scholarly journals The impact of the model for end-stage liver disease (MELD) on liver transplantation in one center in Brazil

2010 ◽  
Vol 47 (3) ◽  
pp. 233-237 ◽  
Author(s):  
Alexandre Coutinho Teixeira de Freitas ◽  
William Massami Itikawa ◽  
Adriana Sayuri Kurogi ◽  
Lucinei G Stadnik ◽  
Mônica Beatriz Parolin ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Intensive Care Unit ◽  
Liver Transplantation ◽  
Intensive Care ◽  
Hospital Stay ◽  
Red Blood Cells ◽  
Blood Cells ◽  
Meld Score ◽  
Warm Ischemia ◽  
Advanced Cirrhosis

CONTEXT: Presently the MELD score is used as the waiting list criterion for liver transplantation in Brazil. In this method more critical patients are considered priority to transplantation. OBJECTIVE: To compare the results of liver transplantation when the chronologic waiting list was the criterion for organ allocation (pre-MELD era) with MELD score period (MELD era) in one liver transplantation unit in Brazil. METHODS: The charts of the patients subjected to liver transplantation at the Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, PR, Brazil, were reviewed from January of 2001 to August of 2008. Patients were divided into two groups: pre-MELD era and MELD era. They were compared in relation to demographics of donors and receptors, etiology of cirrhosis, cold and warm ischemia time, presence of hepatocellular carcinoma, MELD score and Child-Pugh score and classification at the time of transplantation, units of red blood cells transfused during the transplantation, intensive care unit stay, total hospital stay and 3 month and 1 year survival. RESULTS: Initially, 205 liver transplantations were analyzed. Ninety four were excluded and 111 were included: 71 on the pre-MELD era and 40 on the MELD era. The two groups were comparable in relation to donors and receptors age and sex, etiology of cirrhosis and cold and warm ischemia time. The receptors of the MELD era had more hepatocellular carcinoma than those of the pre-MELD era (37.5% vs 16.9%). Patients with hepatocellular carcinoma had less advanced cirrhosis on both eras. The MELD score was the same on both eras. Excluding the cases of hepatocellular carcinoma, MELD era score was higher than pre-MELD score (18.2 vs 15.8). There were an increased number of transplants on Child-Pugh A and C and a decreased number on Child-Pugh B receptors on MELD era. Both eras had the same need of red blood cells transfusion, intensive care unit stay and hospital stay. Also, 3 month and 1 year survival were the same: 76% and 74.6% on pre-MELD era and 75% and 70.9% on MELD era. CONCLUSION: In our center, after the introduction of MELD score as the priority criterion for liver transplantation there were an increased number of transplants with hepatocellular carcinoma. Excluding these patients, the receptors were operated upon with more advanced cirrhosis. Nevertheless the patients had the same need for red blood cells transfusion, intensive care unit and hospital stay and 3 months and 1 year survival.

scholarly journals P-86 MELD SCORE AND EARLY EXTUBATION IN THE INTENSIVE CARE UNIT AFTER LIVER TRANSPLANTATION: 20 YEARS EXPERIENCE IN A SINGLE CENTER IN PERU

2021 ◽  
Vol 24 ◽  
pp. 100449
Author(s):  
Carmen Cerron ◽  
Rosa Lopez ◽  
Gino Salcedo ◽  
Bertha Cardenas ◽  
Carlos Rondon ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Liver Transplantation ◽  
Intensive Care ◽  
Meld Score ◽  
Early Extubation ◽  
Single Center

scholarly journals Does the Age of Packed Red Blood Cells, Donor Sex or Sex Mismatch Affect the Sublingual Microcirculation in Critically Ill Intensive Care Unit Patients? — A Secondary Interpretation of a Retrospective Analysis

2021 ◽  
Author(s):  
Demian Knobel ◽  
Jonas Scheuzger ◽  
Andreas Buser ◽  
Alexa Hollinger ◽  
Caroline E. Gebhard ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Red Blood Cells ◽  
Sofa Score ◽  
Blood Cells ◽  
Flow Index ◽  
Packed Red Blood Cells ◽  
Microcirculatory Flow ◽  
The Impact

Abstract BackgroundIn vitro studies have thoroughly documented the impact of storage lesions in packed red blood cells (pRBC) on erythrocyte oxygen carrying capacity due to older age of blood products. While studies have examined the effect of pRBC age on patient outcome, only few data exist on the microcirculation, their primary site of action.MethodsIn this secondary analysis, we examined the relationship between the age of pRBC and changes of microcirculatory flow (MCF) in 54 patients. Data from the Basel Bedside assessment Microcirculation Transfusion Limit study (Ba2MiTraL), investigating the effects of one pRBC on the sublingual MCF provided the basis of this study. ResultsMean change from pre-to post-transfusion proportion of perfused vessels (∆PPV) was +8.8% (IQR: -0.5 – 22.5), 5.5% (IQR: 0.1–10.1), and +4.7% (IQR: -2.1 – 6.5) after transfusion of fresh (≤ 14 days old), medium (15 to 34 days old), and old (≥ 35 days old) pRBC, respectively. Values for the microcirculatory flow index (MFI) were +0.22 (IQR: -0.1 – 0.6), +0.22 (IQR: 0.0 – 0.3), and +0.06 (IQR: -0.1 – 0.3) for the fresh, medium, and old pRBC age groups, respectively.Lower ∆PPV and transfusion of older blood were correlated with a higher Sequential Organ Failure Assessment (SOFA) score of patients upon admission to the intensive care unit (ICU) (p=0.01). However, regression models showed no overall significant correlation between pRBC age and ∆PPV (p=0.2). No correlation between donor’s sex or a mismatch between donor and recipient sex was found.ConclusionWe detected no significant correlation between age of pRBC and change in MCF between pre- and post-transfusion among all investigated patients. However, in patients with a higher SOFA score upon ICU admission, there might be a negative effect on the proportion of perfused microcirculatory vessels after transfusion of older blood.

scholarly journals Nucleated Red Blood Cells as Predictors of All-Cause Mortality in Cardiac Intensive Care Unit Patients: A Prospective Cohort Study

PLoS ONE ◽  
2015 ◽  
Vol 10 (12) ◽  
pp. e0144259 ◽  
Author(s):  
José Gildo de Moura Monteiro Júnior ◽  
Dilênia de Oliveira Cipriano Torres ◽  
Maria Cleide Freire Clementino da Silva ◽  
Tadzia Maria de Brito Ramos ◽  
Marilene Leite Alves ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Red Blood Cells ◽  
Blood Cells ◽  
Prospective Cohort ◽  
Cardiac Intensive Care Unit ◽  
Nucleated Red Blood Cells ◽  
All Cause Mortality ◽  
Cardiac Intensive Care

scholarly journals Use of REBOA to stabilize in-hospital iatrogenic intra-abdominal hemorrhage

2018 ◽  
Vol 3 (1) ◽  
pp. e000165 ◽  
Author(s):  
Christopher J Goodenough ◽  
Tyler A Cobb ◽  
John B Holcomb
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Red Blood Cells ◽  
Blood Cells ◽  
Balloon Occlusion ◽  
X Ray ◽  
Packed Red Blood Cells ◽  
Chest X Ray ◽  
Endovascular Balloon Occlusion ◽  
Abdominal Hemorrhage

Resuscitative endovascular balloon occlusion of the aorta (REBOA) has become an increasingly popular alternative to emergency thoracotomy and aortic cross-clamping in patients with exsanguinating hemorrhage.1 This new capability is increasingly being used in non-trauma situations.2 3 This report demonstrates another novel use of REBOA for iatrogenic intra-abdominal hemorrhage.An 83-year-old man with multiple medical comorbidities and a history of chronic mesenteric ischemia was admitted to our institution for an elective mesenteric revascularization. Revascularization was unsuccessful, despite attempts to cross the lesion. Postprocedure, the patient developed a right groin hematoma, and CT on postprocedure day 0 demonstrated a femoral artery pseudoaneurysm and subintimal contrast at the level of the celiac artery, representing an iatrogenic dissection.The following day, he complained of dizziness. Physical examination revealed a blood pressure of 68/35 mm Hg, heart rate of 100 beats per minute, and a distended abdomen. Because the surgical intensive care unit (SICU) was full, he was transferred to the neurotrauma intesive care unit (NTICU) and intubated for hemodynamic instability. A chest X-ray revealed a prior thoracic endovascular aortic repair (figure 1), but no intrathoracic hemorrhage or pathology. Bedside ultrasonography revealed intra-abdominal fluid. Laboratory workup showed hemoglobin of 6.1 g/dL, from 10.9 the previous day. The patient was given two units of packed red blood cells, without response. The intensive care unit (ICU) team initiated norepinephrine, with minimal improvement despite increasing doses. Figure 1Chest X-ray with catheter in zone 1. Arrows mark the proximal and distal markers of the resuscitative endovascular balloon occlusion of the aorta.What would you do?Transfuse two units of packed red blood cells and observe.Proceed to the operating room (OR) for exploratory laparotomy.Endovascular balloon occlusion of the aorta (zone 1).

scholarly journals Postoperative Delirium in the Intensive Care Unit Predicts Worse Outcomes in Liver Transplant Recipients

2013 ◽  
Vol 27 (4) ◽  
pp. 207-212 ◽  
Author(s):  
Thomas Lescot ◽  
Constantine J Karvellas ◽  
Prosanto Chaudhury ◽  
Jean Tchervenkov ◽  
Steven Paraskevas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Red Blood Cells ◽  
Replacement Therapy ◽  
Blood Cells ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Packed Red Blood Cells

BACKGROUND: Delirium is common in intensive care unit patients and is associated with worse outcome.OBJECTIVE: To identify early risk factors for delirium in patients admitted to the intensive care unit following orthotopic liver transplantation (OLT).METHODS: An observational study of patients admitted to the intensive care unit from January 2000 to May 2010 for elective or semi-elective OLT was conducted. The primary end point was delirium in the intensive care unit. Pre- and post-transplantation and intraoperative factors potentially associated with this outcome were examined.RESULTS: Of the 281 patients included in the study, 28 (10.03%) developed delirium in the intensive care unit at a median of two days (interquartile range one to seven days) after OLT. According to multivariate analysis, independent risk factors for delirium were intraoperative transfusion of packed red blood cells (OR 1.15 [95% CI 1.01 to 1.18]), renal replacement therapy during the pretransplantation period (OR 13.12 [95% CI 2.82 to 72.12]) and Acute Physiologic and Health Evaluation (APACHE) II score (OR per unit increase 1.10 [95% CI 1.03 to 1.29]). Using Cox proportional hazards models adjusted for baseline covariates, delirium was associated with an almost twofold risk of remaining in hospital, a fourfold increased risk of dying in hospital and an almost threefold increased rate of death by one year.CONCLUSION: Intraoperative transfusion of packed red blood cells, pretransplantation renal replacement therapy and APACHE II score are predictors for the development of delirium in intensive care unit patients post-OLT and are associated with increased hospital lengths of stay and mortality.

scholarly journals Anemia, Bleeding, and Blood Transfusion in the Intensive Care Unit: Causes, Risks, Costs, and New Strategies

2013 ◽  
Vol 22 (6) ◽  
pp. eS1-eS13 ◽  
Author(s):  
Michael T. McEvoy ◽  
Aryeh Shander
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Red Blood Cells ◽  
Blood Cells ◽  
Hospitalized Patients ◽  
Adverse Outcomes ◽  
Care Utilization ◽  
Internal Bleeding ◽  
Potential Benefits ◽  
Definition Of

The definition of anemia is controversial and varies with the sex, age, and ethnicity of the patient. Anemia afflicts half of hospitalized patients and most elderly hospitalized patients. Acute anemia in the operating room or intensive care unit is associated with increased morbidity as well as other adverse outcomes, including death. The risks of anemia are compounded by the added risks associated with transfusion of red blood cells, the most common treatment for severe anemia. The causes of anemia in hospitalized patients include iron deficiency, suppression of erythropoietin and iron transport, trauma, phlebotomy, coagulopathies, adverse effects of and reactions to medications, and stress-induced gastrointestinal bleeding. The types and causes of anemia and the increased health care utilization and costs associated with anemia and undetected internal bleeding are described. The potential benefits and risks associated with transfusion of red blood cells also are explored. Last, the strategies and new tools to help prevent anemia, allow earlier detection of internal bleeding, and avoid unnecessary blood transfusions are discussed.

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