Perioperative risk factors for prolonged mechanical ventilation after liver transplantation due to acute liver failure

Paracetamol is the most common drug taken in overdose in the UK, and this is recognised as a major cause of acute liver failure. However, death rates from acute liver failure have fallen, due to the rapid availability and accessibility of the antidote, N-acetylcysteine (NAC). This article critically evaluates the literature on the assessment and management of patients presenting with paracetamol overdose, in order to promote best practice within their clinical team. It includes discussion of presentation, risk factors and complications, as well as treatment and referral to specialist centres for liver transplantation.

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Perioperative risk factors for delirium development after elective cardiovascular surgery

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2020-2-83-94 ◽

2020 ◽

Vol 24 (2) ◽

pp. 83

Author(s):

V. V. Pasyuga ◽

D. A. Demin ◽

I. L. Nudel ◽

E. V. Demina ◽

A. V. Kadykova ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Acute Kidney Injury ◽

Cardiac Surgery ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Conflict Of Interest ◽

Kidney Injury ◽

Perioperative Risk ◽

Perioperative Risk Factors

Aim. This study was conducted to determine the incidence of delirium after cardiac surgery and its effect on the length of the patient’s stay in the ICU and to identify the perioperative risk factors. Methods. This research was a retrospective assessment of 1941 medical records and the course of the perioperative period in patients subjected to elective cardiac surgery. Results. Delirium developed in 193 cases (9.94%); whereas, hyperactive, hypoactive and mixed delirium was observed in 13%, 43% and 44% of the patients, respectively. Most often (26% of the cases), delirium occurred after complex combined surgeries. Independent risk factors for the development of delirium were older age (OR 1.041, 95% CI [1.002–1.081], p = 0.038), EuroSCORE II score (OR 1.286, 95% CI [1.093–1.731], p = 0.025), acute kidney injury (OR 1.306, 95% CI [1.107–1.942], p = 0.0018) and renal replacement therapy (OR 1.399 95% CI [1.361–2.792], p = 0.001). Cardiopulmonary bypass duration and time of clamping of the aorta, postoperative serum creatinine level, need for blood transfusions and duration of mechanical ventilation and duration of ICU stay were identified as predictors and were also significantly higher in the delirium group. Delirium was closely associated with critical illness polyneuropathy (OR 9.201, 95% CI [2.13–38.826], p < 0.001) and neurogenic dysphagia (OR 7.48, 95% CI [1.12–56.07], p = 0.022). Conclusion. The key factors for delirium development in the postoperative period include advanced age, high EuroSCORE II scale and acute kidney injury requiring continuous renal replacement therapy. Delirium significantly increases the duration of mechanical ventilation and the duration of ICU stay.Received 30 January 2020. Revised 18 March 2020. Accepted 24 March 2020.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Author contributions Conception and design: V.V. Pasyuga, I.N. Leiderman Data collection: D.A. Demin, E.V. Demina, I.L. Nudel, V.V. Pasyuga Data analysis: V.V. Pasyuga, I.N. Leiderman, D.A. Demin, D.G. Tarasov Drafting the article: V.V. Pasyuga, D.A. Demin Critical revision of the article: I.N. Leiderman, A.V. Kadykova Final approval of the version to be published: V.V. Pasyuga, D.A. Demin, I.L. Nudel, E.V. Demina, A.V. Kadykova, D.G. Tarasov, I.N. Leiderman

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Root causes and outcomes of postoperative pulmonary complications after abdominal surgery: a retrospective observational cohort study

Patient Safety in Surgery ◽

10.1186/s13037-019-0221-5 ◽

2019 ◽

Vol 13 (1) ◽

Cited By ~ 2

Author(s):

Antero Fernandes ◽

Jéssica Rodrigues ◽

Patrícia Lages ◽

Sara Lança ◽

Paula Mendes ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Abdominal Surgery ◽

Pulmonary Complications ◽

Perioperative Risk ◽

Postoperative Pulmonary Complications ◽

Elective Abdominal Surgery ◽

Perioperative Risk Factors

Abstract Background Postoperative pulmonary complications (PPCs) contribute significantly to overall postoperative morbidity and mortality. In abdominal surgery, PPCs remain frequent. The study aimed to analyze the profile and outcomes of PPCs in patients submitted to abdominal surgery and admitted in a Portuguese polyvalent intensive care unit. Methods From January to December 2017 in the polyvalent intensive care unit of Hospital Garcia de Orta, Almada, Portugal, we conducted a retrospective, observational study of inpatients submitted to urgent or elective abdominal surgery who had severe PPCs. We evaluated the perioperative risk factors and associated mortality. Logistic regression was performed to find which perioperative risk factors were most important in the occurrence of PPCs. Results Sixty patients (75% male) with a median age of 64.5 [47–81] years who were submitted to urgent or elective abdominal surgery were included in the analysis. Thirty-six patients (60%) developed PPCs within 48 h and twenty-four developed PPCs after 48 h. Pneumonia was the most frequent PPC in this sample. In this cohort, 48 patients developed acute respiratory failure and needed mechanical ventilation. In the emergency setting, peritonitis had the highest rate of PPCs. Electively operated patients who developed PPCs were mostly carriers of digestive malignancies. Thirty-day mortality was 21.7%. The risk of PPCs development in the first 48 h was related to the need for neuromuscular blocking drugs several times during surgery and preoperative abnormal arterial blood gases. Median abdominal surgical incision, long surgery duration, and high body mass index were associated with PPCs that occurred more than 48 h after surgery. The American Society of Anesthesiologists physical status score 4 and COPD/Asthma determined less mechanical ventilation needs since they were preoperatively optimized. Malnutrition (low albumin) before surgery was associated with 30-day mortality. Conclusion PPCs after abdominal surgery are still a major problem since they have profound effects on outcomes. Our results suggest that programs before surgery, involve preoperative lifestyle changes, such as nutritional supplementation, exercise, stress reduction, and smoking cessation, were an effective strategy in mitigating postoperative complications by decreasing mortality.

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