Minerva anestesiologica
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Minerva anestesiologica · Aug 2012
Ascites characterizes perioperative clinical indices better than preoperative body mass index. A study in orthotopic liver transplant candidates.
Preoperative body mass index (pre-BMI) affecting patients' recovery from orthotropic liver transplantation (OLT) is controversial. Pre-BMI measurements may be exaggerated by ascites. Aim of the study was the assessment of early outcome associated with pre-BMI and ascites. ⋯ Pre-OLT BMI does not correlate with ascites or postoperative BMI, nor does it affect duration of ventilation, especially <6 h after surgery. These results dissociate ascites from pre- and post-OLT.
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Minerva anestesiologica · Aug 2012
Outcome prediction in cardiac surgery: the first logistic scoring model for cardiac surgical intensive care patients.
In the process of risk stratification, a logistic calculation of mortality risk in percentage is easier to interpret. Unfortunately, there is no reliable logistic model available for postoperative intensive care patients. The aim of this study was to present the first logistic model for postoperative mortality risk stratification in cardiac surgical intensive care units. This logistic version is based on our previously presented and established additive model (CASUS) that proved a very high reliability. ⋯ The logistic model shows statistical superiority. Because of the precise weighing the individual risk factors, it offers a reliable risk prediction. It is easier to interpret and to facilitate the integration of mortality risk stratification into the daily management more than the additive one.
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The recording of esophageal pressure (Pes) in supine position as a substitute for pleural pressure is difficult and fraught with potential errors. Pes is affected by the: 1) elastance and weight of the lung; 2) elastance and weight of the rib cage; 3) weight of the mediastinal organs; 4) elastance and weight of the diaphragm and abdomen; 5) elastance of the esophageal wall; and 6) elastance of the esophageal balloon (if filled with too much air). If the purpose is to measure lung compliance in the intensive care patient, reasonably useful information might be obtained by measuring airway pressure alone, considering chest wall compliance to be a weight that is forced away by the ventilation. ⋯ The transpulmonary pressure, whether calculated with Pes or by another measure of abdominal pressure, may guide in PEEP titration. It may also enable calculation of stresses applied to the lung and these may be more important in guiding an optimal ventilator setting than an optimum compliance or oxygenation of blood. Diaphragm function can be estimated by esophageal minus gastric pressure and with even more precision, when combined with diaphragm electromyography.