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Critical Care |

Maintaining Hemodynamic and Metabolic Homeostasis in Anheptaic Critically Ill Patients

Roozehra Khan*, MD; Ronaldo Go, MD; Sumit Kapoor, MD; Ananda Dharshan, MD; Marjan Rahmanian, MD; Anthony Manasia, MD; Adel Bassily-Marcus, MD; Roopa Kohli-Seth, MD; John Oropello, MD; Ernest Benjamin, MD
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Mount Sinai Hospital, New York, NY


Chest. 2012;142(4_MeetingAbstracts):390A. doi:10.1378/chest.1387695
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Abstract

SESSION TYPE: Non Pulmonary Critical Care Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Complications of primary non-function after orthotopic liver transplant (OLT) can be managed by total hepatectomy to avoid toxic liver syndrome as bridge therapy to re-transplantation. Postoperative critical care of these patients is challenging. We present the largest case series of critically ill anhepatic patients awaiting re-transplantation. Continuous venovenous hemofiltration (CVVH) was utilized to control volume status and maintain metabolic homeostasis.

METHODS: A retrospective chart review was completed on eight patients admitted to the surgical ICU after unsuccessful OLT in an anhepatic state to await re-transplantation between 2006 and 2010. Upon admission to the ICU, patients were on mechanical ventilation and placed on CVVH using a polysulfone filter. Lab tests were repeated every six hours and changes to CVVH replacement fluid and balance were adjusted accordingly. The retrospective data was recorded prior to the start of CVVH and before re-transplantation to examine changes in lab values during the anhepatic phase. Data is reported as mean±SD and was analyzed using a Student's paired t-Test with a two-tailed distribution. A p-value <0.05 was considered significant.

RESULTS: As expected, ALT decreased by an average of 607±588 (p=0.02), and AST by 1781±2130 (p=0.05). The pH increased from 7.17±0.08 to 7.32±0.14 (p=0.02). Serum lactate remained constant (14.4±7.6 mmol/L pre-CVVH, and 14.4±8.4 mmol/ L prior to re-transplant). There were no significant changes in INR (3.2±1.3, 2.2±0.6), glucose (124±39, 145±45 mg/dL), Na (146±4, 139±9 mEq/L), K (4.6±0.7, 4.4±0.6 mEq/L), and iCa (1.1±0.1, 1.17±0.4 mmol/L).

CONCLUSIONS: Seven of the eight patients were successfully bridged to re-transplantation. The mean time to re-transplantation was 39.1±17.4 hours. The longest anhepatic period was 65.7 hours. Patients can be successfully managed using CVVH in the anhepatic state until a new donor liver is available.

CLINICAL IMPLICATIONS: Without the use of liver support systems, anhepatic patients were kept metabolically stable utilizing CVVH.

DISCLOSURE: The following authors have nothing to disclose: Roozehra Khan, Ronaldo Go, Sumit Kapoor, Ananda Dharshan, Marjan Rahmanian, Anthony Manasia, Adel Bassily-Marcus, Roopa Kohli-Seth, John Oropello, Ernest Benjamin

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Mount Sinai Hospital, New York, NY

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