Management of Complications of End-Stage Liver Disease in the Intensive Care Unit

2014 ◽  
Vol 31 (2) ◽  
pp. 94-103 ◽  
Author(s):  
Jeffrey D. DellaVolpe ◽  
Jeffrey M. Garavaglia ◽  
David T. Huang
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Liver Disease ◽  
End Stage Liver Disease ◽  
Management Of Complications ◽  
End Stage

scholarly journals THE COST OF ADULT LIVER TRANSPLANTATION IN A REFERRAL CENTER IN SOUTHERN BRAZIL

2019 ◽  
Vol 56 (2) ◽  
pp. 165-171 ◽  
Author(s):  
Adriane B de SOUZA ◽  
Santiago RODRIGUEZ ◽  
Fábio Luís da MOTTA ◽  
Ajacio B de Mello BRANDÃO ◽  
Claudio Augusto MARRONI
Keyword(s):  
Intensive Care Unit ◽  
Liver Transplantation ◽  
Intensive Care ◽  
Liver Disease ◽  
Southern Brazil ◽  
Referral Center ◽  
End Stage Liver Disease ◽  
End Stage ◽  
The Cost ◽  
Surgical Unit

ABSTRACT BACKGROUND: Liver transplantation (LTx) is the primary and definitive treatment of acute or chronic cases of advanced or end-stage liver disease. Few studies have assessed the actual cost of LTx categorized by hospital unit. OBJECTIVE: To evaluate the cost of LTx categorized by unit specialty within a referral center in southern Brazil. METHODS: We retrospectively reviewed the medical records of 109 patients undergoing LTx between April 2013 and December 2014. Data were collected on demographic characteristics, etiology of liver disease, and severity of liver disease according to the Child-Turcotte-Pugh (CTP) and Model for End-stage Liver Disease (MELD) scores at the time of LTx. The hospital bill was transformed into cost using the full absorption costing method, and the costs were grouped into five categories: Immediate Pretransplant Kit; Specialized Units; Surgical Unit; Intensive Care Unit; and Inpatient Unit. RESULTS: The mean total LTx cost was US$ 17,367. Surgical Unit, Specialized Units, and Intensive Care Unit accounted for 31.9%, 26.4% and 25.3% of the costs, respectively. Multivariate analysis showed that total LTx cost was significantly associated with CTP class C (P=0.001) and occurrence of complications (P=0.002). The following complications contributed to significantly increase the total LTx cost: septic shock (P=0.006), massive blood transfusion (P=0.007), and acute renal failure associated with renal replacement therapy (dialysis) (P=0.005). CONCLUSION: Our results demonstrated that the total cost of LTx is closely related to liver disease severity scores and the development of complications.

scholarly journals Liver transplantation in patients with end-stage liver disease requiring intensive care unit admission and intubation

2015 ◽  
Vol 21 (10) ◽  
pp. 1331-1332 ◽  
Author(s):  
Eric Levesque ◽  
Moez Khemiss ◽  
Zaid Noorah ◽  
Cyrille Feray ◽  
Daniel Azoulay ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Liver Transplantation ◽  
Intensive Care ◽  
Liver Disease ◽  
Intensive Care Unit Admission ◽  
End Stage Liver Disease ◽  
End Stage

Increased model for end-stage liver disease score at the time of liver transplant results in prolonged hospitalization and overall intensive care unit costs

2010 ◽  
Vol 16 (5) ◽  
pp. 668-677 ◽  
Author(s):  
Matthew R. Foxton ◽  
Mohammad A. B. Al-Freah ◽  
Andrew J. Portal ◽  
Elizabeth Sizer ◽  
William Bernal ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Liver Disease ◽  
Liver Transplant ◽  
Disease Score ◽  
End Stage Liver Disease ◽  
Unit Costs ◽  
Prolonged Hospitalization ◽  
End Stage

Liver transplantation in patients with end-stage liver disease requiring intensive care unit admission and intubation

2015 ◽  
Vol 21 (6) ◽  
pp. 761-767 ◽  
Author(s):  
Jan Knaak ◽  
Mark McVey ◽  
Fateh Bazerbachi ◽  
Nicolás Goldaracena ◽  
Vinzent Spetzler ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Liver Transplantation ◽  
Intensive Care ◽  
Liver Disease ◽  
Intensive Care Unit Admission ◽  
End Stage Liver Disease ◽  
End Stage

Using Quality Improvement Methods to Understand Incidence, Timing, and Factors Associated With Unplanned Intensive Care Unit Transfers of Patients With End-Stage Liver Disease

2019 ◽  
Vol 29 (4) ◽  
pp. 361-363
Author(s):  
Kelly S. Grimshaw ◽  
Kitty Fan ◽  
Alyssa Mullins ◽  
Janet Parkosewich
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Quality Improvement ◽  
Liver Disease ◽  
Hospital Admissions ◽  
Chi Square ◽  
Improvement Project ◽  
Factors Associated ◽  
End Stage Liver Disease ◽  
End Stage

Introduction: Patients with end-stage liver disease are at risk for clinical deterioration, often requiring hospital admissions while awaiting transplantation. Nurses observed that many patients were or became unstable soon after arrival, requiring transfers to the medical intensive care unit. Objective: To explore the incidence, timing, and factors associated with unplanned intensive care transfers. Design: We conducted a quality improvement project using plan-do-study-act methods to explore administrative data from adult patients admitted to the hepatology service’s medical–surgical unit. Chi-square and t-tests were used to examine associations between demographic, clinical, and temporal factors and unplanned transfers. Data were analyzed at the hospital encounter level. Results: Unplanned transfers occurred in 8.6% of 1418 encounters. The number of transfers during these encounters ranged from 1 to 6. Most unplanned transfers (65.9%) occurred during the evening shift. On average, there was a 4.2-hour delay to the transfer. Fifty-one percent of these encounters required support from clinicians outside the unit while waiting for a bed. Factors associated with unplanned intensive care unit transfer were male sex ( P = .02), self-referral to the emergency department ( P < .001), and lower initial mean Rothman Index ( P < .001). Discussion: Results validated nurses’ concerns about the patients’ severity of illnesses at the time of admission and frequent need for transfer to intensive care soon after admission. We now have actionable data that are being used by leaders to assess unit admission criteria and develop operating budgets for human and material resources needed to care for this challenging population.

When Is Intensive Care Treatment Futile in Patients with Organ Failure and End-Stage Liver Disease?

2016 ◽  
Vol 64 (2) ◽  
pp. S166
Author(s):  
K.P. Lindvig ◽  
M. Thiele ◽  
V. Fuhrmann ◽  
W. Laleman ◽  
K. Roedl ◽  
...  
Keyword(s):  
Intensive Care ◽  
Liver Disease ◽  
Organ Failure ◽  
Intensive Care Treatment ◽  
End Stage Liver Disease ◽  
Care Treatment ◽  
End Stage
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