Readmission to the intensive care unit after liver transplantation

Levy, Marlon F.; Greene, Lonnie; Ramsay, Michael A. E.; Jennings, Linda W.; Ramsay, BA Kirsten J.; Meng, Jie; Hein, H. A. Tillmann; Goldstein, Robert M.; Husberg, Bo S.; Gonwa, Thomas A.; Klintmalm, Göran B.

doi:10.1097/00003246-200101000-00004

Cited by 75 publications

(65 citation statements)

References 7 publications

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“…Ancak KT'de kan ürünleri [ES, TDP , trombosit süspansiyonu (TS)] transfüzyonunun artmış morbidite/ mortalite [transfüzyonla ilişkili akut akciğer hasarı (TRALI), enfeksiyon, HAT vb. oranlarında artış] ve yeniden yoğun bakıma yatışla ilişkili olduğunu gösteren birçok kanıt vardır (65)(66)(67)(68)(69)(70)(71). Bu yüzden son kılavuzlarda kan ürünlerinin kullanımı oldukça kısıtlanmıştır.…”

Section: Postoperatif Kanama Koagülasyon Dengesi Ve Transfüzyon Tedaunclassified

“…Solunumsal komplikasyonların, ARDS dahil olmak üzere, yönetimi primer olarak destek tedavisidir (enfeksiyon tedavisi, oksijen tedavisi, hipervoleminin önlenmesi, masif plevral effüzyon ve asitin drenajı, bronkoskopik aspirasyon vb.) ancak solunum yetersizliği bulguları varsa gecikmeden invaziv/noninvaziv mekanik ventilasyon desteğine başlanmalıdır (12,14,67,79 (93)(94)(95)(96)(97)(98).…”

Section: Pulmoner Sorunlar Ve Solunumsal Yönetimunclassified

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Critical Care Management after Adult Liver Transplantation

Akan¹

2017

tybdd

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1ÖZ Karaciğer transplantasyonu uygulanan hastaların yoğun bakım yönetimi çok yönlü bir izlemi ve multidisipliner bir yaklaşımı gerektirir. Günümüzde ideal bir yoğun bakım tedavisi için deneyimli bir ekibe ve gelişmiş yoğun bakım/hastane olanaklarına gereksinim vardır. Karaciğer transplantasyon olgularının postoperatif yoğun bakım yönetimi zaman içinde hızlı bir gelişme göstermiştir. Preoperatif optimizasyon, cerrahi teknik, intraoperatif anestezi yönetimi, organ prezervasyonu, yoğun bakım ve immünosüpresyon tedavilerindeki gelişmeler ile 1998'de %79 düzeyinde olan karaciğer transplantasyonu sonrası bir yıllık sağkalım 2008'de %90'a yükselmiştir. Karaciğer transplantasyonlu olguların yoğun bakım yönetiminde özellikle hızlı kardiyorespiratuvar stabilizasyon, ağır koagülopatinin düzeltilmesi, mekanik ventilasyondan erken ayırma, uygun sıvı-elektrolit tedavisi, böbrek fonksiyonlarının korunması, greft rejeksiyonun önlenmesi ve enfeksiyon profilaksisi/tedavisi büyük önem taşır. Erken postoperatif dönem çok hassas bir süreç olduğundan yakın monitörizasyon, kardiyorespiratuvar fonksiyonların stabilizasyonu, greft fonksiyonunun sık değerlendirilmesi, komplikasyonların erken tanınması ve ekstrahepatik organ yetersizliklerinin hızlı tedavisi mortalite/morbiditenin azaltılabilmesi için zorunludur. Anahtar Kelimeler: Karaciğer transplantasyonu, postoperatif dönem, yoğun bakım, karaciğer yetersizliği ABSTRACT Critical care management after liver transplantation requires a sophisticated monitoring and multi-disciplinary team work. An experienced team and advanced critical care/hospital facilities are necessary for an ideal critical care treatment today. Critical care management after liver transplantation has shown a rapid development since the introduction of liver transplantation. While one-year survival rate after liver transplantation was 79% in 1998, it raised to 90% in 2008 related to the improvements in preoperative optimization, surgical technique, anesthetic management, organ preservation, critial care and immunosuppressive treatment. Treatment of severe coagulopathy, prompt hemodynamic and respiratory stabilization, early weaning from mechanical ventilation, proper fluid-electrolyte therapy, prevention of graft rejection, protection of renal functions and prophylaxis/treatment of infection are particularly important in critical care management after liver transplantation. As early postoperative period of liver transplantation is a critical phase; close monitoring, stabilization of cardiopulmonary functions, frequent evaluation of graft function, early diagnosis of complications and rapid treatment of extrahepatic organ failure are mandatory in order to reduce mortality/morbidity.

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Section: Postoperatif Kanama Koagülasyon Dengesi Ve Transfüzyon Tedaunclassified

Section: Pulmoner Sorunlar Ve Solunumsal Yönetimunclassified

Critical Care Management after Adult Liver Transplantation

Akan¹

2017

tybdd

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“…1 Major emphasis is therefore placed on cardiovascular monitoring during perioperative care of these patients.…”

Section: Hemodynamic Monitoringmentioning

confidence: 99%

Perioperative Monitoring in Liver Transplant Patients

Singh

Nasa

Tandon

2012

Journal of Clinical and Experimental Hepatology

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Liver transplant (LT) is a major surgical undertaking involving major fluid shifts, hemodynamic instability and metabolic derangements in a patient with preexisting liver failure and multisystemic derangements. Monitoring and organ support initiated in the preoperative phase is continued intraoperatively and into the postoperative phase to ensure an optimal outcome. As cardiovascular events are the leading cause of non-graft related death among LT recipients, major emphasis is placed on cardiovascular monitoring. The other essential monitoring are the continuous assessment of coagulapathy, extent of metabolic derangements, dyselectrolytemis and intracranial pressure monitoring in patients with fulminant hepatic failure. The type and extent of monitoring differs with need according to preexisting child status of the patient and the extent of systemic derangements. It also varies among transplant centers and is mainly determined by individual or institutional practices. ( J CLIN EXP HEPATOL 2012;2:271-278)

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“…1 Most liver transplant recipients are admitted to the intensive care unit (ICU) during the early postoperative period. However, patients may require late ICU admission as a result of respiratory and nonrespiratory causes posttransplant.…”

Section: Introductionmentioning

confidence: 99%

“…Levy and associates reported that 1 adult liver transplant recipient of every 5 requires ICU readmission, with 20% needing more than 1 readmission primarily because of cardiopulmonary deterioration. 1 Postoperative respiratory problems are common after OLT and have been reported in 64% to 88% of patients. [2][3][4] Postoperative respiratory complications affect these patients during both the early postoperative period and the long-term period.…”

Section: Introductionmentioning

confidence: 99%

Untitled

Atar

Gedik²,

Kaplan³

et al. 2015

Exp Clin Transplant

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Results: Among 173 patients, 37 (21.4%) were admitted to an intensive care unit, including 22 (59.5%) with acute respiratory failure. The leading cause of acute respiratory failure was pneumonia (n = 19, 86.4%). Patients with acute respiratory failure had significantly lower levels of albumin before intensive care unit admission (P = .003). In patients with acute respiratory failure, severe sepsis and septic shock were more frequently observed and tracheotomy was more frequently performed (P = .041). Conclusions: Acute respiratory failure developed in 59.5% of liver transplant recipients with late intensive care unit admission. The leading cause was pneumonia, with this group of patients having higher requirements for invasive mechanical ventilation and tracheotomy, longer stays in an intensive care unit, and higher mortality.

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Readmission to the intensive care unit after liver transplantation

Cited by 75 publications

References 7 publications

Critical Care Management after Adult Liver Transplantation

Critical Care Management after Adult Liver Transplantation

Perioperative Monitoring in Liver Transplant Patients

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