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Hanami Y, Kimura S, Suga T, Okamoto T, Ogawa E, Ashina K, Nakamura N, Kai S, Okajima H, Hatano E, Egi M, Takita J. Postoperative fluid balance and outcomes in pediatric living-donor liver transplant recipients: a retrospective cohort study. J Anesth 2025:10.1007/s00540-025-03515-9. [PMID: 40411562 DOI: 10.1007/s00540-025-03515-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2025] [Accepted: 05/06/2025] [Indexed: 05/26/2025]
Abstract
PURPOSE This study aimed to investigate the relationship between postoperative fluid balance (FB) and clinical outcomes in pediatric living-donor liver transplant (LDLT) recipients. METHODS This retrospective study was conducted at a tertiary care center. Patients aged ≤ 18 years who underwent LDLT between January 2010 and September 2023 were included. Postoperative FB was calculated as [(total fluid intake-total fluid output) / body weight] × 100 for 48 h. Patients were categorized into four groups: < 5%, 5-10%, 10-15%, and ≥ 15% FB. The primary outcome was ventilator-free days (VFD) within 30 days post-transplantation. Secondary outcomes included acute kidney injury (AKI), reintubation, hepatic arterial thrombosis, acute rejection, primary graft dysfunction, intensive care unit (ICU) length of stay (LOS), and mortality. RESULTS The study included 200 patients with a median weight of 9.0 (interquartile range [IQR]: 6.9-19.3) kg. Median VFD did not significantly differ across the FB groups: < 5% FB, 29.3 (IQR, 28.3-29.4) days; 5-10% FB, 29.3 (IQR, 28.3-29.4) days; 10-15% FB, 29.3 (IQR, 28.3-29.4) days; and ≥ 15% FB, 27.4 (IQR, 23.3-29.4) days (p = 0.27). However, multivariable analysis showed ≥ 15% FB was associated with 4.59 days shorter VFD (p = 0.004) and higher AKI incidence (odds ratio: 6.60, p = 0.012). Thrombosis occurred in 7 patients (3.5%) with no significant differences among groups (p = 0.61). Other secondary outcomes showed no significant differences. CONCLUSION Excessive postoperative FB (≥ 15%) in pediatric LDLT recipients was significantly associated with reduced VFD and increased AKI incidence, whereas other adverse outcomes were not significantly affected.
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Affiliation(s)
- Yotaro Hanami
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoshi Kimura
- Department of Anesthesiology, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Takenori Suga
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tatsuya Okamoto
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Eri Ogawa
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazushige Ashina
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Natsumi Nakamura
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinichi Kai
- Department of Anesthesiology, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hideaki Okajima
- Department of Pediatric Surgery, Kanazawa Medical University, Ishikawa, Japan
| | - Etsuro Hatano
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Moritoki Egi
- Department of Anesthesiology, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Junko Takita
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Lobo SM, Paulucci PS, Tavares LM, Luckemeyer GB, Machado LF, Elias de Oliveira N, Minhoto SP, Alves Silva RC, da Silva RF, Freitas MS, Lobo FRM, Berger-Estilita J. Fluid balance dynamics and early postoperative outcomes in orthotopic liver transplantation: a prospective cohort study. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2025; 75:844619. [PMID: 40189046 PMCID: PMC12047465 DOI: 10.1016/j.bjane.2025.844619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2024] [Revised: 03/18/2025] [Accepted: 03/22/2025] [Indexed: 04/24/2025]
Abstract
INTRODUCTION This study evaluates the impact of Fluid Balance (FB) patterns on outcomes after Orthotopic Liver Transplantation (OLT). It hypothesizes that deviations from optimal FB increase morbidity. METHODS In a single-center cohort post hoc analysis of 73 post-OLT patients, FB was categorized into three groups based on cumulative FB at 72 hours: Lowest (negative FB), Intermediate (0-2000 mL), and Highest (> 2000 mL). We analyzed Sequential Organ Failure Assessment (SOFA) scores, mortality rates, and causes of death. Logistic regression identified mortality predictors. RESULTS The Highest FB group had the highest SOFA scores and mortality (Group "Lo": 18.2%, Group "In": 8.6%, Group "Hi": 40.5%, p = 0.009). A U-shaped relationship between FB and hospital mortality was observed, with extremes of FB associated with higher mortality. Cumulative FB independently predicted all-cause mortality with a 29.5% increase in the risk of death. FB on day 3 also predicted all-cause mortality, increasing the risk by 83.9%. Furthermore, FB on day 1 was linked to a 134.5% increase in the risk of death due to primary non-function of the liver. SOFALIVER score strongly predicted all-cause mortality, with a one-point increase associated with a 98.8% to 114.7% increase in mortality risk. DISCUSSION These findings suggest that both negative and positive extremes of FB are associated with worse outcomes after OLT, reinforcing the U-shaped relationship between FB and mortality. Our results underscore the importance of balanced fluid management, particularly in the early postoperative period. The study highlights the need for individualized FB strategies to optimize organ function and reduce mortality. The use of SOFALIVER scores as a predictor of mortality further emphasizes the importance of liver function monitoring in post-OLT patients. However, the single-centre design and convenience sample limit the generalizability of our findings, necessitating validation through multicenter studies. CONCLUSION Our study provides valuable insights into the relationship between FB patterns and mortality in OLT patients. Both negative and positive extremes of FB are associated with higher mortality, suggesting the need for a balanced and individualized fluid management approach. The strong predictive value of SOFALIVER scores for all-cause mortality highlights the importance of early and continuous monitoring of liver function. Future multicenter randomized controlled trials are needed to validate these findings and develop optimized fluid management protocols for OLT patients.
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Affiliation(s)
- Suzana Margareth Lobo
- Hospital de Base da Faculdade de Medicina de São José do Rio Preto (FAMERP), Divisão de Terapia Intensiva, São José do Rio Preto, SP, Brazil.
| | - Pedro Saggioro Paulucci
- Hospital de Base da Faculdade de Medicina de São José do Rio Preto (FAMERP), Divisão de Terapia Intensiva, São José do Rio Preto, SP, Brazil
| | - Lucas Martins Tavares
- Hospital de Base da Faculdade de Medicina de São José do Rio Preto (FAMERP), Divisão de Terapia Intensiva, São José do Rio Preto, SP, Brazil
| | - Graziela Benardin Luckemeyer
- Hospital de Base da Faculdade de Medicina de São José do Rio Preto (FAMERP), Divisão de Terapia Intensiva, São José do Rio Preto, SP, Brazil
| | - Luana Fernandes Machado
- Hospital de Base da Faculdade de Medicina de São José do Rio Preto (FAMERP), Divisão de Terapia Intensiva, São José do Rio Preto, SP, Brazil
| | - Neymar Elias de Oliveira
- Hospital de Base da Faculdade de Medicina de São José do Rio Preto (FAMERP), Divisão de Terapia Intensiva, São José do Rio Preto, SP, Brazil
| | - Silvia Prado Minhoto
- Hospital de Base da Faculdade de Medicina de São José do Rio Preto (FAMERP), Divisão de Terapia Intensiva, São José do Rio Preto, SP, Brazil
| | - Rita Cassia Alves Silva
- Hospital de Base da Faculdade de Medicina de São José do Rio Preto (FAMERP), Divisão de Transplantes, São José do Rio Preto, SP, Brazil
| | - Renato Ferreira da Silva
- Hospital de Base da Faculdade de Medicina de São José do Rio Preto (FAMERP), Divisão de Transplantes, São José do Rio Preto, SP, Brazil
| | - Marlon Souza Freitas
- Hospital de Base da Faculdade de Medicina de São José do Rio Preto (FAMERP), Divisão de Terapia Intensiva, São José do Rio Preto, SP, Brazil
| | - Francisco Ricardo Marques Lobo
- Hospital de Base da Faculdade de Medicina de São José do Rio Preto (FAMERP), Divisão de Terapia Intensiva, São José do Rio Preto, SP, Brazil
| | - Joana Berger-Estilita
- Institute of Anaesthesiology and Intensive Care, Salem Spital, Hirslanden Hospital Group, Switzerland; Institute for Medical Education, University of Bern, Switzerland; University of Porto, Faculty of Medicine, Centre for Health Technology and Services Research, CINTESIS@RISE, Porto, Portugal
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Codes L, Zapata R, Mendizabal M, Junior ADMF, Restrepo JC, Schiavon LDL, Malbouisson LMS, Andraus W, Gadano A, Padilla-Machaca PM, Villamil A, Stucchi RSB, Castro-Narro GE, Pages J, Terrabuio DRB, Urzúa A, Pessoa MG, Mainardi V, Pedro R, Imventarza O, Gerona S, Wolff R, Abdala E, Tenorio L, Cerda-Reyes E, Cairo F, Uribe M, Bittencourt PL. Latin American association for the study of the liver (ALEH) guidance on postoperative care after liver transplantation. Ann Hepatol 2025; 30:101899. [PMID: 40057036 DOI: 10.1016/j.aohep.2025.101899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2024] [Revised: 12/12/2024] [Accepted: 01/01/2025] [Indexed: 03/16/2025]
Abstract
Liver transplantation (LT) is a well-established therapy for patients with decompensated cirrhosis and early-stage hepatocellular carcinoma. Liver transplantation activity varies sharply across Latin American (LATAM) countries due to differences in resources, expertise, and funding and local attitudes toward organ donation and transplantation. This current guidance of postoperative care after LT is the first position paper of the Latin American Association for the Study of the Liver (ALEH) Special Interest Group (SIG), drawing evidence-based recommendations regarding immediate and long-term postoperative care of LT recipients, taking into consideration their applicability in Latin America.
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Affiliation(s)
- Liana Codes
- Hospital Português, Salvador, Bahia, Brazil; Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil.
| | - Rodrigo Zapata
- Unidad de Trasplante hepático, Clínica Alemana/ Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile.
| | - Manuel Mendizabal
- Unidad de Hepatología y Trasplante de Hígado, Hospital Universitario Austral, Provincia de Buenos Aires, Pilar, Argentina.
| | | | | | | | | | - Wellington Andraus
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - P Martin Padilla-Machaca
- Liver Unit, Guillermo Almenara National Hospital, EsSalud, Lima, Perú, and National University of San Marcos, Lima, Perú
| | | | | | - Graciela Elia Castro-Narro
- Unidad de Hepatología y Trasplantes, Hospital Médica Sur, Ciudad de México, México; Servicio de Gastroenterología, Hepatología y Trasplantes, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Josefina Pages
- Unidad de Hepatología y Trasplante de Hígado, Hospital Universitario Austral, Provincia de Buenos Aires, Pilar, Argentina.
| | | | - Alvaro Urzúa
- Hospital Clínico Universidad de Chile, Santiago, Chile.
| | - Mário Guimarães Pessoa
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
| | | | - Rodolpho Pedro
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Oscar Imventarza
- Hospital Argerich, Hospital Garrahan, Stalyc Representative, Buenos Aires, Argentina
| | - Solange Gerona
- Hospital Central de Las Fuerzas Armadas, Montevideo, Uruguay
| | - Rodrigo Wolff
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Edson Abdala
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
| | - Laura Tenorio
- Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú
| | - Eira Cerda-Reyes
- Hospital Central Militar, Escuela Militar de Graduados de Sanidad, Ciudad de México, Mexico
| | | | - Mario Uribe
- Hospital Dr. Luis Calvo Mackenna, Santiago, Chile
| | - Paulo Lisboa Bittencourt
- Hospital Português, Salvador, Bahia, Brazil; Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil.
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Li D, Guan Q, Chen C, Sheng B, Zhang Z, Hu Y. Relevance of perioperative fluid dynamics in liver transplantation to acute kidney injury and patient outcomes: a cross-sectional survey. J Pharm Policy Pract 2024; 18:2438225. [PMID: 39776465 PMCID: PMC11703520 DOI: 10.1080/20523211.2024.2438225] [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] [Received: 09/02/2024] [Accepted: 11/14/2024] [Indexed: 01/11/2025] Open
Abstract
Background Fluid administration is a critical component of perioperative management for liver transplant recipients, and excessive fluid infusion can lead to acute kidney injury (AKI) and poor patient outcomes. Method We conducted a cross-sectional survey on the fluid intake and output of adult liver transplant recipients over a 7-day period. The patients were divided into AKI and non-AKI groups. Multivariate logistic regression analyses were used to evaluate the association between fluid balance (FB) and AKI. A Kaplan-Meier survival analysis was performed to determine the survival of the recipient survival at 180 days. Results A total of 210 liver transplant recipients were included. The peak FB occurred on the second day after transplantation, which was higher than on the seventh day (0.3 [IQR, -0.2 to 0.8] L vs. -0.4 [IQR, -1.0 to 0.3] L, p < 0.001). The highest incidence of AKI was observed on the second day after transplantation and the lowest on the seventh day (52.4% vs. 15.4%, p < 0.001). Multivariate analysis showed that a cumulative FB > 1 L within the first 2 days postoperatively was an independent risk factor for AKI on the second day after liver transplantation (LT) (OR = 2.66, 95% CI, 1.31-5.41, p = 0.007). Survival analysis indicated significant differences in 180-day survival rates among patients with different grades of AKI [94.0% (grade 1) vs. 91.4% (grade 2) vs. 77.8% (grade 3), χ 2 = 12.93, p < 0.001]. Conclusion There is a significant correlation between post-LT AKI and perioperative FB. Cumulative FB > 1 L in the first 2 days postoperatively is an independent risk factor for AKI on the second day after LT. AKI after LT is associated with a lower 180-day survival rate in patients.
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Affiliation(s)
- Desheng Li
- School of Clinical Medicine, Qinghai University, Xining, People's Republic of China
| | - Qinghua Guan
- Liver ICU, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, People's Republic of China
| | - Chuanlin Chen
- School of Clinical Medicine, Qinghai University, Xining, People's Republic of China
| | - Bo Sheng
- Liver ICU, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, People's Republic of China
| | - Zhenyu Zhang
- Liver ICU, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, People's Republic of China
| | - Yongfang Hu
- Department of Clinical Pharmacy, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, People's Republic of China
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Bai R, An R, Chen S, Ding W, Xue M, Zhao G, Ma Q, Shen X. Risk factors and prediction score for new-onset diabetes mellitus after liver transplantation. J Diabetes Investig 2024; 15:1105-1114. [PMID: 38641877 PMCID: PMC11292396 DOI: 10.1111/jdi.14204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 03/14/2024] [Accepted: 03/18/2024] [Indexed: 04/21/2024] Open
Abstract
AIM New-onset diabetes mellitus is a frequent and severe complication arising after liver transplantation (LT). We aimed to identify the risk factors for new-onset diabetes mellitus after liver transplantation (NODALT) and to develop a risk prediction score system for relevant risks. METHODS We collected and analyzed data from all recipients who underwent liver transplantation at the First Affiliated Hospital of Xi'an Jiaotong University. The OR derived from a multiple logistic regression predicting the presence of NODALT was used to calculate the risk prediction score. The performance of the risk prediction score was externally validated in patients who were from the CLTR (China Liver Transplant Registry) database. RESULTS A total of 468 patients met the outlined criteria and finished the follow-up. Overall, NODALT was diagnosed in 115 (24.6%) patients. Age, preoperative impaired fasting glucose (IFG), postoperative fasting plasma glucose (FPG), and the length of hospital stay were significantly associated with the presence of NODALT. The risk prediction score includes age, preoperative IFG, postoperative FPG, and the length of hospital stay. The risk prediction score of the area under the receiver operating curve was 0.785 (95% CI: 0.724-0.846) in the experimental population and 0.782 (95% CI: 0.708-0.856) in the validation population. CONCLUSIONS Age at the time of transplantation, preoperative IFG, postoperative FPG, and length of hospital stay were independent predictive factors of NODALT. The use of a simple risk prediction score can identify the patients who have the highest risk of NODALT and interventions may start early.
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Affiliation(s)
- Ruiping Bai
- Department of AnesthesiologyThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Rui An
- Department of AnesthesiologyThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Siyu Chen
- Department of AnesthesiologyThe First Affiliated Hospital of Xinjiang Medical UniversityUrumqiChina
| | - Wenkang Ding
- Department of AnesthesiologyThe Second Xiangya Hospital of Central South UniversityChangshaChina
| | - Mengwen Xue
- Department of AnesthesiologyThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Ge Zhao
- Department of AnesthesiologyThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Qingyong Ma
- Department of Hepatobiliary SurgeryThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
- The Center of Pancreatic Disease Diagnosis and TreatmentThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Xin Shen
- Department of AnesthesiologyThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
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Patel S, Green A, Ashokumar S, Hoke A, Rachoin JS. Objective Methods of Assessing Fluid Status to Optimize Volume Management in Kidney Disease and Hypertension: The Importance of Ultrasound. J Clin Med 2023; 12:6368. [PMID: 37835014 PMCID: PMC10573183 DOI: 10.3390/jcm12196368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 09/21/2023] [Accepted: 09/30/2023] [Indexed: 10/15/2023] Open
Abstract
Fluid overload, a prevalent complication in patients with renal disease and hypertension, significantly impacts patient morbidity and mortality. The daily clinical challenges that clinicians face include how to identify fluid overload early enough in the course of the disease to prevent adverse outcomes and to guide and potentially reduce the intensity of the diuresis. Traditional methods for evaluating fluid status, such as pitting edema, pulmonary crackles, or chest radiography primarily assess extracellular fluid and do not accurately reflect intravascular volume status or venous congestion. This review explores the rationale, mechanism, and evidence behind more recent methods used to assess volume status, namely, lung ultrasound, inferior vena cava (IVC) ultrasound, venous excess ultrasound score, and basic and advanced cardiac echocardiographic techniques. These methods offer a more accurate and objective assessment of fluid status, providing real-time, non-invasive measures of intravascular volume and venous congestion. The methods we discuss are primarily used in inpatient settings, but, given the increased pervasiveness of ultrasound technology, some could soon expand to the outpatient setting.
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Affiliation(s)
- Sharad Patel
- Division of Critical Care Medicine, Cooper University Health Care, Camden, NJ 08103, USA; (S.P.); (A.G.); (S.A.)
- Department of Medicine, Cooper Medical School of Rowan University, Camden, NJ 08103, USA
| | - Adam Green
- Division of Critical Care Medicine, Cooper University Health Care, Camden, NJ 08103, USA; (S.P.); (A.G.); (S.A.)
- Department of Medicine, Cooper Medical School of Rowan University, Camden, NJ 08103, USA
| | - Sandhya Ashokumar
- Division of Critical Care Medicine, Cooper University Health Care, Camden, NJ 08103, USA; (S.P.); (A.G.); (S.A.)
| | - Andrew Hoke
- Department of Medicine, Cooper University Health Care, Camden, NJ 08103, USA;
| | - Jean-Sebastien Rachoin
- Division of Critical Care Medicine, Cooper University Health Care, Camden, NJ 08103, USA; (S.P.); (A.G.); (S.A.)
- Department of Medicine, Cooper Medical School of Rowan University, Camden, NJ 08103, USA
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Polz M, Bergmoser K, Horn M, Schörghuber M, Lozanović J, Rienmüller T, Baumgartner C. A system theory based digital model for predicting the cumulative fluid balance course in intensive care patients. Front Physiol 2023; 14:1101966. [PMID: 37123264 PMCID: PMC10133509 DOI: 10.3389/fphys.2023.1101966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/04/2023] [Indexed: 05/02/2023] Open
Abstract
Background: Surgical interventions can cause severe fluid imbalances in patients undergoing cardiac surgery, affecting length of hospital stay and survival. Therefore, appropriate management of daily fluid goals is a key element of postoperative intensive care in these patients. Because fluid balance is influenced by a complex interplay of patient-, surgery- and intensive care unit (ICU)-specific factors, fluid prediction is difficult and often inaccurate. Methods: A novel system theory based digital model for cumulative fluid balance (CFB) prediction is presented using recorded patient fluid data as the sole parameter source by applying the concept of a transfer function. Using a retrospective dataset of n = 618 cardiac intensive care patients, patient-individual models were created and evaluated. RMSE analyses and error calculations were performed for reasonable combinations of model estimation periods and clinically relevant prediction horizons for CFB. Results: Our models have shown that a clinically relevant time horizon for CFB prediction with the combination of 48 h estimation time and 8-16 h prediction time achieves high accuracy. With an 8-h prediction time, nearly 50% of CFB predictions are within ±0.5 L, and 77% are still within the clinically acceptable range of ±1.0 L. Conclusion: Our study has provided a promising proof of principle and may form the basis for further efforts in the development of computational models for fluid prediction that do not require large datasets for training and validation, as is the case with machine learning or AI-based models. The adaptive transfer function approach allows estimation of CFB course on a dynamically changing patient fluid balance system by simulating the response to the current fluid management regime, providing a useful digital tool for clinicians in daily intensive care.
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Affiliation(s)
- Mathias Polz
- Institute of Health Care Engineering with European Testing Center of Medical Devices, Graz University of Technology, Graz, STM, Austria
| | - Katharina Bergmoser
- Institute of Health Care Engineering with European Testing Center of Medical Devices, Graz University of Technology, Graz, STM, Austria
- CBmed Center for Biomarker Research in Medicine, Graz, STM, Austria
| | - Martin Horn
- Institute of Automation and Control, Graz University of Technology, Graz, STM, Austria
| | - Michael Schörghuber
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, STM, Austria
| | - Jasmina Lozanović
- Institute of Health Care Engineering with European Testing Center of Medical Devices, Graz University of Technology, Graz, STM, Austria
| | - Theresa Rienmüller
- Institute of Health Care Engineering with European Testing Center of Medical Devices, Graz University of Technology, Graz, STM, Austria
| | - Christian Baumgartner
- Institute of Health Care Engineering with European Testing Center of Medical Devices, Graz University of Technology, Graz, STM, Austria
- *Correspondence: Christian Baumgartner,
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Neves APCDF, Gomes AGDR, Vassallo PF, Silva ACSE, Penna FGCE, Bastos FDL, Muniz MR, Rocha GC, dos Santos ACS, Ravetti CG, Nobre V. Risk factors for acute kidney injury after liver transplantation in intensive care unit: a retrospective cohort study. SAO PAULO MED J 2022; 140:559-565. [PMID: 35946679 PMCID: PMC9491471 DOI: 10.1590/1516-3180.2021.0641.r2.12112021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/12/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a frequent complication during the postoperative period following liver transplantation. Occurrence of AKI in intensive care unit (ICU) patients is associated with increased mortality and higher costs. OBJECTIVE To evaluate occurrences of moderate or severe AKI among patients admitted to the ICU after liver transplantation and investigate characteristics associated with this complication. DESIGN AND SETTING Single-center retrospective cohort study in a public hospital, Belo Horizonte, Brazil. METHODS Forty-nine patients admitted to the ICU between January 2015 and April 2017 were included. AKI was defined from a modified Kidney Disease Improving Global Outcomes (KDIGO) score (i.e. based exclusively on serum creatinine levels). RESULTS Eighteen patients (36.7%) developed AKI KDIGO 2 or 3; mostly KDIGO 3 (16 out of the 18 patients). Lactate level within the first six hours after ICU admission (odds ratio, OR: 1.3; 95% confidence interval, CI: 1.021-1.717; P = 0.034) and blood transfusion requirement within the first week following transplantation (OR: 8.4; 95% CI: 1.687-41.824; P = 0.009) were independently associated with development of AKI. Patients with AKI KDIGO 2 or 3 underwent more renal replacement therapy (72.2% versus 3.2%; P < 0.01), had longer hospital stay (20 days versus 15 days; P = 0.001), higher in-hospital mortality (44.4% versus 6.5%; P < 0.01) and higher mortality rate after one year (44.4% versus 9.7%; P = 0.01). CONCLUSION Need for blood transfusion during ICU stay and hyperlactatemia within the first six postoperative hours after liver transplantation are independently associated with moderate or severe AKI. Developing AKI is apparently associated with poor outcomes.
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Affiliation(s)
- Ana Paula Camargos de Figueirêdo Neves
- MD. Physician and Master’s Student, Postgraduate Program on Infectology and Tropical Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
| | - Angélica Gomides dos Reis Gomes
- MD. Physician and Master’s Student, Postgraduate Program on Infectology and Tropical Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
| | - Paula Frizera Vassallo
- MD, PhD. Physician in the Intensive Care Unit, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
| | - Ana Cristina Simões e Silva
- MD, PhD. Physician, Department of Pediatrics, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
| | | | - Fabrício de Lima Bastos
- MD. Physician, Department of Internal Medicine, School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
| | - Mateus Rocha Muniz
- Undergraduate Medical Student, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
| | - Guilherme Carvalho Rocha
- Undergraduate Medical Student, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
| | - Augusto Cesar Soares dos Santos
- MD, PhD. Physician, Department of Nephrology, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
| | - Cecilia Gómez Ravetti
- MD, PhD. Physician, Department of Internal Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
| | - Vandack Nobre
- MD, PhD. Physician, Postgraduate Program on Infectology and Tropical Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
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9
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Froghi F, Gopalan V, Anastasiou Z, Koti R, Gurusamy K, Eastgate C, McNeil M, Filipe H, Pinto M, Singh J, Longworth L, Mallett S, Schofield N, Thorburn D, Martin D, Davidson BR. Effect of post-operative goal-directed fluid therapy (GDFT) on organ function after orthotopic liver transplantation: Secondary outcome analysis of the COLT randomised control trial. Int J Surg 2022; 99:106265. [PMID: 35181556 DOI: 10.1016/j.ijsu.2022.106265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/28/2021] [Accepted: 02/09/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Goal-directed fluid therapy (GDFT) has been shown to reduce the complications following a variety of major surgical procedures, possibly mediated by improved organ perfusion and function. We have shown that it is feasible to randomise patients to GDFT or standard fluid management following liver transplant in the cardiac-output optimisation following liver transplantation (COLT) trial. The current study compares end organ function in patients from the COLT trial who received GDFT in comparison to those receiving standard care (SC) following liver transplant. METHODS Adult patients with liver cirrhosis undergoing liver transplantation were randomised to GDFT or SC for the first 12 h following surgery as detailed in a published trial protocol. GDFT protocol was based on stroke volume (SV) optimisation using 250 ml crystalloid boluses. Total fluid administration and time to extubation were recorded. Hourly SV and cardiac output (CO) readings were recorded from the non-invasive cardiac output monitoring (NICOM) device in both groups. Pulmonary function was assessed by arterial blood gas (ABG) and ventilatory parameters. Lung injury was assessed using PaO2:FiO2 ratios and calculated pulmonary compliance. The KDIGO score was used for determining acute kidney injury. Renal and liver graft function were assessed during the post-operative period and at 3 months and 1-year. RESULTS 60 patients were randomised to GDFT (n = 30) or SC (n = 30). All patients completed the 12 h intervention period. GDFT group received a significantly higher total volume of fluid during the 12 h trial intervention period (GDFT 5317 (2335) vs. SC 3807 (1345) ml, p = 0.003); in particular crystalloids (GDFT 3968 (2073) vs. SC 2510 (1027) ml, p = 0.002). There was no evidence of significant difference between the groups in SV or CO during the assessment periods. Time to extubation, PaO2: FIO2 ratios, pulmonary compliance, ventilatory or blood gas measurements were similar in both groups. There was a significant rise in serum creatinine from baseline (77 μmol/L) compared to first (87 μmol/L, p = 0.039) and second (107 μmol/L, p = 0.001) post-operative days. There was no difference between GDFT and SC in the highest KDIGO scores for the first 7 days post-LT. At 1-year follow-up, there was no difference in need for renal replacement therapy or graft function. CONCLUSIONS In this randomised trial of fluid therapy post liver transplant, GDFT was associated with an increased volume of crystalloids administered but did not alter early post-operative pulmonary or renal function when compared with standard care.
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Affiliation(s)
- Farid Froghi
- UCL Division of Surgery & Interventional Sciences, HPB and Liver Transplantation, London, United Kingdom UCL Joint Research Office, Biostatistics Group, London, United Kingdom Royal Free Hospital, Critical Care Unit, London, United Kingdom PHMR Limited, London, United Kingdom UCL Institute for Liver and Digestive Health, London, United Kingdom UCL Division of Surgery & Interventional Sciences, London, United Kingdom Peninsula Medical School, University of Plymouth, Plymouth, United Kingdom
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10
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Wang M, Zhu B, Jiang L, Luo X, Wang N, Zhu Y, Xi X. Association between Latent Trajectories of Fluid Balance and Clinical Outcomes in Critically Ill Patients with Acute Kidney Injury: A Prospective Multicenter Observational Study. KIDNEY DISEASES (BASEL, SWITZERLAND) 2022; 8:82-92. [PMID: 35224009 PMCID: PMC8820145 DOI: 10.1159/000515533] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 02/26/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION We aimed to identify different trajectories of fluid balance (FB) and investigate the effect of FB trajectories on clinical outcomes in intensive care unit (ICU) patients with acute kidney injury (AKI) and the dose-response association between fluid overload (FO) and mortality. METHODS We derived data from the Beijing Acute Kidney Injury Trial (BAKIT). A total of 1,529 critically ill patients with AKI were included. The primary outcome was 28-day mortality, and hospital mortality, ICU mortality and AKI stage were the secondary outcomes. A group-based trajectory model was used to identify the trajectory of FB during the first 7 days. Multivariable logistic regression was performed to examine the relationship between FB trajectories and clinical outcomes. A logistic regression model with restricted cubic splines was used to examine the dose relationship between FO and 28-day mortality. RESULTS Three distinct trajectories of FB were identified: low FB (1,316, 86.1%), decreasing FB (120, 7.8%), and high FB (93, 6.1%). Compared with low FB, high FB was associated with increased 28-day mortality (odds ratio [OR] 1.94, 95% confidence interval [CI] 1.17-3.19) and AKI stage (OR 2.04, 95% CI 1.23-3.37), whereas decreasing FB was associated with a reduction in 28-day mortality by approximately half (OR 0.53, 95% CI 0.32-0.87). Similar results were found for the outcomes of ICU mortality and hospital mortality. We observed a J-shaped relationship between maximum FO and 28-day mortality, with the lowest risk at a maximum FO of 2.8% L/kg. CONCLUSION Different trajectories of FB in critically ill patients with AKI were associated with clinical outcomes. An FB above or below a certain range was associated with an increased risk of mortality. Further studies should explore this relationship and search for the optimal fluid management strategies for critically ill patients with AKI.
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Affiliation(s)
- Meiping Wang
- Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing, China
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Bo Zhu
- Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Li Jiang
- Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing, China
- Department of Critical Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xuying Luo
- Department of Critical Care Medicine, Tiantan Hospital, Capital Medical University, Beijing, China
| | - Na Wang
- Emergency Department, China Rehabilitation Research Center, Capital Medical University, Beijing, China
| | - Yibing Zhu
- Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing, China
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiuming Xi
- Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing, China
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11
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Wang MP, Jiang L, Zhu B, Du B, Li W, He Y, Xi XM. Association of fluid balance trajectories with clinical outcomes in patients with septic shock: a prospective multicenter cohort study. Mil Med Res 2021; 8:40. [PMID: 34225807 PMCID: PMC8258941 DOI: 10.1186/s40779-021-00328-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 05/25/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Septic shock has a high incidence and mortality rate in Intensive Care Units (ICUs). Earlier intravenous fluid resuscitation can significantly improve outcomes in septic patients but easily leads to fluid overload (FO), which is associated with poor clinical outcomes. A single point value of fluid cannot provide enough fluid information. The aim of this study was to investigate the impact of fluid balance (FB) latent trajectories on clinical outcomes in septic patients. METHODS Patients were diagnosed with septic shock during the first 48 h, and sequential fluid data for the first 3 days of ICU admission were included. A group-based trajectory model (GBTM) which is designed to identify groups of individuals following similar developmental trajectories was used to identify latent subgroups of individuals following a similar progression of FB. The primary outcomes were hospital mortality, organ dysfunction, major adverse kidney events (MAKE) and severe respiratory adverse events (SRAE). We used multivariable Cox or logistic regression analysis to assess the association between FB trajectories and clinical outcomes. RESULTS Nine hundred eighty-six patients met the inclusion criteria and were assigned to GBTM analysis, and three latent FB trajectories were detected. 64 (6.5%), 841 (85.3%), and 81 (8.2%) patients were identified to have decreased, low, and high FB, respectively. Compared with low FB, high FB was associated with increased hospital mortality [hazard ratio (HR) 1.63, 95% confidence interval (CI) 1.22-2.17], organ dysfunction [odds ratio (OR) 2.18, 95% CI 1.22-3.42], MAKE (OR 1.80, 95% CI 1.04-2.63) and SRAE (OR 2.33, 95% CI 1.46-3.71), and decreasing FB was significantly associated with decreased MAKE (OR 0.46, 95% CI 0.29-0.79) after adjustment for potential covariates. CONCLUSION Latent subgroups of septic patients followed a similar FB progression. These latent fluid trajectories were associated with clinical outcomes. The decreasing FB trajectory was associated with a decreased risk of hospital mortality and MAKE.
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Affiliation(s)
- Mei-Ping Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10, Xitoutiao, You'anmen, Beijing, Fengtai District, China.,Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, No. 20, Street Fuxingmenwai, Beijing, Xicheng District, China
| | - Li Jiang
- Department of Critical Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Bo Zhu
- Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, No. 20, Street Fuxingmenwai, Beijing, Xicheng District, China
| | - Bin Du
- Medical Intensive Care Unit, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Wen Li
- Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, No. 20, Street Fuxingmenwai, Beijing, Xicheng District, China
| | - Yan He
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10, Xitoutiao, You'anmen, Beijing, Fengtai District, China.
| | - Xiu-Ming Xi
- Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, No. 20, Street Fuxingmenwai, Beijing, Xicheng District, China.
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12
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Kohli M, Garg N, Sindwani G, Tempe D, Pamecha V, Pasupuleti SSR. Effect of positive cumulative fluid balance on postoperative complications after living donor liver transplantation: A retrospective analysis. Indian J Anaesth 2021; 65:383-389. [PMID: 34211196 PMCID: PMC8202804 DOI: 10.4103/ija.ija_1457_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/02/2021] [Accepted: 03/02/2021] [Indexed: 12/14/2022] Open
Abstract
Background and Aims: Fluid administration during liver transplant (LT) surgery is controversial. Although adverse outcomes following positive intraoperative fluid balance have been reported, studies presenting the influence of cumulative postoperative fluid balance (CFB) on complications following LT are sparse. Patients with chronic liver disease tend to receive more fluid during and after surgery due to their unique physiological disease state. The aim of this study was to evaluate the influence of 48-hour CFB on the development of acute kidney injury (AKI) and pulmonary complications on day 4 after live donor LT. Methods: This retrospective study included 230 patients undergoing live donor LT. The effect of CFB on day 2 on AKI and pulmonary complications was analysed. Chi-square test, Fisher's exact test, samples t-test, Mann-Whitney U-test were used. Results: Bivariate analysis showed a lower graft vs recipient weight ratio (GRWR), sepsis (P < 0.001) and a higher 48-hour CFB after surgery significantly increased the development of AKI. For pulmonary complications, higher Model for End- stage Liver Disease-Na(MELD-Na) score, higher peak arterial lactate, higher 48-hour CFB (P = 0.016) and sepsis (P = 0.003) were found to be statistically significant. Upon multivariate analysis, CFB at 48 hours was significantly higher in patients suffering from pulmonary complications, and GRWR and sepsis were significant for AKI. For every one litre increase in CFB on day 2, the odds of pulmonary complications increased by 37%. Conclusion: A more positive CFB on day 2 increased the development of pulmonary complications and lower GRWR and sepsis increased the development of AKI.
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Affiliation(s)
- Megha Kohli
- Department of Anaesthesia, Institute of Liver and Biliary Sciences, Delhi, India
| | - Neha Garg
- Department of Anaesthesia, Institute of Liver and Biliary Sciences, Delhi, India
| | - Gaurav Sindwani
- Department of Anaesthesia, Institute of Liver and Biliary Sciences, Delhi, India
| | - Deepak Tempe
- Department of Anaesthesia, Institute of Liver and Biliary Sciences, Delhi, India
| | - Viniyendra Pamecha
- Department of Liver Transplant and Hepatobiliary Surgery, Institute of Liver and Biliary Sciences, Delhi, India
| | - Samba Siva Rao Pasupuleti
- Department of Statistics, Mizoram University (A Central University), Pachhunga University College Campus, Aizawl, Mizoram, India
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13
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Zhou J, Zhang X, Lyu L, Ma X, Miao G, Chu H. Modifiable risk factors of acute kidney injury after liver transplantation: a systematic review and meta-analysis. BMC Nephrol 2021; 22:149. [PMID: 33888081 PMCID: PMC8063403 DOI: 10.1186/s12882-021-02360-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 04/12/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a common and critical complication of liver transplantation (LT), which is associated with increased morbidity, mortality and health care cost. We aimed to identify modifiable risk factors of AKI after LT. METHODS A literature search of Pubmed, EMBASE and Cochrane Databases was performed to identify studies investigating risk factors of AKI after LT. The Newcastle-Ottawa Scale was used to rate study quality. Effect size and 95% confidence interval were pooled using a random-effect model with inverse-variance method. RESULTS Sixty-seven articles with 28,844 patients were included in the meta-analysis. Seventeen modifiable risk factors were found, including overweight, preoperative use of diuretic, preoperative anemia, donation after cardiac death organ, donor BMI ≥ 30 kg/m2, ABO-incompatible LT, low graft to recipient body weight ratio, intraoperative hypotension, major bleeding, intraoperative use of vasopressor, large RBC transfusion, postreperfusion syndrome, postoperative use of vasopressors, overexposure to calcineurin inhibitor, calcineurin inhibitor without mycophenolate mofetil, graft dysfunction and infection. A total of 38 articles were included in the systematic review, in which 8 modifiable risk factors and 1 protective factor were additionally associated in single studies with the incidence of AKI after LT. CONCLUSIONS Effective interventions based on identified modifiable risk factors in the perioperative management and graft allocation and preservation may be promising to reduce the incidence of AKI after LT. TRIAL REGISTRATION The protocol for this systematic review is registered with PROSPERO (No. CRD42020166918 ).
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Affiliation(s)
- Jian Zhou
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, School of Clinical Medicine, Qingdao University, No. 59, Haier Road, Qingdao, 266100, Shandong Province, China
| | - Xueying Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610000, Sichuan Province, China
| | - Lin Lyu
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, School of Clinical Medicine, Qingdao University, No. 59, Haier Road, Qingdao, 266100, Shandong Province, China
| | - Xiaojun Ma
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, School of Clinical Medicine, Qingdao University, No. 59, Haier Road, Qingdao, 266100, Shandong Province, China
| | - Guishen Miao
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, School of Clinical Medicine, Qingdao University, No. 59, Haier Road, Qingdao, 266100, Shandong Province, China
| | - Haichen Chu
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, School of Clinical Medicine, Qingdao University, No. 59, Haier Road, Qingdao, 266100, Shandong Province, China.
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14
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Ávila MON, Rocha PN, Perez CA, Faustino TN, Batista PBP, Yu L, Zanetta DMT, Burdmann EA. Positive fluid balance as an early biomarker for acute kidney injury: a prospective study in critically ill adult patients. Clinics (Sao Paulo) 2021; 76:e1924. [PMID: 33567044 PMCID: PMC7847255 DOI: 10.6061/clinics/2021/e1924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 12/16/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Positive fluid balance is frequent in critically ill patients and has been considered a potential biomarker for acute kidney injury (AKI). This study aimed to evaluate positive fluid balance as a biomarker for the early detection of AKI in critically ill patients. METHODS This was a prospective cohort study. The sample was composed of patients ≥18 years old who stayed ≥3 days in an intensive care unit. Fluid balance, urinary output and serum creatinine were assessed daily. AKI was diagnosed by the Kidney Disease Improving Global Outcome criteria. RESULTS The final cohort was composed of 233 patients. AKI occurred in 92 patients (40%) after a median of 3 (2-6) days following ICU admission. When fluid balance was assessed as a continuous variable, a 100-ml increase in fluid balance was independently associated with a 4% increase in the odds of AKI (OR 1.04; 95% CI 1.01-1.08). Positive fluid balance categorized using different thresholds was always significantly associated with subsequent detection of AKI. The mixed effects model showed that increased fluid balance preceded AKI by 4 to 6 days. CONCLUSION These results suggest that a positive fluid balance might be an early biomarker for AKI development in critically ill patients.
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Affiliation(s)
- Maria Olinda Nogueira Ávila
- LIM 12, Disciplina de Nefrologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Monte Tabor Hospital Sao Rafael, Salvador, BA, BR
- Universidade do Estado da Bahia, Salvador, BA, BR
- *Corresponding author. E-mail:
| | - Paulo Novis Rocha
- Medicina Interna e Apoio Diagnostico, Universidade Federal da Bahia, Salvador, BA, BR
| | - Caio A. Perez
- Escola Bahiana de Medicina e Saude Publica, Salvador, BA, BR
| | | | - Paulo Benigno Pena Batista
- Monte Tabor Hospital Sao Rafael, Salvador, BA, BR
- Faculdade de Medicina, Uniao Metropolitana de Educacao e Cultura UNIME/KROTON, Lauro de Freitas, BA, BR
| | - Luis Yu
- LIM 12, Disciplina de Nefrologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Dirce Maria T. Zanetta
- Departamento de Epidemiologia, Faculdade de Saude Publica, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Emmanuel A. Burdmann
- LIM 12, Disciplina de Nefrologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
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15
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Wang M, Zhu B, Jiang L, Wen Y, Du B, Li W, Liu G, Li W, Wen J, He Y, Xi X. Dose-response association between fluid overload and in-hospital mortality in critically ill patients: a multicentre, prospective, observational cohort study. BMJ Open 2020; 10:e039875. [PMID: 33372073 PMCID: PMC7772328 DOI: 10.1136/bmjopen-2020-039875] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Fluid management is important in ensuring haemodynamic stability in critically ill patients, but can easily lead to fluid overload (FO). However, the optimal fluid balance plot or range for critically ill patients is unknown. This study aimed to explore the dose-response relationship between FO and in-hospital mortality in critically ill patients. DESIGN Multicentre, prospective, observational study. SETTING Eighteen intensive care units (ICUs) of 16 tertiary hospitals in China. PARTICIPANTS Critically ill patients in the ICU for more than 3 days. PRIMARY OUTCOME MEASURES AND ANALYSES FO was defined as the ratio of the cumulative fluid balance (L) and initial body weight (kg) on ICU admission, expressed as a percentage. Maximum FO was defined as the peak value of FO during the first 3 days of ICU admission. Logistic regression models with restricted cubic splines were used to explore the pattern and magnitude of the association between maximum FO and risk of in-hospital mortality. Age, sex, Acute Physiology and Chronic Health Evaluation II score, Sequential Organ Failure Assessment score on admission, main diagnosis on admission to ICU, comorbidities, time of maximum FO, mechanical ventilation, renal replacement therapy, use of vasopressors and centres were adjusted in multivariable analysis. RESULTS A total of 3850 patients were included in the study, 929 (24.1%) of whom died in the hospital. For each 1% L/kg increase in maximum FO, the risk of in-hospital mortality increased by 4% (adjusted HR (aHR) 1.04, 95% CI 1.03 to 1.05, p<0.001). A maximum FO greater than 10% was associated with a 44% increased HR of in-hospital mortality compared with an FO less than 5% (aHR 1.44, 95% CI 1.27 to 1.67). Notably, we found a non-linear dose-response association between maximum FO and in-hospital mortality. CONCLUSIONS Both higher and negative fluid balance levels were associated with an increased risk of in-hospital mortality in critically ill patients. TRIAL REGISTRATION NUMBER ChiCTR-ECH-13003934.
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Affiliation(s)
- Meiping Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
- Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Bo Zhu
- Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Li Jiang
- Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing, China
- Department of Critical Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ying Wen
- Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing, China
- Department of General Practice, Beitaipingzhuang Community Health Service Centre, Beijing, China
| | - Bin Du
- Medical Intensive Care Unit, Peking Union Medical College Hospital, Peking Union Medical College Hospital and Chinese Academy of Medical Sciences, Beijing, China
| | - Wen Li
- Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Guangxu Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Wei Li
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Jing Wen
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Yan He
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
| | - Xiuming Xi
- Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing, China
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16
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Pan P, Su L, Liu D, Wang X. Microcirculation-guided protection strategy in hemodynamic therapy. Clin Hemorheol Microcirc 2020; 75:243-253. [PMID: 31903987 DOI: 10.3233/ch-190784] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Microcirculatory shock is a condition defined by the presence of tissue hypoperfusion despite the normalization of systemic and regional blood flow. Currently, more evidence shows that intrinsic septic shock is microcirculatory shock, which results in septic shock that is difficult to resuscitate. At present, treatments are aimed at recovering macro-circulation functions and include fluid resuscitation, vasoactive drugs, positive inotropic drugs, de-obstruction, and even mechanical assistance to improve oxygen delivery. However, the application of these treatments to more accurately improve microcirculation or avoid further microcirculatory damage is more important in clinics. In this article, we discuss the need for microcirculation protection and microcirculation-guided protection strategies in hemodynamic therapies.
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Affiliation(s)
- Pan Pan
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.,Center of Respiratory and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
| | - Longxiang Su
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Dawei Liu
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoting Wang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
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17
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Joosten A, Coeckelenbergh S, Alexander B, Delaporte A, Cannesson M, Duranteau J, Saugel B, Vincent JL, Van der Linden P. Hydroxyethyl starch for perioperative goal-directed fluid therapy in 2020: a narrative review. BMC Anesthesiol 2020; 20:209. [PMID: 32819296 PMCID: PMC7441629 DOI: 10.1186/s12871-020-01128-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/12/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Perioperative fluid management - including the type, dose, and timing of administration -directly affects patient outcome after major surgery. The objective of fluid administration is to optimize intravascular fluid status to maintain adequate tissue perfusion. There is continuing controversy around the perioperative use of crystalloid versus colloid fluids. Unfortunately, the importance of fluid volume, which significantly influences the benefit-to-risk ratio of each chosen solution, has often been overlooked in this debate. MAIN TEXT The volume of fluid administered during the perioperative period can influence the incidence and severity of postoperative complications. Regrettably, there is still huge variability in fluid administration practices, both intra-and inter-individual, among clinicians. Goal-directed fluid therapy (GDFT), aimed at optimizing flow-related variables, has been demonstrated to have some clinical benefit and has been recommended by multiple professional societies. However, this approach has failed to achieve widespread adoption. A closed-loop fluid administration system designed to assist anesthesia providers in consistently applying GDFT strategies has recently been developed and tested. Such an approach may change the crystalloid versus colloid debate. Because colloid solutions have a more profound effect on intravascular volume and longer plasma persistence, their use in this more "controlled" context could be associated with a lower fluid balance, and potentially improved patient outcome. Additionally, most studies that have assessed the impact of a GDFT strategy on the outcome of high-risk surgical patients have used hydroxyethyl starch (HES) solutions in their protocols. Some of these studies have demonstrated beneficial effects, while none of them has reported severe complications. CONCLUSIONS The type and volume of fluid used for perioperative management need to be individualized according to the patient's hemodynamic status and clinical condition. The amount of fluid given should be guided by well-defined physiologic targets. Compliance with a predefined hemodynamic protocol may be optimized by using a computerized system. The type of fluid should also be individualized, as should any drug therapy, with careful consideration of timing and dose. It is our perspective that HES solutions remain a valid option for fluid therapy in the perioperative context because of their effects on blood volume and their reasonable benefit/risk profile.
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Affiliation(s)
- Alexandre Joosten
- Department of Anesthesiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
- Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Université Paris-Saclay, Hôpital De Bicêtre, Assistance Publique Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France
- Department of Anesthesiology & Perioperative Medicine, Bicêtre Hospital, 78, Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Sean Coeckelenbergh
- Department of Anesthesiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Brenton Alexander
- Department of Anesthesiology & Perioperative Care, University of California San Diego, San Diego, USA
| | - Amélie Delaporte
- Department of Anesthesiology & Intensive Care, Marie Lannelongue Hospital, Paris, France
| | - Maxime Cannesson
- Department of Anesthesiology & Perioperative Medicine, University of California Los Angeles, Los Angeles, USA
| | - Jacques Duranteau
- Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Université Paris-Saclay, Hôpital De Bicêtre, Assistance Publique Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France
| | - Bernd Saugel
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Outcomes Research Consortium, Cleveland, OH USA
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Philippe Van der Linden
- Department of Anesthesiology, Brugmann Hospital, Université Libre de Bruxelles, Brussels, Belgium
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18
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The cardiac output optimisation following liver transplant (COLT) trial: a feasibility randomised controlled trial. HPB (Oxford) 2020; 22:1112-1120. [PMID: 31874736 DOI: 10.1016/j.hpb.2019.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 11/18/2019] [Accepted: 11/24/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Perioperative goal directed fluid therapy (GDFT) has been shown to reduce postoperative complications following major surgery; this intervention has not been formally evaluated in the setting of liver transplantation. METHODS We conducted a prospective trial of GDFT following liver transplantation randomising patients with liver cirrhosis to either 12 h of GDFT using non-invasive cardiac output monitoring or standard care (SC). The primary outcome was feasibility. Secondary outcomes included survival, postoperative complications (Clavien-Dindo), quality of life (by EQ-5D-5L) and resource use. Trial specific follow up occurred at 90 and 180 days after surgery. RESULTS The study was feasible. Of 224 eligible patients, 122 were approached, 114 consented to participate and 60 were enrolled into the trial. The mean (SD) volume of IV crystalloid administered to the GDFT group during the 12-h study period was 3968 (2073) ml for the GDFT group and 2510 (1026) ml for the SC group. As regards secondary outcomes there was no difference in survival or overall complication rates. There was no significant difference in quality of life scores and resource use between the groups. CONCLUSION A randomised study of GDFT following liver transplantation is feasible. A post-trial stakeholder meeting supported proceeding with a full multi-centre trial.
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19
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Sun L, Feng Y. Pre-operative anaemia and postoperative acute kidney injury in liver transplantation: valuable but there are still some unanswered questions. Anaesthesia 2020; 75:690. [PMID: 32557530 DOI: 10.1111/anae.14981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- L Sun
- Peking University People's Hospital, Beijing, China
| | - Y Feng
- Peking University People's Hospital, Beijing, China
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20
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Kampmeier TG, Ertmer C. Individualized Goal-Directed Therapy: The Challenge With the Fluids. Anesth Analg 2020; 130:596-598. [PMID: 32068587 DOI: 10.1213/ane.0000000000004525] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Tim G Kampmeier
- From the Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital of Muenster, Muenster, Germany
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21
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Zhang S, Ma J, An R, Liu L, Li J, Fang Z, Wang Q, Ma Q, Shen X. Effect of cumulative fluid balance on acute kidney injury and patient outcomes after orthotopic liver transplantation: A retrospective cohort study. Nephrology (Carlton) 2020; 25:700-707. [PMID: 32105370 DOI: 10.1111/nep.13702] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 11/26/2019] [Accepted: 01/29/2020] [Indexed: 12/20/2022]
Abstract
AIM Acute kidney injury (AKI) is a serious complication following orthotopic liver transplantation (OLT) and it affects long-term patient survival. The aims of this study were to identify the effects of cumulative fluid balance (FB) on early post-OLT AKI and adverse outcomes and to construct a model to predict AKI. METHODS We retrospectively analysed 146 adult patients who underwent OLT. AKI severity was classified according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Univariate and multivariate logistic regression analyses were used to evaluate the association between cumulative FB and post-OLT AKI. The Kaplan-Meier method was used to estimate the survival rate. RESULTS Within the perioperative period of 72 hours, 50% (66/132) of patients developed AKI, with 36 (54%), 16 (24%) and 14 (21%) patients having AKI stages 1, 2 and 3, respectively. The cumulative FB was the risk factors for post-OLT AKI (odds ratio [OR], 1.011; 95% confidence interval [CI], 1.156~6.001; P = .021). Preoperative albumin was a protective factor for post-OLT AKI (OR, 0.309; 95% CI, 0.140~0.731; P = .007). The AKI group requires renal replacement therapy (RRT) more (15.2% vs 0%, P = .001) and associated with postoperative complications (56% vs 28.8%, P = .003). The complication-free survival was lower in the AKI group ([11.90 vs 18.74] months, χ2 = 9.60, P = .002). CONCLUSION Cumulative FB within 72 hours is associated with post-OLT AKI and requires RRT. Cumulative FB impacts the long-term complication-free survival of the recipients.
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Affiliation(s)
- Simei Zhang
- Department of Anesthesiology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Jiguang Ma
- Department of Anesthesiology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Rui An
- Department of Anesthesiology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Lin Liu
- Department of Anesthesiology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Jianpeng Li
- Department of Hepatobiliary Surgery, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Zeping Fang
- Department of Epidemiology and Biostatistics, Xi'an Jiaotong University School of Public Health, Xi'an, Shanxi Province, China
| | - Qiang Wang
- Department of Anesthesiology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Qingyong Ma
- Department of Hepatobiliary Surgery, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Xin Shen
- Department of Anesthesiology, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
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22
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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: 4.0] [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.
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23
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Smith NK, Zerillo J, Schlichting N, Sakai T. Abdominal Organ Transplantation: Noteworthy Literature in 2018. Semin Cardiothorac Vasc Anesth 2019; 23:188-204. [DOI: 10.1177/1089253219842655] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A PubMed search revealed 1382 articles on pancreatic transplantation, 781 on intestinal transplantation, more than 7200 on kidney transplantation, and more than 5500 on liver transplantation published between January 1, 2018, and December 31, 2018. After narrowing the list down to human studies, 436 pancreatic, 302 intestinal, 1920 liver, and more than 2000 kidney transplantation studies were screened for inclusion in this review.
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Affiliation(s)
- Natalie K. Smith
- The Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Jeron Zerillo
- The Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | | | - Tetsuro Sakai
- University of Pittsburgh Medical Center Health System, PA, USA
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24
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Oh TK, Oh AY, Hwang JW. Association Between Perioperative Fluid Balance and 30-Day Unplanned Readmission After Major Abdominal Surgery. Surg Innov 2019; 26:401-407. [PMID: 30920902 DOI: 10.1177/1553350619836856] [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] [Indexed: 01/07/2023]
Abstract
Perioperative positive fluid balance (FB) increases postoperative complication and length of hospital stay. We aimed to investigate 30-day unplanned readmission after major abdominal surgery based on perioperative FB (%) on postoperative days (POD) 0 to 3. This retrospective cohort study analyzed medical records of patients who underwent elective major abdominal surgery (surgery time >2 hours, estimated blood loss >500 mL) at a single tertiary academic hospital from January 2010 to December 2017. Cumulative FB was calculated by total input fluid - output fluid in liters × weight (kg)-1 on admission × 100 during POD 0 (24 hours), 0 to 1 (48 hours), 0 to 2 (72 hours), and 0 to 3 (96 hours). Of the 3650 patients in the final analysis, 503 (13.8%) had unplanned readmission within 30 days. In the multivariable logistic regression analysis, FB on POD 0 (24 hours), 0 to 1 (48 hours), 0 to 2 (72 hours), and 0 to 3 (96 hours) showed no significant association with 30-day unplanned readmission (all P > .05). However, an increase of 10 000 points in the total relative value unit scores was associated with 5% increase in 30-day unplanned readmission (odds ratio = 1.05, 95% confidence interval = 1.02-1.07; P = .001), and 1-hour increase in surgery time was associated with 10% increase in 30-day unplanned readmission (odds ratio = 1.10, 95% confidence interval = 1.05-1.15; P < .001). This study showed that perioperative FB is not associated with 30-day unplanned readmission rate after a major abdominal surgery. Total relative value unit scores and duration of surgery were significantly associated with 30-day unplanned readmission rate after major abdominal surgery in a single tertiary academic hospital.
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Affiliation(s)
- Tak Kyu Oh
- 1 Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ah-Young Oh
- 1 Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.,2 Department of Anesthesiology and Pain Medicine, Seoul National University, Seoul, South Korea
| | - Jung-Won Hwang
- 1 Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.,2 Department of Anesthesiology and Pain Medicine, Seoul National University, Seoul, South Korea
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