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Liver critical care

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https://www.readbyqxmd.com/read/28217372/psychotropic-drugs-and-liver-disease-a-critical-review-of-pharmacokinetics-and-liver-toxicity
#1
REVIEW
Diogo Telles-Correia, António Barbosa, Helena Cortez-Pinto, Carlos Campos, Nuno B F Rocha, Sérgio Machado
The liver is the organ by which the majority of substances are metabolized, including psychotropic drugs. There are several pharmacokinetic changes in end-stage liver disease that can interfere with the metabolization of psychotropic drugs. This fact is particularly true in drugs with extensive first-pass metabolism, highly protein bound drugs and drugs depending on phase I hepatic metabolic reactions. Psychopharmacological agents are also associated with a risk of hepatotoxicity. The evidence is insufficient for definite conclusions regarding the prevalence and severity of psychiatric drug-induced liver injury...
February 6, 2017: World Journal of Gastrointestinal Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/28212159/liver-allocation-and-distribution-time-for-a-change
#2
Ranjit Deshpande, Ryutaro Hirose, David Mulligan
PURPOSE OF REVIEW: Liver allograft allocation has been a topic of hot debate for over a decade. New redistricting changes have been proposed by the Liver and Intestinal Transplant Committee to the existing United Network for Organ Sharing (UNOS) liver allocation policy. The basis of this new proposal is similar to the old one with an aim to distribute organs in a fair, efficient and equitable fashion. In this review, we plan to look in depth at the redistribution proposals thus far, their merits and how they may help patients who do not have adequate access to livers...
February 15, 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28208022/protein-requirements-for-critically-ill-patients-with-renal-and-liver-failure
#3
Jayshil J Patel, Craig J McClain, Menaka Sarav, Jill Hamilton-Reeves, Ryan T Hurt
Diseases leading to critical illness induce proteolysis resulting in muscle wasting and negative nitrogen balance. Muscle wasting has been associated with poor intensive care unit (ICU)-related outcomes, including an increased risk for mortality. Acute kidney injury (AKI) represents a common organ dysfunction associated with ICU-related disorders, such as sepsis, trauma, and respiratory failure. AKI and renal replacement therapy lead to amino acid loss. Decompensated liver cirrhosis (DLC) and acute liver failure (ALF) represent more severe forms of liver dysfunction leading to ICU admission...
February 1, 2017: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/28190602/prevention-of-acute-kidney-injury-in-intensive-care-units
#4
S Mas-Font, J Ros-Martinez, C Pérez-Calvo, P Villa-Díaz, S Aldunate-Calvo, E Moreno-Clari
Acute kidney injury (AKI) is a growing concern in Intensive Care Units. The advanced age of our patients, with the increase in associated morbidity and the complexity of the treatments provided favor the development of AKI. Since no effective treatment for AKI is available, all efforts are aimed at prevention and early detection of the disorder in order to establish secondary preventive measures to impede AKI progression. In critical patients, the most frequent causes are sepsis and situations that result in renal hypoperfusion; preventive measures are therefore directed at securing hydration and correct hemodynamics through fluid perfusion and the use of inotropic or vasoactive drugs, according to the underlying disease condition...
February 9, 2017: Medicina Intensiva
https://www.readbyqxmd.com/read/28186674/mechanism-of-impairment-on-liver-regeneration-in-elderly-patients-the-role-of-hepatic-stellate-cell-function
#5
REVIEW
Yu Saito, Yuji Morine, Mitsuo Shimada
Japan, along with most other countries in the world, is facing an increasingly aging population with a prolonged life expectancy. Concurrently, the need for medical intervention including hepatectomy, has also increased for the elderly. Though surgical outcomes for older patients are reported to be comparable with those for younger patients, additional care in the selection of older patients for hepatectomy is considered necessary. Although the effect of aging on human liver regeneration is not fully understood, the regeneration of liver tissue after hepatectomy in elderly patients is shown to be generally worse than in younger patients and to date the mechanisms involved in the impairment of liver regeneration have not been fully clarified...
February 10, 2017: Hepatology Research: the Official Journal of the Japan Society of Hepatology
https://www.readbyqxmd.com/read/28178063/detecting-pulmonary-edema-in-obstetric-patients-through-point-of-care-lung-ultrasonography
#6
Sarah Pachtman, Seth Koenig, Natalie Meirowitz
BACKGROUND: Point-of-care lung ultrasonography is used in critical care settings for evaluating respiratory symptoms. Lung ultrasonography is sensitive and specific for the diagnosis of pulmonary edema in nonpregnant patients but is not well-studied in pregnancy. TECHNIQUE: Lung ultrasonography was performed using a portable ultrasound machine with a 2- to 5-MHz curvilinear probe that is available on many labor and delivery units. EXPERIENCE: Lung ultrasonography guided management decisions in a case of shortness of breath after induction of labor for preeclampsia and a case of hemolysis, elevated liver enzymes, and low platelet count syndrome complicated by pulmonary edema...
March 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28167225/no-child-left-behind-liver-transplantation-in-critically-ill-children
#7
Abbas Rana, Michael Kueht, Moreshwar Desai, Fong Lam, Tamir Miloh, Jennifer Moffett, N Thao N Galvan, Ronald Cotton, Christine O'Mahony, John Goss
BACKGROUND: Advances in critical care prolong survival in children with liver failure, allowing more critically ill children to undergo orthotopic liver transplantation (OLT). In order to justify the use of a scarce donor resource and avoid futile transplants, we sought to determine survival in children who undergo OLT while receiving pre-OLT critical care. STUDY DESIGN: We analyzed 13,723 pediatric OLTs using the United Network for Organ Sharing (UNOS) database from 1987 to 2015, including 6,746 recipients in the Model for End-Stage Liver Disease/Pediatric End-Stage Liver Disease (MELD/PELD) era (2002 to 2015)...
February 3, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28166165/automated-variable-aortic-control-vs-complete-aortic-occlusion-in-a-swine-model-of-hemorrhage
#8
Timothy K Williams, Lucas P Neff, M Austin Johnson, Rachel M Russo, Sarah-Ashley Ferencz, Anders J Davidson, Nathan F Clement, J Kevin Grayson, Todd E Rasmussen
BACKGROUND: Future endovascular hemorrhage control devices will require features that mitigate the adverse effects of vessel occlusion. Permissive regional hypoperfusion (PRH) with variable aortic control (VAC) is a novel strategy to minimize hemorrhage and reduce the ischemic burden of complete aortic occlusion (AO). The objective of this study was to compare PRH with VAC to AO in a lethal model of hemorrhage. METHODS: Twenty-five swine underwent cannulation of the supraceliac aorta, with diversion of aortic flow through an automated extracorporeal circuit...
February 4, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28151948/model-for-end-stage-liver-disease-excluding-inr-meld-xi-score-in-critically-ill-patients-easily-available-and-of-prognostic-relevance
#9
Bernhard Wernly, Michael Lichtenauer, Marcus Franz, Bjoern Kabisch, Johanna Muessig, Maryna Masyuk, Uta C Hoppe, Malte Kelm, Christian Jung
PURPOSE: MELD-XI, an adapted version of Model for End-stage Liver Disease (MELD) score excluding INR, was reported to predict outcomes e.g. in patients with acute heart failure. We aimed to evaluate MELD-XI in critically ill patients admitted to an intensive care unit (ICU) for prognostic relevance. METHODS: A total of 4381 medical patients (66±14 years, 2862 male) admitted to a German ICU between 2004 and 2009 were included and retrospectively investigated. Admission diagnoses were e...
2017: PloS One
https://www.readbyqxmd.com/read/28124458/hepatic-ischemia-reperfusion-injury-associates-with-acute-kidney-injury-in-liver-transplantation-prospective-cohort-study
#10
Ina Jochmans, Nicolas Meurisse, Arne Neirynck, Marleen Verhaegen, Diethard Monbaliu, Jacques Pirenne
: Solid clinical prospective studies investigating the association between hepatic ischemia reperfusion injury and acute kidney injury after liver transplantation are missing. Hepatic ischemia reperfusion injury -reflected by transaminase release- induces acute kidney injury in rodents and retrospective studies suggest a similar association in man. This prospective cohort study determined risk factors for acute kidney injury in 80 adult liver-only recipients. Acute kidney injury -defined by RIFLE-criteria- developed in 21 (26%) recipients at 12 hours postreperfusion [inter quartile range: 6 hours-postoperative day 1]; 13 progressed from "Risk" to "Injury"; 5 to "Failure"...
January 25, 2017: Liver Transplantation
https://www.readbyqxmd.com/read/28114104/aki-clif-sofa-a-novel-prognostic-score-for-critically-ill-cirrhotic-patients-with-acute-kidney-injury
#11
Dan-Qin Sun, Chen-Fei Zheng, Wen-Yue Liu, Sven Van Poucke, Zhi Mao, Ke-Qing Shi, Xiao-Dong Wang, Ji-Dong Wang, Ming-Hua Zheng
Critically ill cirrhotic patients with acute kidney injury (AKI) are associated with high mortality rates. The aims of this study were to develop a specific prognostic score for critically ill cirrhotic patients with AKI, the acute kidney injury - Chronic Liver Failure - Sequential Organ Failure- Assessment score (AKI-CLIF-SOFA) score. This study focused on 527 cirrhotic patients with AKI admitted to intensive care unit and constructed a new scoring system, the AKI-CLIF-SOFA, which can be used to prognostically assess mortality in these patient population...
January 19, 2017: Aging
https://www.readbyqxmd.com/read/28111335/assessment-of-abilities-of-gastroenterology-fellows-to-provide-information-to-patients-with-liver-disease
#12
Noami Chaudhary, Catherine Lucero, Gerald Villanueva, Michael Poles, Colleen Gillespie, Sondra Zabar, Elizabeth Weinshel
PURPOSE: Patient education is critical in ensuring patient compliance and good health outcomes. Fellows must be able to effectively communicate with their patients, delivering enough information for the patient to understand their medical problem and maximize patient compliance. We created an objective structured clinical examination (OSCE) with four liver disease cases to assess fellows' knowledge and ability to inform standardized patients about their clinical condition. METHODS: We developed four cases highlighting different aspects of liver disease and created a four station OSCE: hepatitis B, acute hepatitis C, new diagnosis of cirrhosis, and an end-stage cirrhotic non transplant candidate...
January 19, 2017: Clinical Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/28105603/resuscitation-fluid-composition-affects-hepatic-inflammation-in-a-murine-model-of-early-sepsis
#13
Amanda L Patrick, Peter M Grin, Nicole Kraus, Michelle Gold, Matthew Berardocco, Patricia C Liaw, Alison E Fox-Robichaud
BACKGROUND: Fluid resuscitation is a crucial therapy for sepsis, and the use of balanced fluids and/or isotonic albumin may improve patient survival. We have previously demonstrated that resuscitation with normal saline results in increased hepatic leukocyte recruitment in a murine model of sepsis. Given that clinical formulations of albumin are in saline, our objectives were to develop a novel balanced electrolyte solution specifically for sepsis and to determine if supplementing this solution with albumin would improve the inflammatory response in sepsis...
December 2017: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/28073146/value-based-care-in-hepatology
#14
REVIEW
Mario Strazzabosco, John I Allen, Elizabeth O Teisberg
The migration from legacy fee-for-service reimbursement to payments linked to high value health care is accelerating in the United States because of new legislation and re-design of payments from the Centers for Medicare and Medicaid Services (CMS). Since patients with chronic diseases account for substantial use of health care resources, payers and health systems are focusing on maximizing the value of care for these patients. Since chronic liver diseases impose a major health burden worldwide affecting the health and lives of many individuals and families as well as substantial costs for individuals and payers, hepatologists must understand how they can improve their practices ...
January 10, 2017: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://www.readbyqxmd.com/read/28069526/opportunities-to-improve-care-of-hepatocellular-carcinoma-in-vulnerable-patient-populations
#15
Richard S Hoehn, Dennis J Hanseman, Vikhrom K Dhar, Derek E Go, Michael J Edwards, Shimul A Shah
BACKGROUND: Hepatocellular carcinoma (HCC) patients with Medicaid or no health insurance have inferior survival compared with privately insured patients. Safety-net hospitals that care for these patients are often criticized for their inferior outcomes. We hypothesized that HCC survival was related to appropriate surgical management. STUDY DESIGN: The American College of Surgeons National Cancer Database was queried for patients diagnosed with HCC (n = 111,481) from 1998 to 2010...
January 6, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28040717/predictors-of-the-use-of-specific-critical-care-therapies-in-patients-with-metastatic-cancer
#16
Kah Poh Loh, Ankit Kansagra, Meng-Shiou Shieh, Penelope Pekow, Peter Lindenauer, Mihaela Stefan, Tara Lagu
OBJECTIVE: Understanding which factors are associated with the use of critical care therapies (CCTs) can help with clinical decision-making and goals of care discussion. The goal of this study was to describe the predictors of CCT use (eg, mechanical ventilation, tracheostomy, percutaneous endoscopic gastrostomy tube, total parenteral nutrition, acute use of dialysis) in hospitalized patients with metastatic cancer. METHODS: We used the 2010 California State Inpatient Databases sponsored by the Agency for Healthcare Research and Quality to identify all hospitalizations with a diagnosis of metastatic cancer (patients aged ≥18 years)...
January 2017: Journal of the National Comprehensive Cancer Network: JNCCN
https://www.readbyqxmd.com/read/28030513/acute-circulatory-failure-chronic-liver-failure-sequential-organ-failure-assessment-score-a-novel-scoring-model-for-mortality-risk-prediction-in-critically-ill-cirrhotic-patients-with-acute-circulatory-failure
#17
Xiao-Dong Zhou, Qin-Fen Chen, Zheng-Xian Wang, Wen-Yue Liu, Sven Van Poucke, Zhi Mao, Sheng-Jie Wu, Wei-Jian Huang, Ming-Hua Zheng
BACKGROUND AND AIM: Acute circulatory failure (ACF) is associated with high mortality rates in critically ill cirrhotic patients. Only a few accurate scoring models exist specific to critically ill cirrhotic patients with acute circulatory failure (CICCF) for mortality risk assessment. The aim was to develop and evaluate a novel model specific to CICCF. PATIENTS AND METHODS: This study collected and analyzed the data on CICCF from the Multiparameter Intelligent Monitoring in Intensive Care-III database...
December 26, 2016: European Journal of Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/28030432/outcomes-and-disparities-in-liver-transplantation-will-be-improved-by-redistricting-cons
#18
David Seth Goldberg, Seth Karp
PURPOSE OF REVIEW: Over the last 2 years, the liver transplant community has been debating a proposal to redraw the maps of organ distribution. The basis for these proposed changes is reported disparities in severity of illness at transplantation across the USA - however, this is based on the allocation model for end-stage liver disease score. In this review, we provide a critical overview of the redistribution proposal, its flaws and how it may worsen outcomes and exacerbate disparities in liver transplantation...
December 26, 2016: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28026108/outcomes-utilizing-imported-liver-grafts-for-recipients-with-hepatocellular-carcinoma
#19
Narendra Battula, Trevor W Reichman, Yamah Amiri, Ian C Carmody, Gretchen Galliano, John Seal, Emily Ahmed, Humberto Bohorquez, David Bruce, Ari Cohen, George E Loss
BACKGROUND: Liver transplantation (LT) offers the best chance of survival in selected patients with hepatocellular carcinoma (HCC). Wait list mortality or dropout due to tumor progression can be significant and therefore timely transplantation is critical. Liver grafts discarded by outside organ procurement organizations are a potential source of grafts for low MELD tumor patients. The primary aim of this study was to assess the disease-free and overall survival of patients with HCC transplanted with imported liver grafts (ILG)...
December 27, 2016: Liver Transplantation
https://www.readbyqxmd.com/read/28003948/salvage-plasmapheresis-for-post-hepatectomy-liver-failure
#20
Faisal Inayat, Qulsoom Hussain, Syed H Tasleem, Sajid Farooq, Abu Hurairah
In the latest decades, an important change has been registered in liver surgery related to the progress of surgical techniques, critical care, and postoperative treatment, allowing a sharp decrease in mortality and morbidity. However, management of post-hepatectomy liver failure (PHLF) still remains a challenge and no supportive treatment has been found to be generally effective. The present study is a reappraisal of plasmapheresis as a potential supportive measure in patients with PHLF following major liver resection...
November 17, 2016: Curēus
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