Introduction The effect of sarcopenia, malnutrition, and functional status on immediate post liver transplantation outcome is not well established. Most studies on sarcopenia are related to 1 and 3-year mortality. Studies evaluating the effect of malnutrition are at least a decade old. Project Aims We evaluated the effect of preoperative sarcopenia, malnutrition, and functional status on postoperative length of hospital and ICU stay, incidence of complications, and mortality. Design In this prospective study conducted on living donor liver transplant recipients, sarcopenia and malnutrition were identified using the psoas muscle thickness to height and the Royal Free Hospital- Nutritional Prioritizing Tool respectively. The Eastern Cooperative Oncology Group performance status score was noted. Postoperatively, length-of-hospital stay, ICU stay, duration of mechanical ventilation and incidence of postoperative complications were noted. Results Hospital and ICU length of stay, and duration of mechanical ventilation were greater in sarcopenic versus non-sarcopenic patients (35.9 (14.6) versus 26.7 (10.7) days, P = 0.02; 12.9 (4.8) versus 9.6 (3.8) days, P = 0.02 and 8 [5,23] versus 5 [4,7] days, P = 0.01 respectively). The incidence of acute kidney injury was higher in patients with sarcopenia (53.3% vs 19.4%, P = 0.02). Patients with malnutrition and repeated hospitalizations had higher ICU stays but hospital length of stay duration of mechanical ventilation or the incidence of postoperative complications were not affected. The Eastern Cooperative Oncology Group score did not affect postoperative outcome. Conclusion In living donor liver transplant recipients, sarcopenia increased hospital and ICU stays, and duration of mechanical ventilation postoperatively. Malnutrition increased ICU stays.
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Conventionally, oxygen is given at 4 to 6 L/min through nasal cannula for supplementation of oxygen. The FiO2 achieved through this can be up to 0.4. Flows more than this can cause dryness to the nasal mucosa without much increase in the FiO2. High-flow nasal cannula (HFNC) uses flow up to 60 L/min. Positive end-expiratory pressure is created in the nasopharynx and it is also conducted to the lower airways. Studies have shown HFNC improves washout of CO2 and decreases respiratory rate. Patient compliance also improves due to the comfort of the cannula compared to the non-invasive ventilation through a mask.
Background: Organ transplantation is associated with ischemic and reperfusion injury. Ischemic reperfusion injury (IRI) during liver transplantation results in coagulopathy caused by the release of heparin like substances and platelet trapping. During renal transplantation IRI may be associated with a similar phenomenon, and thromboelastography (TEG) can be used to detect and manage coagulopathy in renal transplantation surgeries. Methods: TEG was done on pre-operative, immediate post-reperfusion and post-operative day 1 (POD1), for 25 consecutive cases of live related renal transplantation. Coagulopathy was defined as deranged and abnormal TEG variables and supported by the clinical presence of non-surgical oozing and bleeding in the surgical field. Results: The post reperfusion TEG values showed coagulopathic changes. The 64% patients had R-time (RT) more than 12 minutes, 64% patients showed maximum amplitude (MA) less than 55 mm, and 76% patients had alpha angle less than 55°. The pre-operative TEG coagulation index (CI) was 2.45±1.25, post-reperfusion CI was-1.96±4.54 and POD1 CI was 4.02±1.35. Univariate analysis revealed anti-thymocyte globulin (ATG) and etiology other than chronic glomerulonephritis, as risk factors for the hypocoagulable CI in the post reperfusion phase. Changes in CI did not translate into symptomatic non-surgical bleeding in the surgical field (χ 2 =0.17; P=0.67). Conclusions: Ischemic reperfusion injury in renal transplantation is associated with transient self-limiting coagulopathy as detected by TEG. CI values in POD1 indicate a hypercoagulable or prothrombotic state. Whereas immediate post-reperfusion CI values show hypocoagulable state. Magnitude of changes shown by TEG did not translate into requirement of blood product transfusion.
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