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Di Martino M, Van Laarhoven S, Ielpo B, Ramia JM, Manuel-Vázquez A, Martínez-Pérez A, Pavel M, Beltran Miranda P, Orti-Rodríguez R, de la Serna S, Ortega Rabbione GJ, Sanz-Garcia A, Martín-Pérez E. Systematic review and meta-analysis of fluid therapy protocols in acute pancreatitis: type, rate and route. HPB (Oxford) 2021; 23:1629-1638. [PMID: 34325967 DOI: 10.1016/j.hpb.2021.06.426] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/21/2021] [Accepted: 06/25/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Adequate fluid resuscitation is paramount in the management of acute pancreatitis (AP). The aim of this study is to assess benefits and harms of fluid therapy protocols in patients with AP. METHODS MEDLINE, Embase, Science Citation Index and clinical trial registries were searched for randomised clinical trials published before May 2020, assessing types of fluids, routes and rates of administration. RESULTS A total 15 trials (1073 participants) were included. Age ranged from 38 to 73 years; follow-up period ranged from 0.5 to 6 months. Ringer lactate (RL) showed a reduced number of severe adverse events (SAE) when compared to normal saline (NS) (OR 0.48; 95%CI 0.29-0.81, p = 0.006); additionally, NS showed reduced SAE (RR 0.38; 95%IC 0.27-0.54, p < 0.001) and organ failure (RR 0.30; 95%CI 0.21-0.44, p < 0.001) in comparison with hydroxyethyl starch (HES). High fluid rate fluid infusion showed increased mortality (OR 2.88; 95%CI 1.41-5.88, p = 0.004), increased number of SAE (RR 1.42; 95%CI 1.04-1.93, p = 0.030) and higher incidence of sepsis (RR 2.80; 95%CI 1.51-5.19, p = 0.001) compared to moderate fluid rate infusion. CONCLUSIONS In patients with AP, RL should be preferred over NS and HES should not be recommended. Based on low-certainty evidence, moderate-rate fluid infusion should be preferred over high-rate infusion.
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Affiliation(s)
- Marcello Di Martino
- HPB Unit, Department of General and Digestive Surgery, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain.
| | - Stijn Van Laarhoven
- Department of HPB Surgery University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Benedetto Ielpo
- HPB Unit, University Mar Hospital, Parc Salut, Barcelona, Spain
| | - Jose M Ramia
- Faculty of Health Sciences, Valencian International University (VIU), 46002, Valencia, Spain; Department of Surgery, Hospital General Universitario de Alicante, ISABIALAlicante (Spain)
| | - Alba Manuel-Vázquez
- Department of General and Digestive Surgery, Hospital Universitario de Getafe, Madrid, Spain
| | - Aleix Martínez-Pérez
- Faculty of Health Sciences, Valencian International University (VIU), 46002, Valencia, Spain
| | - Mihai Pavel
- HPB Unit, Department of General Surgery, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain, Universitat Rovira i Virgili, Departament de Medicina i Cirugia, Reus, Spain, Universitat Rovira i Virgili, Departament de Medicina i Cirugia, Reus, Spain
| | - Pablo Beltran Miranda
- Unidad de Cirugía Hepato-Bilio-Pancreática, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | - Rafael Orti-Rodríguez
- Department of General and Digestive Surgery, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Sofía de la Serna
- HPB Surgery Unit, Department of General and Digestive Surgery, Hospital Universitario Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Spain
| | - Guillermo J Ortega Rabbione
- Data Analysis Unit, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Ancor Sanz-Garcia
- Data Analysis Unit, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | - Elena Martín-Pérez
- HPB Unit, Department of General and Digestive Surgery, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain
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Miranda PB, Artacho GS, Bellido CB, Marín Gómez LM, Franco CC, Álamo Martinez JM, Padillo Ruiz FJ, Gómez Bravo MÁ. Management of Large, Spontaneous Portosystemic Shunts in Liver Transplantation: Case Report and Review of Literature. Transplant Proc 2020; 52:566-568. [PMID: 32057499 DOI: 10.1016/j.transproceed.2019.11.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 11/06/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The presence of collateral circulation in liver cirrhosis patients with portal hypertension is quite frequent due to re-permeabilization of closed embryonic channels. In some cases, these shunts could measure over 1 cm wide, therefore, containing a significative blood flow. Its management during liver transplantation could be challenging due to possible complications resulting from either ligation of the shunts or from ignoring them. We present the case of a patient with recurrent hepatic encephalopathy (HE) and a large spontaneous portosystemic shunt (SPSS) who submitted to liver transplant and review the literature identifying options, complications, and outcomes with the aim of facilitating decision making. MATERIAL AND METHODS A 68-year-old, Spanish man diagnosed with liver cirrhosis with portal hypertension and recurrent episodes of HE is proposed for LT. The patient's Child-Pugh score was A6-B7, and the Model for End-stage Liver Disease score was 12. Preoperatively, a computed tomography scan showed a large SPSS running to the inferior cava vein. During the surgery, a small-sized portal vein and a large shunt measuring almost 3 cm wide were identified. After reperfusion, portal vein flow was 1000 to 1100 mL/min. Owing to the previous HE and the risk of low portal flow, the shunt was closed increasing the portal flow to 1800 mL/min. The patient was discharged without any complications. CONCLUSIONS The presence of large SPSSs are frequent during LT. Decision making intraoperatively can be challenging due to possible complications derived from ligation of the SPSS or from ignoring it. Either preoperative assessment of a further HE risk or portal vein flow measurement after reperfusion are essential to achieve a correct resolution.
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Affiliation(s)
- Pablo Beltran Miranda
- HPB and Liver Transplant Unit, General and Digestive Surgery Department, University Hospital Virgen del Rocio, Seville, Spain.
| | - Gonzalo Suarez Artacho
- HPB and Liver Transplant Unit, General and Digestive Surgery Department, University Hospital Virgen del Rocio, Seville, Spain
| | - Carmen Bernal Bellido
- HPB and Liver Transplant Unit, General and Digestive Surgery Department, University Hospital Virgen del Rocio, Seville, Spain
| | - Luis Miguel Marín Gómez
- HPB and Liver Transplant Unit, General and Digestive Surgery Department, University Hospital Virgen del Rocio, Seville, Spain
| | - Carmen Cepeda Franco
- HPB and Liver Transplant Unit, General and Digestive Surgery Department, University Hospital Virgen del Rocio, Seville, Spain
| | - Jose María Álamo Martinez
- HPB and Liver Transplant Unit, General and Digestive Surgery Department, University Hospital Virgen del Rocio, Seville, Spain
| | - Francisco Javier Padillo Ruiz
- HPB and Liver Transplant Unit, General and Digestive Surgery Department, University Hospital Virgen del Rocio, Seville, Spain
| | - Miguel Ángel Gómez Bravo
- HPB and Liver Transplant Unit, General and Digestive Surgery Department, University Hospital Virgen del Rocio, Seville, Spain
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Beltran Miranda P, Gomez Bravo MA, Padillo Ruiz FJ. Safety and Benefit of Using Liver Grafts From Older Donors. JAMA Surg 2019; 154:978-979. [PMID: 31339525 DOI: 10.1001/jamasurg.2019.2186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Pablo Beltran Miranda
- Hepatobiliary and Liver Transplant Unit, General and Digestive Surgery Department, University Hospital Virgen del Rocio, Seville, Spain
| | - Miguel Angel Gomez Bravo
- Hepatobiliary and Liver Transplant Unit, General and Digestive Surgery Department, University Hospital Virgen del Rocio, Seville, Spain
| | - Francisco Javier Padillo Ruiz
- Hepatobiliary and Liver Transplant Unit, General and Digestive Surgery Department, University Hospital Virgen del Rocio, Seville, Spain
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Abstract
Surface melting on the (0001) face of hexagonal ice ( I(h)) was studied by sum-frequency vibrational spectroscopy in the OH stretch frequency range. The degree of orientational order of the dangling OH bonds at the surface was measured as a function of temperature. Disordering sets in around 200 K and increases dramatically with temperature. The results show that the disordered (quasiliquid) layer on ice is structurally different from normal liquid water.
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Affiliation(s)
- X Wei
- Department of Physics, University of California, Berkeley 94720, USA
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