Risk Factors for Intensive Care Unit Readmission After Liver Transplantation: A Retrospective Cohort Study.

BACKGROUND Most liver transplant patients require Intensive Care Unit (ICU) care in the immediate postoperative period and some patients require readmission to the ICU before discharge from the hospital. A retrospective cohort study was conducted to identify risk factors for ICU readmission after liver transplantation. MATERIAL AND METHODS Adult patients who underwent living donor or deceased donor liver transplantation at Seoul National University Hospital between 2004 and 2015 were included. A retrospective review of baseline and perioperative factors that may be associated with ICU readmission was performed. Patients requiring ICU readmission during the hospitalization for LT (readmission group) were compared with patients who did not need ICU readmission (control group). A multivariable logistic regression analysis was performed to identify factors associated with ICU readmission after LT. RESULTS Of the 1181 patients, 68 patients (5.8%) were readmitted to the ICU during the postoperative period after liver transplantation. Common causes of ICU readmission included postoperative bleeding, pulmonary complications, and sepsis. Multivariate analysis revealed that old age (OR 1.030 95%CI 1.002-1.059, p=0.035), pre-transplant chronic kidney disease (CKD) (OR 4.912 95%CI 2.556-9.439, p<0.001), intraoperative red blood cell (RBC) transfusion (OR 1.029 95%CI 1.008-1.050, p=0.007), new-onset atrial fibrillation in the ICU (OR 2.807 95%CI 1.087-7.249, p=0.033), and transplantation between 2011 and 2015 (vs. 2004-2010) were risk factors for ICU readmission after LT. CONCLUSIONS Old age, pre-transplant CKD, more intraoperative RBC transfusion, new-onset atrial fibrillation during ICU stay, and transplant period were identified as risk factors for ICU readmission.

Pneumonitis and pneumonia after aspiration.

Aspiration pneumonitis and aspiration pneumonia are clinical syndromes caused by aspiration. These conditions are clinically significant due to their high morbidity and mortality. However, aspiration as a preceding event are often unwitnessed, particularly in cases of asymptomatic or silent aspiration. Furthermore, despite the difference in treatment approaches for managing aspiration pneumonitis and aspiration pneumonia, these two disease entities are often difficult to discriminate from one another, resulting in inappropriate treatment. The use of unclear terminologies hinders the comparability among different studies, making it difficult to produce evidence-based conclusions and practical guidelines. We reviewed the most recent studies to define aspiration, aspiration pneumonitis, and aspiration pneumonia, and to further assess these conditions in terms of incidence and epidemiology, pathophysiology, risk factors, diagnosis, management and treatment, and prevention.

The anhepatic phase extended by temporary portocaval shunt does not affect anesthetic sensitivity and postoperative cognitive function: A case-control study.

Temporary portocaval shunt (TPCS) prolongs the duration of the anhepatic phase, during which anesthetic sensitivity is highest among the 3 phases of living donor liver transplantation (LDLT). Cognitive dysfunction has been associated with increased anesthetic sensitivity and poor hepatic function. Therefore, we assessed anesthetic sensitivity to desflurane and perioperative cognitive function in patients undergoing LDLT, in whom the duration of the anhepatic phase was extended by TPCS to test the hypothesis that the prolonged anhepatic phase increases anesthetic sensitivity and causes postoperative cognitive decline.This case-control study was conducted in 67 consecutive patients undergoing LDLT from February 2014 to January 2016. Anesthesia was maintained at a 0.6 end-tidal age-adjusted minimum alveolar concentration of desflurane. The bispectral index (BIS) was maintained at less than 60 and averaged at 1-minute intervals. The mini-mental state examination (MMSE-KC) was performed 1 day before and 7 days after the LDLT. All parameters were compared between the patients undergoing TPCS (TPCS group) and the remaining patients (non-TPCS group).TPCS was performed in 16 patients (24%). TPCS prolonged the duration of the anhepatic phase (125.9 ±â€Š29.4 vs 54.9 ±â€Š20.5 minutes [mean ±â€Šstandard deviation], P < 0.0001). The averaged BIS values during the 3 phases were comparable between the 2 groups. No significant interval changes in the averaged BIS values were observed during the 3 consecutive phases. Similarly, there were no significant differences in MMSE-KC score assessed 1 day before and 7 days after LDLT between the 2 groups. The preoperative MMSE-KC scores were unchanged postoperatively in the 2 groups.The extension of the anhepatic phase did not affect anesthetic sensitivity and postoperative cognitive function.

Electrical, Optical, and Thermal Behaviors of Transparent Film Heater Made of Reduced Graphene Oxide.

The electrical conductivity and the thermal performance of the films made of reduced graphene oxide (rGO) spray-coated on polycarbonate substrate were investigated. The electrical conductivity and the transmittance of 10 times spray coated film made from the solution with 0.08 wt% of rGO, 0.16 wt% of surfactant were 30 komega/sq and 64%, respectively. The steady-state temperature of the films increased from 25 degrees C for 40 komega/sq to 100 degrees C for 490 omega/sq at an applied voltage of 110 V. The heat transfer coefficient of the rGO coated film, a, was obtained as 139 W/m2 K using the model equation based on the thermal balance, which includes Joule heating convectional, and radiative heat transfers. The transmittance of the films decreased continuously from 73% with the increase of surface resistivity.