duque
- Postoperative Care Unit, Hospital General Universitario Gregorio Marañon, Madrid, Spain.,Department of Anesthesiology and Intensive Care, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Magdalena Salcedo
- Hepatology and Liver Transplant Unit, Department of Digestive Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Jose M Asencio
- Department of Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jose A Lopez-Baena
- Department of Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Przemyslaw Maruszewski
- Department of Pediatric Surgery and Organ Transplantation, Children´s Memorial Health Institute, Warsaw, Poland
| | - Rafael Bañares
- Hepatology and Liver Transplant Unit, Department of Digestive Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria of Hospital General Universitario Gregorio Marañon (IiSGM), Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Jose M Perez-Peña
- Department of Anesthesiology and Intensive Care, Hospital General Universitario Gregorio Marañon, Madrid, Spain.,Instituto de Investigación Sanitaria of Hospital General Universitario Gregorio Marañon (IiSGM), Madrid, Spain
| |
Collapse
|
10
|
Restrictive fluid management strategies and outcomes in liver transplantation: a systematic review. Can J Anaesth 2019; 67:109-127. [PMID: 31556006 DOI: 10.1007/s12630-019-01480-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/12/2019] [Accepted: 06/14/2019] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Restrictive fluid management strategies have been proposed to reduce complications in liver transplant recipients. We conducted a systematic review to evaluate the effects of restrictive perioperative fluid management strategies, compared with liberal ones, on postoperative outcomes in adult liver transplant recipients. Our primary outcome was acute kidney injury (AKI). Our secondary outcomes were bleeding, mortality, and other postoperative complications. SOURCE We searched major databases (CINAHL, EMB Reviews, EMBASE, MEDLINE, and the grey literature) from their inception to 10 July 2018 for randomized-controlled trials (RCTs) and observational studies comparing two fluid management strategies (or observational studies reporting two outcomes with available data on fluid volume received) in adult liver transplant recipients. Study selection, data abstraction, and risk of bias assessment were performed by at least two investigators. Data from RCTs were pooled using risk ratios (RR) and mean differences (MD) with random-effect models. PRINCIPAL FINDINGS We found seven RCTs and 29 observational studies. Based on RCTs, fluid management strategies did not have any effect on AKI, mortality, or any other postoperative complications. Intraoperative RCTs suggested that a restrictive fluid management strategy reduced pulmonary complications (RR, 0.69; 95% confidence interval [CI], 0.47 to 0.99; n = 283; I2 = 27%), duration of mechanical ventilation (MD, -13.04 hr; 95% CI, -22.2 to -3.88; n = 130; I2 = 0%) and blood loss (MD, -1.14 L; 95% CI, -1.72 to -0.57; n = 151; I2 = 0%). CONCLUSION Based on low or very low levels of evidence, we did not find any association between restrictive fluid management strategies and AKI, but we observed possible protective effects of intraoperative restrictive fluid management strategies on other outcomes. TRIAL REGISTRATION PROSPERO (CRD42017054970); registered 18 May, 2017.
Collapse
|
11
|
Motiño O, Francés DE, Casanova N, Fuertes-Agudo M, Cucarella C, Flores JM, Vallejo-Cremades MT, Olmedilla L, Pérez Peña J, Bañares R, Boscá L, Casado M, Martín-Sanz P. Protective Role of Hepatocyte Cyclooxygenase-2 Expression Against Liver Ischemia-Reperfusion Injury in Mice. Hepatology 2019; 70:650-665. [PMID: 30155948 DOI: 10.1002/hep.30241] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 08/22/2018] [Indexed: 02/05/2023]
Abstract
Liver ischemia and reperfusion injury (IRI) remains a serious clinical problem affecting liver transplantation outcomes. IRI causes up to 10% of early organ failure and predisposes to chronic rejection. Cyclooxygenase-2 (COX-2) is involved in different liver diseases, but the significance of COX-2 in IRI is a matter of controversy. This study was designed to elucidate the role of COX-2 induction in hepatocytes against liver IRI. In the present work, hepatocyte-specific COX-2 transgenic mice (hCOX-2-Tg) and their wild-type (Wt) littermates were subjected to IRI. hCOX-2-Tg mice exhibited lower grades of necrosis and inflammation than Wt mice, in part by reduced hepatic recruitment and infiltration of neutrophils, with a concomitant decrease in serum levels of proinflammatory cytokines. Moreover, hCOX-2-Tg mice showed a significant attenuation of the IRI-induced increase in oxidative stress and hepatic apoptosis, an increase in autophagic flux, and a decrease in endoplasmic reticulum stress compared to Wt mice. Interestingly, ischemic preconditioning of Wt mice resembles the beneficial effects observed in hCOX-2-Tg mice against IRI due to a preconditioning-derived increase in endogenous COX-2, which is mainly localized in hepatocytes. Furthermore, measurement of prostaglandin E2 (PGE2 ) levels in plasma from patients who underwent liver transplantation revealed a significantly positive correlation of PGE2 levels and graft function and an inverse correlation with the time of ischemia. Conclusion: These data support the view of a protective effect of hepatic COX-2 induction and the consequent rise of derived prostaglandins against IRI.
Collapse
Affiliation(s)
- Omar Motiño
- Instituto de Investigaciones Biomédicas "Alberto Sols," CSIC-UAM, Madrid, Spain
| | - Daniel E Francés
- Instituto de Fisiología Experimental (IFISE-CONICET), Rosario, Argentina
| | - Natalia Casanova
- Instituto de Investigaciones Biomédicas "Alberto Sols," CSIC-UAM, Madrid, Spain
| | | | - Carme Cucarella
- Instituto de Biomedicina de Valencia, IBV-CSIC, Valencia, Spain
| | - Juana M Flores
- Department of Animal Medicine and Surgery, Veterinary Faculty, Universidad Complutense de Madrid, Spain
| | | | - Luis Olmedilla
- Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain
| | - José Pérez Peña
- Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain
| | - Rafael Bañares
- Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain
- Medicine Faculty, Universidad Complutense de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Lisardo Boscá
- Instituto de Investigaciones Biomédicas "Alberto Sols," CSIC-UAM, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERcv), Madrid, Spain
| | - Marta Casado
- Instituto de Biomedicina de Valencia, IBV-CSIC, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERcv), Madrid, Spain
| | - Paloma Martín-Sanz
- Instituto de Investigaciones Biomédicas "Alberto Sols," CSIC-UAM, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERcv), Madrid, Spain
| |
Collapse
|
12
|
Avolio AW, Gaspari R, Teofili L, Bianco G, Spinazzola G, Soave PM, Paiano G, Francesconi AG, Arcangeli A, Nicolotti N, Antonelli M. Postoperative respiratory failure in liver transplantation: Risk factors and effect on prognosis. PLoS One 2019; 14:e0211678. [PMID: 30742650 PMCID: PMC6370207 DOI: 10.1371/journal.pone.0211678] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 01/20/2019] [Indexed: 01/01/2023] Open
Abstract
Background Postoperative respiratory failure (PRF, namely mechanical ventilation >48 hours) significantly affects morbidity and mortality in liver transplantation (LTx). Previous studies analyzed only one or two categories of PRF risk factors (preoperative, intraoperative or postoperative ones). The aims of this study were to identify PRF predictors, to assess the length of stay (LoS) in ICU and the 90-day survival according to the PRF in LTx patients. Methods Two classification approaches were used: systematic classification (recipient-related preoperative factors; intraoperative factors; logistic factors; donor factors; postoperative ICU factors; postoperative surgical factors) and patient/organ classification (patient-related general factors; native-liver factors; new-liver factors; kidney factors; heart factors; brain factors; lung factors). Two hundred adult non-acute patients were included. Missing analysis was performed. The competitive role of each factor was assessed. Results PRF occurred in 36.0% of cases. Among 28 significant PRF predictors at univariate analysis, 6 were excluded because of collinearity, 22 were investigated by ROC curves and by logistic regression analysis. Recipient age (OR = 1.05; p = 0.010), female sex (OR = 2.75; p = 0.018), Model for End-Stage Liver Disease (MELD, OR = 1.09; p<0.001), restrictive lung pattern (OR = 2.49; p = 0.027), intraoperative veno-venous bypass (VVBP, OR = 3.03; p = 0.008), pre-extubation PaCO2 (OR = 1.11; p = 0.003) and Model for Early Allograft Function (MEAF, OR = 1.37; p<0.001) resulted independent PRF risk factors. As compared to patients without PRF, the PRF-group had longer LoS (10 days IQR 7–18 versus 5 days IQR 4–7, respectively; p<0.001) and lower day-90 survival (86.0% versus 97.6% respectively, p<0.001). Conclusion In conclusion, MELD, restrictive lung pattern, surgical complexity as captured by VVBP, pre-extubation PaCO2 and MEAF are the main predictors of PRF in non-acute LTx patients.
Collapse
Affiliation(s)
- Alfonso Wolfango Avolio
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Department of Surgery -Transplantation Service, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
- * E-mail:
| | - Rita Gaspari
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Department of Anaesthesiology and Intensive Care Medicine, Rome, Italy
| | - Luciana Teofili
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Institute of Hematology, Rome, Italy
| | - Giuseppe Bianco
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Department of Surgery -Transplantation Service, Rome, Italy
| | - Giorgia Spinazzola
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Department of Anaesthesiology and Intensive Care Medicine, Rome, Italy
| | - Paolo Maurizio Soave
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Department of Anaesthesiology and Intensive Care Medicine, Rome, Italy
| | - Gianfranco Paiano
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Department of Anaesthesiology and Intensive Care Medicine, Rome, Italy
| | - Alessandra Gioia Francesconi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Department of Anaesthesiology and Intensive Care Medicine, Rome, Italy
| | - Andrea Arcangeli
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Department of Anaesthesiology and Intensive Care Medicine, Rome, Italy
| | - Nicola Nicolotti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Institute of Hygiene and Epidemiology, Rome, Italy
| | - Massimo Antonelli
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Department of Anaesthesiology and Intensive Care Medicine, Rome, Italy
| |
Collapse
|
13
|
Trebbia G, Sage E, Le Guen M, Roux A, Soummer A, Puyo P, Parquin F, Stern M, Pham T, Sakka SG, Cerf C. Assessment of lung edema during ex-vivo lung perfusion by single transpulmonary thermodilution: A preliminary study in humans. J Heart Lung Transplant 2018; 38:83-91. [PMID: 30391201 DOI: 10.1016/j.healun.2018.09.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 08/21/2018] [Accepted: 09/25/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Single transpulmonary thermodilution (SD) with extravascular lung water index (EVLWI) could become a new tool to better assess lung graft edema during ex-vivo lung perfusion (EVLP). In this study we compare EVLWI with conventional methods to better select lungs during EVLP and to predict post-transplant primary graft dysfunction (PGD). METHODS We measured EVLWI, arterial oxygen/fraction of inspired oxygen (P/F) ratio, and static lung compliance (SLC) during EVLP in an observational study. At the end of EVLP, grafts were accepted or rejected according to a standardized protocol blinded to EVLWI results. We compared the respective ability of EVLWI, P/F, and SLC to predict PGD. Mann-Whitney U-test, Fisher's exact test, and receiver-operating characteristic (ROC) curve data were used for analysis. p < 0.05 was considered statistically significant. RESULTS Thirty-five lungs were evaluated by SD during EVLP. Three lungs were rejected for pulmonary edema. Thirty-two patients were transplanted, 8 patients developed Grade 2 or 3 PGD, and 24 patients developed Grade 0 or 1 PGD. In contrast to P/F ratio, SLC, and pulmonary artery pressure, EVLWI differed between these 2 populations (p < 0.001). The area under the ROC for EVLWI assessing Grade 2 or 3 PGD at the end of EVLP was 0.93. Donor lungs with EVLWI >7.5 ml/kg were more likely associated with a higher incidence of Grade 2 or 3 PGD at Day 3. CONCLUSIONS Increased EVLWI during EVLP was associated with PGD in recipients.
Collapse
Affiliation(s)
| | | | | | - Antoine Roux
- Department of Pulmonary Medicine, Foch Hospital, Suresnes, France
| | | | | | | | - Marc Stern
- Department of Pulmonary Medicine, Foch Hospital, Suresnes, France
| | - Tai Pham
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada; Sorbonne Universités, Université Pierre et Marie Curie, Paris, France
| | - Samir G Sakka
- Sorbonne Universités, Université Pierre et Marie Curie, Paris, France
| | - Charles Cerf
- Department of Anesthesiology and Operative Intensive Care Medicine, Medical Center Cologne‒Merheim, University of Witten/Herdecke, Cologne, Germany
| | | |
Collapse
|
14
|
Li X, Chen C, Wei X, Zhu Q, Yao W, Yuan D, Luo G, Cai J, Hei Z. Retrospective Comparative Study on Postoperative Pulmonary Complications After Orthotopic Liver Transplantation Using the Melbourne Group Scale (MGS-2) Diagnostic Criteria. Ann Transplant 2018; 23:377-386. [PMID: 29853713 PMCID: PMC6248093 DOI: 10.12659/aot.907883] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Postoperative pulmonary complications (PPCs) after orthotopic liver transplantation (OLT) are associated with poor postoperative survival. However, there are no standard criteria for diagnosis of PPCs. This retrospective study aimed to explore the reliability of the Melbourne Group Scale version 2 (MGS-2) for determining PPCs after OLT. Material/Methods A total of 121 patients were divided into 3 groups. In the PPC and non-PPC groups, PPCs were determined to be present or absent in accordance with both the MGS-2 and the conventional broad criteria for diagnosis of PPCs; in the potential-PPC group, PPCs were determined to be present only in accordance with the conventional broad criteria. The perioperative risk factors for PPCs and prognosis of patients in potential-PPC group were all compared with non-PPC groups and PPC groups. Results The preoperative characteristics of patients in the potential-PPC group were similar to those in non-PPC group. The length of intensive care unit stay (2.26±0.22 vs. 4.75±0.47 days; P=0.017), duration of hospitalization (33.33±1.70 vs. 48.78±2.53 days; P<0.001), and treatment cost (28.01±1.78 vs. 38.35±1.85×10 000 yuan; P=0.018) were significantly less in the potential-PPC group than in the PPC group. Furthermore, in accordance with the MGS-2 criteria for diagnosis of PPCs, patients with PPCs showed poorer overall survival rates than those without (P=0.038). Conclusions The MGS-2 appears to be a more suitable and reliable tool for diagnosis of PPCs and to identify the post-OLT patients with poorer perioperative characteristics and prognosis.
Collapse
Affiliation(s)
- Xiaoyun Li
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China (mainland)
| | - Chaojin Chen
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China (mainland)
| | - Xiaoxia Wei
- Department of Anesthesiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China (mainland)
| | - Qianqian Zhu
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Nanning, Guangxi, China (mainland)
| | - Weifeng Yao
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China (mainland)
| | - Dongdong Yuan
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China (mainland)
| | - Gangjian Luo
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China (mainland)
| | - Jun Cai
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China (mainland)
| | - Ziqing Hei
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China (mainland)
| |
Collapse
|
15
|
Sun Y, Yu L, Liu Y. Predictive Value of Indocyanine Green Plasma Disappearance Rate on Liver Function and Complications After Liver Transplantation. Med Sci Monit 2018; 24:3661-3669. [PMID: 29855460 PMCID: PMC6007494 DOI: 10.12659/msm.907783] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the correlation between indocyanine green plasma disappearance rate (ICG-PDR) and allograft function as well as postoperative complications after liver transplantation. MATERIAL AND METHODS In this prospective study, 115 cases of adult liver transplantation performed from 1 June 2016 to 1 December 2016 were enrolled. These 115 patients were divided into a group of PDR <18%/min (50 cases) and a group of PDR ≥18%/min (65 cases). The rates of liver recovery, postoperative complications, and survival were compared between these 2 groups. RESULTS Among the total of 115 patients, 111 patients recovered well and were discharged, whereas 4 patients died during the first month after the operation. Between the 2 groups, significant differences were observed in terms of the model for end-stage liver disease (MELD) score, intraoperative bleeding volume, and the level of hemoglobin (Hb), pre-albumin (PA) and total bilirubin (TB) the first week after the operation. Overall, the incidence of hepatic arterial complications and pneumonia was much higher in the PDR<18%/min group (P<0.05). CONCLUSIONS The early postoperative value of ICG-PDR was closely related to graft function and could act as a good predictor for the incidence of postoperative arterial complications.
Collapse
Affiliation(s)
- Yan Sun
- Department of Organ Transplantation, Tianjin First Central Hospital, Tianjin, China (mainland)
| | - Lixin Yu
- Department of Organ Transplantation, Tianjin First Central Hospital, Tianjin, China (mainland)
| | - Yihe Liu
- Department of Organ Transplantation, Tianjin First Central Hospital, Tianjin, China (mainland)
| |
Collapse
|
16
|
Quantitative computed tomography in comparison with transpulmonary thermodilution for the estimation of pulmonary fluid status: a clinical study in critically ill patients. J Clin Monit Comput 2018; 33:5-12. [PMID: 29680878 DOI: 10.1007/s10877-018-0144-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 04/16/2018] [Indexed: 01/09/2023]
Abstract
Extravascular lung water (index) (EVLW(I)) can be estimated using transpulmonary thermodilution (TPTD). Computed tomography (CT) with quantitative analysis of lung tissue density has been proposed to quantify pulmonary edema. We compared variables of pulmonary fluid status assessed using quantitative CT and TPTD in critically ill patients. In 21 intensive care unit patients, we performed TPTD measurements directly before and after chest CT. Based on the density data of segmented CT images we calculated the tissue volume (TV), tissue volume index (TVI), and the mean weighted index of voxel aqueous density (VMWaq). CT-derived TV, TVI, and VMWaq did not predict TPTD-derived EVLWI values ≥ 14 mL/kg. There was a significant moderate positive correlation between VMWaq and mean EVLWI (EVLWI before and after CT) (r = 0.45, p = 0.042) and EVLWI after CT (r = 0.49, p = 0.025) but not EVLWI before CT (r = 0.38, p = 0.086). There was no significant correlation between TV and EVLW before CT, EVLW after CT, or mean EVLW. There was no significant correlation between TVI and EVLWI before CT, EVLWI after CT, or mean EVLWI. CT-derived variables did not predict elevated TPTD-derived EVLWI values. In unselected critically ill patients, variables of pulmonary fluid status assessed using quantitative CT cannot be used to predict EVLWI.
Collapse
|
17
|
Tran-Dinh A, Augustin P, Dufour G, Lasocki S, Allou N, Thabut G, Castier Y, Montravers P, Desmard M. Evaluation of Cardiac Index and Extravascular Lung Water After Single-Lung Transplantation Using the Transpulmonary Thermodilution Technique by the PiCCO2 Device. J Cardiothorac Vasc Anesth 2017; 32:1731-1735. [PMID: 29203299 DOI: 10.1053/j.jvca.2017.10.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVES First evaluation of the transpulmonary thermodilution technique by the PiCCO2 device to assess cardiac index and pulmonary edema during the postoperative course after single-lung transplantation. DESIGN Prospective observational study. SETTINGS Intensive care unit, university hospital (single center). PARTICIPANTS Single-lung transplant patients. INTERVENTIONS The authors compared cardiac index measured by PiCCO2 and pulmonary artery catheter and assessed pulmonary edema using extravascular lung water index and pulmonary vascular permeability index measured by PiCCO2. MEASUREMENTS AND MAIN RESULTS A Bland-Altman method was used to compare cardiac index measured by PiCCO2 and pulmonary artery catheter. Extravascular lung water index and pulmonary vascular permeability index were compared according to the PaO2/FiO2 ratio with a threshold value of 150 mmHg. Ten single-lung transplant patients were included. Cardiac index measured by PiCCO2 and pulmonary artery catheter were 3.3 L/min/m2 (2.9-3.6) and 2.5 L/min/m2 (2.2-3.0). Bias for cardiac index was 0.71 L/min/m2 (-0.03; 1.44) and limit of agreements were -0.03 and 1.44 L/min/m2. Extravascular lung water index was 12 mL/kg (11-16) and pulmonary vascular permeability index was 2.3 (2.0-3.1), consistent with pulmonary edema. Extravascular lung water index was higher in the group of PaO2/FiO2 ratio ≤150 mmHg compared with the group of PaO2/FiO2 ratio >150 mmHg (17 v 12 mL/kg, p = 0.04), whereas pulmonary vascular permeability index only tended to be higher (3.1 v 2.1, p = 0.06). CONCLUSION PiCCO2 device systematically overestimated cardiac index compared with pulmonary artery catheter. However, it might be useful to assess pulmonary edema in acute respiratory failure after single-lung transplantation.
Collapse
Affiliation(s)
- Alexy Tran-Dinh
- Département d'AnesthésieRéanimation, Université Paris Diderot Sorbonne Cite, APHP, CHU Bichat-Claude Bernard, Paris, France; LVTS Inserm U1148, Hôpital Bichat-Claude Bernard, Paris, France.
| | - Pascal Augustin
- Département d'AnesthésieRéanimation, Université Paris Diderot Sorbonne Cite, APHP, CHU Bichat-Claude Bernard, Paris, France
| | - Guillaume Dufour
- Département d'AnesthésieRéanimation, Université Paris Diderot Sorbonne Cite, APHP, CHU Bichat-Claude Bernard, Paris, France
| | - Sigismond Lasocki
- Département d'AnesthésieRéanimation, Université Paris Diderot Sorbonne Cite, APHP, CHU Bichat-Claude Bernard, Paris, France
| | - Nicolas Allou
- Département d'AnesthésieRéanimation, Université Paris Diderot Sorbonne Cite, APHP, CHU Bichat-Claude Bernard, Paris, France
| | - Gabriel Thabut
- Service de Pneumologie B et Transplantation Pulmonaire, Université Paris Diderot Sorbonne Cite, APHP, CHU Bichat-Claude Bernard, Paris, France
| | - Yves Castier
- Inserm UMR 1152, Hôpital Bichat-Claude Bernard, Paris, France; Service de Chirurgie Thoracique et Vasculaire, Université Paris Diderot Sorbonne Cite, APHP(,) CHU Bichat-Claude Bernard, Paris, France
| | - Philippe Montravers
- Département d'AnesthésieRéanimation, Université Paris Diderot Sorbonne Cite, APHP, CHU Bichat-Claude Bernard, Paris, France; Inserm UMR 1152, Hôpital Bichat-Claude Bernard, Paris, France
| | - Mathieu Desmard
- Département d'AnesthésieRéanimation, Université Paris Diderot Sorbonne Cite, APHP, CHU Bichat-Claude Bernard, Paris, France
| |
Collapse
|
18
|
Comparison of pulmonary vascular permeability index PVPI and global ejection fraction GEF derived from jugular and femoral indicator injection using the PiCCO-2 device: A prospective observational study. PLoS One 2017; 12:e0178372. [PMID: 29040264 PMCID: PMC5644983 DOI: 10.1371/journal.pone.0178372] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 05/11/2017] [Indexed: 11/23/2022] Open
Abstract
Background Transpulmonary thermodilution (TPTD) is used to derive cardiac output CO, global end-diastolic volume GEDV and extravascular lung water EVLW. To facilitate interpretation of these data, several ratios have been developed, including pulmonary vascular permeability index (defined as EVLW/(0.25*GEDV)) and global ejection fraction ((4*stroke volume)/GEDV). PVPI and GEF have been associated to the aetiology of pulmonary oedema and systolic cardiac function, respectively. Several studies demonstrated that the use of femoral venous access results in a marked overestimation of GEDV. This also falsely reduces PVPI and GEF. One of these studies suggested a correction formula for femoral venous access that markedly reduced the bias for GEDV. Consequently, the last PiCCO-algorithm requires information about the CVC, and correction for femoral access has been shown. However, two recent studies demonstrated inconsistencies of the last PiCCO algorithm using incorrected GEDV for PVPI, but corrected GEDV for GEF. Nevertheless, these studies were based on mathematical analyses of data displayed in a total of 15 patients equipped with only a femoral, but not with a jugular CVC. Therefore, this study compared PVPI_fem and GEF_fem derived from femoral TPTD to values derived from jugular indicator injection in 25 patients with both jugular and femoral CVCs. Methods 54 datasets in 25 patients were recorded. Each dataset consisted of three triplicate TPTDs using the jugular venous access as the gold standard and the femoral access with (PVPI_fem_cor) and without (PVPI_fem_uncor) information about the femoral indicator injection to evaluate, if correction for femoral GEDV pertains to PVPI_fem and GEF_fem. Results PVPI_fem_uncor was significantly lower than PVPI_jug (1.48±0.47 vs. 1.84±0.53; p<0.001). Similarly, PVPI_fem_cor was significantly lower than PVPI_jug (1.49±0.46 vs. 1.84±0.53; p<0.001). This is explained by the finding that PVPI_fem_uncor was not different to PVPI_fem_cor (1.48±0.47 vs. 1.49±0.46; n.s.). This clearly suggests that correction for femoral CVC does not pertain to PVPI. GEF_fem_uncor was significantly lower than GEF_jug (20.6±5.1% vs. 25.0±6.1%; p<0.001). By contrast, GEF_fem_cor was not different to GEF_jug (25.6±5.8% vs. 25.0±6.1%; n.s.). Furthermore, GEF_fem_cor was significantly higher than GEF_fem_uncor (25.6±5.8% vs. 20.6±5.1%; p<0.001). This finding emphasizes that an appropriate correction for femoral CVC is applied to GEF_fem_cor. The extent of the correction (25.5/20.6; 124%) for GEF and the relation of PVPI_jug/PVPI_fem_uncor (1.84/1.48; 124%) are in the same range as the ratio of GEDVI_fem_uncor/GEDVI_fem_cor (1056ml/m2/821mL/m2; 129%). This further emphasizes that GEF, but not PVPI is corrected in case of femoral indicator injection. Conclusions Femoral indicator injection for TPTD results in significantly lower values for PVPI and GEF. While the last PiCCO algorithm appropriately corrects GEF, the correction is not applied to PVPI. Therefore, GEF-values can be used in case of femoral CVC, but PVPI-values are substantially underestimated.
Collapse
|
19
|
Assaad S, Shelley B, Perrino A. Transpulmonary Thermodilution: Its Role in Assessment of Lung Water and Pulmonary Edema. J Cardiothorac Vasc Anesth 2017; 31:1471-1480. [DOI: 10.1053/j.jvca.2017.02.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Indexed: 11/11/2022]
|
20
|
Factors Associated with Postoperative Prolonged Mechanical Ventilation in Pediatric Liver Transplant Recipients. Anesthesiol Res Pract 2017; 2017:3728289. [PMID: 28757869 PMCID: PMC5512041 DOI: 10.1155/2017/3728289] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 05/18/2017] [Indexed: 11/17/2022] Open
Abstract
Introduction Almost all pediatric orthotopic liver transplant (OLT) recipients require mechanical ventilation in the early postoperative period. Prolonged postoperative mechanical ventilation (PPMV) may be a marker of severe disease and may be associated with morbidity and mortality. We determined the incidence and risk factors for PPMV in children who underwent OLT. Methods This was a retrospective analysis of data collected on 128 pediatric OLT recipients. PPMV was defined as postoperative ventilation ≥ 4 days. Perioperative characteristics were compared between cases and control groups. Multivariable logistic regression analysis was used to calculate odds ratios for PPMV after controlling for relevant cofactors. Results An estimated 25% (95% CI, 17.4%–32.6%) required PPMV. The overall incidence of PPMV varied significantly by age group with the highest incidence among infants. PPMV was associated with higher postoperative mortality (p = 0.004) and longer intensive care unit (p < 0.001) and hospital length of stay (p < 0.001). Multivariable analysis identified young patient age, preoperative hypocalcemia, and increasing duration of surgery as independent predictors of PPMV following OLT. Conclusion The incidence of PPMV is high and it was associated with prolonged ICU and hospital LOS and higher posttransplant mortality. Surgery duration appears to be the only modifiable predictor of PPMV.
Collapse
|
21
|
Patterns of perioperative thoracic fluid indices changes in liver transplantation with or without postoperative acute lung injury. J Formos Med Assoc 2017; 116:432-440. [DOI: 10.1016/j.jfma.2016.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 08/08/2016] [Accepted: 08/12/2016] [Indexed: 12/19/2022] Open
|