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Management of the Potential Organ Donor in the ICU: Society of Critical Care Medicine/American College of Chest Physicians/Association of Organ Procurement Organizations Consensus Statement
This document was developed through the collaborative efforts of the Society of Critical Care Medicine, the American College of Chest Physicians, and the Association of Organ Procurement Organizations. Under the auspices of these societies, a multidisciplinary, multi-institutional task force was convened, incorporating expertise in critical care medicine, organ donor management, and transplantation. Members of the task force were divided into 13 subcommittees, each focused on one of the following general or organ-specific areas: death determination using neurologic criteria, donation after circulatory death determination, ...
Source: Critical Care Medicine - May 16, 2015 Category: Emergency Medicine Tags: Special Article Source Type: research

Effect of Continuous Renal Replacement Therapy on Outcome in Pediatric Acute Liver Failure*
Conclusion: Continuous renal replacement therapy can be used successfully in critically ill children with pediatric acute liver failure to provide stability and bridge to transplantation. Inability to reduce ammonia by 48 hours confers poor prognosis. Continuous renal replacement therapy should be considered at an early stage to help prevent further deterioration and buy time for potential spontaneous recovery or bridge to liver transplantation.
Source: Critical Care Medicine - September 17, 2016 Category: Emergency Medicine Tags: Pediatric Critical Care Source Type: research

Early critical care course in children after liver transplant.
Conclusion. The postoperative course of children after OLT is associated with multiple complications. In recent years OLT was performed in younger children; living donors were more common; the rate of postoperative infection and suspected rejection was reduced significantly; however patients required longer MV and LOS in the PCCU. PMID: 25328695 [PubMed]
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Thromboelastography for evaluation of coagulopathy in nonbleeding patients with sepsis at intensive care unit admission
Conclusion: TEG could differentiate among normocoagulant, hypocoagulant, hypercoagulant states (unlike CCAs). Patients with septic shock had trend toward hypocoagulant state while those without shock had trend toward hypercoagulant state.
Source: Indian Journal of Critical Care Medicine - May 16, 2017 Category: Intensive Care Authors: Syed Nabeel Muzaffar Arvind Kumar Baronia Afzal Azim Anupam Verma Mohan Gurjar Banani Poddar Ratender Kumar Singh Source Type: research

The end-organ impairment in liver cirrhosis: appointments for critical care.
Authors: Figueiredo A, Romero-Bermejo F, Perdigoto R, Marcelino P Abstract Liver cirrhosis (LC) can lead to a clinical state of liver failure, which can exacerbate through the course of the disease. New therapies aimed to control the diverse etiologies are now more effective, although the disease may result in advanced stages of liver failure, where liver transplantation (LT) remains the most effective treatment. The extended lifespan of these patients and the extended possibilities of liver support devices make their admission to an intensive care unit (ICU) more probable. In this paper the LC is approached from t...
Source: Critical Care Research and Practice - December 1, 2014 Category: Intensive Care Tags: Crit Care Res Pract Source Type: research

Hybrid Extracorporeal Therapies as a Bridge to Pediatric Liver Transplantation*
Conclusions: Hybrid extracorporeal therapies can be effectively implemented in pediatric liver failure as a bridge to transplantation. Overall complexity and heavy resource utilization need to be carefully considered in instituting these therapies in suitable candidates.
Source: Pediatric Critical Care Medicine - July 1, 2018 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Critical Care Compendium update
LITFL’s Critical Care Compendium is a comprehensive collection of pages concisely covering the core topics and controversies of critical care. Currently there are almost 1,500 entries with more in the works… Some pages are more developed than others, and all the pages are being constantly revised and improved. Links to new references and online resources are added daily, with an emphasis on those that are free and open access (FOAM!). These pages originated from the FCICM exam study notes created by Dr Jeremy Fernando in 2011, and have been updated, modified and added to since. As such will be particularly us...
Source: Life in the Fast Lane - November 17, 2013 Category: Emergency Medicine Doctors Authors: Chris Nickson Tags: Critical Care Compendium Education eLearning Emergency Medicine Featured CCC LITFL collection Source Type: blogs

Severe Sepsis in Pediatric Liver Transplant Patients: The Emergence of Multidrug-Resistant Organisms
Conclusions: We report that multidrug-resistant organisms are increasingly being identified as causative pathogens for sepsis in pediatric liver transplant recipients and are associated with significantly higher odds for mechanical ventilation and higher organ failure. The emergence of multidrug-resistant organism infections in pediatric liver transplant patients has implications for patient outcomes, antibiotic stewardship, and infection prevention strategies.
Source: Pediatric Critical Care Medicine - July 1, 2019 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Benefits of Early Mobilization After Pediatric Liver Transplantation*
Objective: To evaluate the impact of early mobilization after pediatric liver transplantation in the PICU. Design: A 70-month retrospective before-after study. Setting: Medical and surgical PICU with 20 beds at a tertiary children’s hospital. Patients: Seventy-five patients 2–18 years old who underwent liver transplantation and could walk before surgery. Intervention: We meticulously planned and implemented an early mobilization intervention, a multifaceted framework for early mobilization practice in the PICU focusing on a multidisciplinary team approach. Measurements and Main Results: There was a sig...
Source: Pediatric Critical Care Medicine - February 1, 2019 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Nutrition assessment in patients undergoing liver transplant
Neha Bakshi, Kalyani SinghIndian Journal of Critical Care Medicine 2014 18(10):672-681Liver transplantation (LT) is a major surgery performed on patients with end stage liver disease. Nutrition is an integral part of patient care, and protein-energy malnutrition is almost universally present in patients suffering from liver disease undergoing LT. Nutrition assessment of preliver transplant phase helps to make a good nutrition care plan for the patients. Nutrition status has been associated with various factors which are related to the success of liver transplant such as morbidity, mortality, and length of hospital stay. To...
Source: Indian Journal of Critical Care Medicine - October 3, 2014 Category: Intensive Care Authors: Neha BakshiKalyani Singh Source Type: research

Recent advances in management of acute liver failure
Charles Panackel, Rony Thomas, Benoy Sebastian, Sunil K MathaiIndian Journal of Critical Care Medicine 2015 19(1):27-33Acute liver failure (ALF) is a life-threatening illness, where a previously normal liver fails within days to weeks. Sudden loss of synthetic and detoxification function of liver results in jaundice, encephalopathy, coagulopathy, and multiorgan failure. The etiology of ALF varies demographically. The mortality of ALF is as high as 40-50%. The initial care of patients with ALF depends on prompt recognition of the condition and early detection of etiology. Management includes intensive care support, t...
Source: Indian Journal of Critical Care Medicine - January 6, 2015 Category: Intensive Care Authors: Charles PanackelRony ThomasBenoy SebastianSunil K Mathai Source Type: research

N-acetylcystein in dengue associated severe hepatitis
We report a case of dengue hemorrhagic fever associated severe hepatitis (encephalopathy grade 2-drowsy and intermittent disorientation) treated with NAC resulted in good outcome without hepatic transplantation.
Source: Indian Journal of Critical Care Medicine - March 12, 2014 Category: Intensive Care Authors: Buddhika Widyaratna Peiris HabaragamuwaPalitha Dissanayaka Source Type: research

Urinary neutrophil gelatinase associated lipocalin as an early marker of acute kidney injury in the recipient after liver transplantation
Conclusion Urinary NGAL/creatinine ratio may be used as a test for the early prediction of adverse outcome of LDLT recipient patients at ICU admission.
Source: The Egyptian Journal of Critical Care Medicine - December 23, 2016 Category: Intensive Care Source Type: research

Epidemiological analysis of extended-spectrum beta-lactamase-producing bacterial infections in adult live donor liver transplant patients
Conclusions: Infections with ESBL-producing organism in liver transplant recipients has a high mortality and very limited therapeutic options.
Source: Indian Journal of Critical Care Medicine - April 18, 2018 Category: Intensive Care Authors: Ajeet Singh Deepak Govil Usha Krishan Baveja Anand Gupta Neha Tandon Shrikanth Srinivasan Sachin Gupta Sweta J Patel Sanjiv Saigal Arvinder Singh Soin Source Type: research

Nutrition management of acute postliver transplant recipients
Conclusion: There are scant data on nutrition management in acute post-LT phase. The present study provides the framework for the formulation of continuous, patient-centric, aggressive nutrition management interventions for acute post-LT recipients.
Source: Indian Journal of Critical Care Medicine - November 19, 2018 Category: Intensive Care Authors: Neha Bakshi Kalyani Singh Source Type: research