Relevant risk factors affecting time of ventilation during early postoperative period after orthotopic liver transplantation

Li, Qiang; Yao, Gaiqi; Ge, Qi; Yi, Min; Gao, Jing; Zhu, Xiang

doi:10.1016/j.jcrc.2009.06.048

Cited by 8 publications

(6 citation statements)

References 9 publications

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“…48 Although linked to the development of PTPCs, smoking is a modifiable behavior that is, interestingly, not associated with early mortality rates immediately following liver transplantation. 49,50 However, smoking has been found to be associated with development of secondary malignancies after liver transplantation and subsequent long-term survival at 5 and 10 years. [51][52][53] Although smoking cessation is mandatory for 6 months prior to lung transplantation, recommendations for liver transplantation are not as well defined.…”

Section: Risk Factor Stratification and Managementmentioning

confidence: 99%

Intensive Care of Pulmonary Complications Following Liver Transplantation

Lui

Spaho

Holzwanger

et al. 2018

J Intensive Care Med

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Chronic liver disease has been associated with pulmonary dysfunction both before and after liver transplantation. Post-liver transplantation pulmonary complications can affect both morbidity and mortality often necessitating intensive care during the immediate postoperative period. The major pulmonary complications include pneumonia, pleural effusions, pulmonary edema, and atelectasis. Poor clinical outcomes have been known to be associated with age, severity of liver dysfunction, and preexisting lung disease as well as perioperative events related to fluid balance, particularly transfusion and fluid volumes. Delineating each and every one of these pulmonary complications and their associated risk factors becomes paramount in guiding specific therapeutic strategies.

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Section: Risk Factor Stratification and Managementmentioning

confidence: 99%

Intensive Care of Pulmonary Complications Following Liver Transplantation

Lui

Spaho

Holzwanger

et al. 2018

J Intensive Care Med

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“…Intraoperative variables such as blood loss, urine volume, and postoperative renal failure may contribute to prolonged mechanical ventilation [37]. We developed a post-MELD for testing mortality at 1 year, and that included bilirubin and creatinine to measure early renal or allograft failure [32].…”

Section: Discussionmentioning

confidence: 99%

Sluggish decline in a post-transplant model for end-stage liver disease score is a predictor of mortality in living donor liver transplantation

Hwang

Jeon

Kang

et al. 2010

Korean J Anesthesiol

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BackgroundThe pre-transplant model for end-stage liver disease (pre-MELD) score is controversial regarding its ability to predict patient mortality after liver transplantation (LT). Prominent changes in physical conditions through the surgery may require a post-transplant indicator for better mortality prediction. We aimed to investigate whether the post-transplant MELD (post-MELD) score can be a predictor of 1-year mortality.MethodsPerioperative variables of 269 patients with living donor LT were retrospectively investigated on their association with 1-year mortality. Post-MELD scores until the 30th day and their respective declines from the 1st day post-MELD score were included along with pre-MELD, acute physiology and chronic health evaluation (APACHE) II, and sequential organ failure assessment (SOFA) scores on the 1st post-transplant day. The predictive model of mortality was established by multivariate Cox's proportional hazards regression.ResultsThe 1-year mortality rate was 17% (n = 44), and the leading cause of death was graft failure. Among prognostic indicators, only post-MELD scores after the 5th day and declines in post-MELD scores until the 5th and 30th day were associated with mortality in univariate analyses (P < 0.05). After multivariate analyses, declines in post-MELD scores until the 5th day of less than 5 points (hazard ratio 2.35, P = 0.007) and prolonged mechanical ventilation ≥24 hours were the earliest independent predictors of 1-year mortality.ConclusionsA sluggish decline in post-MELD scores during the early post-transplant period may be a meaningful prognostic indicator of 1-year mortality after LT.

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“…MAP thresholds ranged from 40 mmHg [11][12][13][14] to 85 mmHg [15]. DBP thresholds included 35 mmHg, 40 mmHg [16], 50 mmHg [17][18][19] and 60 mmHg [20][21][22][23][24]. The most frequently used definitions were an SBP below 90 mmHg (n = 69, 43.4% of reported SBP), a MAP below 60 mmHg (n = 57, 35.4% of reported MAP).…”

Section: Absolute Thresholds For Intraoperative Hypotensionmentioning

confidence: 99%

Reported definitions of intraoperative hypotension in adults undergoing non-cardiac surgery under general anaesthesia: a review

Weinberg

Louis

et al. 2022

BMC Anesthesiol

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Background Intraoperative hypotension (IOH) during non-cardiac surgery is common and associated with major adverse kidney, neurological and cardiac events and even death. Given that IOH is a modifiable risk factor for the mitigation of postoperative complications, it is imperative to generate a precise definition for IOH to facilitate strategies for avoiding or treating its occurrence. Moreover, a universal and consensus definition of IOH may also facilitate the application of novel and emerging therapeutic interventions in treating IOH. We conducted a review to systematically record the reported definitions of intraoperative hypotension in adults undergoing non-cardiac surgery under general anaesthesia. Methods In accordance with Cochrane guidelines, we searched three online databases (OVID [Medline], Embase and Cochrane Library) for all studies published from 1 January 2000 to 6 September 2020. We evaluated the number of studies that reported the absolute or relative threshold values for defining blood pressure. Secondary aims included evaluation of the threshold values for defining IOH, the methodology for accounting for the severity of hypotension, whether the type of surgical procedure influenced the definition of IOH, and whether a study whose definition of IOH aligned with the Perioperative Quality Initiative-3 workgroup (POQI) consensus statement for defining was more likely to be associated with determining an adverse postoperative outcome. Results A total of 318 studies were included in the final qualitative synthesis. Most studies (n = 249; 78.3%) used an absolute threshold to define hypotension; 150 (60.5%) reported SBP, 117 (47.2%) reported MAP, and 12 (4.8%) reported diastolic blood pressure (DBP). 126 (39.6%) used a relative threshold to define hypotension. Of the included studies, 153 (48.1%) did not include any duration variable in their definition of hypotension. Among the selected 318 studies 148 (46.5%) studies defined IOH according to the POQI statement. When studies used a “relative blood pressure change” to define IOH, there was a weaker association in detecting adverse postoperative outcomes compared to studies who reported “absolute blood pressure change” (χ2(2) = 10.508, P = 0.005, Cramér’s V = 0.182). When studies used the POQI statement definition of hypotension or defined IOH by values higher than the POQI statement definition there were statistical differences observed between IOH and adverse postoperative outcomes (χ2(1) = 6.581, P = 0.037, Cramér’s V = 0.144). When both the duration of IOH or the numbers of hypotensive epochs were evaluated, we observed a significantly stronger relationship between the definition of IOH use the development of adverse postoperative outcomes. (χ2(1) = 4.860, P = 0.027, Cramér’s V = 0.124). Conclusions Most studies defined IOH by absolute or relative changes from baseline values. There are substantial inconsistencies in how IOH was reported. Further, definitions differed across different surgical specialities. Our findings further suggest that IOH should be defined using the absolute values stated in the POQI statement i.e., MAP < 60–70 mmHg or SBP < 100 mmHg. Finally, the number of hypotensive epochs or time-weighted duration of IOH should also be reported.

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Relevant risk factors affecting time of ventilation during early postoperative period after orthotopic liver transplantation

Cited by 8 publications

References 9 publications

Intensive Care of Pulmonary Complications Following Liver Transplantation

Intensive Care of Pulmonary Complications Following Liver Transplantation

Sluggish decline in a post-transplant model for end-stage liver disease score is a predictor of mortality in living donor liver transplantation

Reported definitions of intraoperative hypotension in adults undergoing non-cardiac surgery under general anaesthesia: a review

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