Intensive care complications in liver and multivisceral transplantation.

The complications concerning liver and intestinal transplant surgery have relevance for the field of intensive care because they share some characteristics with those following complex long-term surgery. Thus, in this article we shall try to describe complications that are specific to liver and multivisceral transplants. A review of the existing literature on this topic reveals a large number of studies dedicated to early as well as late surgical complications, and immunosuppressive treatment, while there are far fewer contributions describing complications exclusively concerning intensive care. We shall thus attempt to focus on certain aspects where, besides the literature data, we have personal experience. In particular we want to underline the implications of failure in the functional recovery of the graft; alterations in water, electrolyte, and glycemic balance; as well as neurological, respiratory, renal, nutritional, and infective complications.

Peripherally inserted central venous catheters in preterm newborns: two unusual complications.

This report describes the case of two newborns who suffered unusual complications after peripheral insertion of a central venous catheter. In one baby a fragment of the catheter tip became embolized in a peripheral branch of the left pulmonary artery. In the other baby, the catheter perforated a peripheral branch of the pulmonary artery, giving rise to chemical pneumonitis with extensive pleural effusion. The outcome was positive for both babies. A large clinical series is necessary to establish the complications of this procedure, their prevention and management.

[Therapeutic applications of hypothermia in intensive care]. / Applicazioni terapeutiche dell'ipotermia in terapia intensiva.

A brief review about the effects of hypothermia is presented, with regards to the difference between accidental hypothermia and controlled mild hypothermia (Core temperature = 33-35 degrees C). Mild hypothermia does not seem to affect the cardiac performance, while recent experimental reports show potential protective effects on the cardiac muscle during acute infarction. Mild hypothermia improve the outcome of brain function after cardiac arrest and head injury, while experimental reports show a potential protective effect of local spinal cord cooling during ischemic injury. Induced hypothermia of single organ is widely applied in liver resection and in other surgical procedures, further the cardiac ones. In the acute respiratory failure, mild hypothermia may induce a decrease in PaCO2, in sedated and muscle relaxed patients, due to the decrease of metabolic demand. In this setting a mild induced hypothermia potentially may decrease the side effects of therapeutic hypoventilation (permissive hypercapnia) both on haemodynamics and brain circulation. Preliminary data are presented about five ALI/ARDS patients, enclosed in a randomized trial, who were mechanically ventilated and cooled with an air-sheet: three patients died because of underlying disease and two patients survived with complete recovery. Mild controlled hypothermia seems to provide new interesting clinic uses.