PubMed Açık Erişimli Yayınlar

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Author: search.filters.author.Ozdemirkan, Aycansearch.filters.applied.f.publicationcategory: search.filters.publicationcategory.Makale - Uluslararası Hakemli Dergi

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    Multivariable haemodynamic approach to predict the fluid challenge response A multicentre cohort study
    (2021) Messina, Antonio; Romano, Salvatore M.; Ozdemirkan, Aycan; Persona, Paolo; Tarquini, Riccardo; Cammarota, Gianmaria; Romagnoli, Stefano; Della Corte, Francesco; Bennett, Victoria; Monge Garcia, Manuel I.; 32833857; AAH-7003-2019
    BACKGROUND Beat-to-beat stroke volume (SV) results from the interplay between left ventricular function and arterial load. Fluid challenge induces time-dependent responses in cardiac performance and peripheral vascular and capillary characteristics. OBJECTIVE To assess whether analysis of the determinants of the haemodynamic response during fluid challenge can predict the final response at 10 and 30 min. DESIGN Observational multicentric cohort study. SETTING Three university ICUs. PATIENTS 85 ICU patients with acute circulatory failure diagnosed within the first 48 h of admission. INTERVENTION(S) The fluid challenge consisted of 500 ml of Ringer's solution infused over 10 min. A SV index increase at least 10% indicated fluid responsiveness. MAIN OUTCOME MEASURES The SV, pulse pressure variation (PPV), arterial elastance, the systolic-dicrotic pressure difference (SAP-P-dic) and cardiac cycle efficiency (CCE) were measured at baseline, 1, 2, 3, 4, 5, 10, 15 and 30 min after the start of the fluid challenge. All haemodynamic data were submitted to a univariable logistic regression model and a multivariable analysis was then performed using the significant variables given by univariable analysis. RESULTS The multivariable model including baseline PPV, and the changes of arterial elastance at 1 min and of the CCE and SAP-P-dic at 5 min when compared with their baseline values, correctly classified 80.5% of responders and 90.7% of nonresponders at 10 min. For the response 30 min after starting the fluid challenge, the model, including the changes of PPV, CCE, SAP-P-dic at 5 min and of arterial elastance at 10 min compared with their baseline values, correctly identified 93.3% of responders and 91.4% of nonresponders. CONCLUSION In a selection of mixed ICU patients, a statistical model based on a multivariable analysis of the changes of PPV, CCE, arterial elastance and SAP-P-dic, with respect to baseline values, reliably predicts both the early and the late response to a standardised fluid challenge.
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    Effect of Graft Weight to Recipient Body Weight Ratio on Hemodynamic and Metabolic Parameters in Pediatric Liver Transplant: A Retrospective Analysis
    (2017) Haberal, Mehmet; Ersoy, Zeynep; Kaplan, Serife; Ozdemirkan, Aycan; Torgay, Adnan; Arslan, Gulnaz; Pirat, Arash; 0000-0003-0767-1088; 0000-0002-6829-3300; 0000-0002-3462-7632; 28260433; AAF-3066-2021; AAJ-5221-2021; AAJ-8097-2021; AAH-7003-2019
    Objectives: To analyze how graft-weight-to-body-weight ratio in pediatric liver transplant affects intraoperative and early postoperative hemodynamic and metabolic parameters. Materials and Methods: We reviewed data from 130 children who underwent liver transplant between 2005 and 2015. Recipients were divided into 2 groups: those with a graft weight to body weight ratio > 4% (large for size) and those with a ratio <= 4% (normal for size). Data included demographics, preoperative laboratory findings, intraoperative metabolic and hemodynamic parameters, and intensive care follow-up parameters. Results: Patients in the large-graft-for-size group (>4%) received more colloid solution (57.7 +/- 20.1 mL/kg vs 45.1 +/- 21.9 mL/kg; P = .08) and higher doses of furosemide (0.7 +/- 0.6 mg/kg vs 0.4 +/- 0.7 mg/kg; P = .018). They had lower mean pH (7.1 +/- 0.1 vs 7.2 +/- 0.1; P = .004) and PO2 (115.4 +/- 44.6 mm Hg vs 147.6 +/- 49.3 mm Hg; P = .004) values, higher blood glucose values (352.8 +/- 96.9 mg/dL vs 262.8 +/- 88.2 mg/dL; P < .001), and lower mean body temperature (34.8 +/- 0.7 degrees C vs 35.2 +/- 0.6 degrees C; P = .016) during the neohepatic phase. They received more blood transfusions during both the anhepatic (30.3 +/- 24.3 mL/kg vs 18.8 +/- 21.8 mL/kg; P = .013) and neohepatic (17.7 +/- 20.4 mL/kg vs 10.3 +/- 15.5 mL/kg; P = .031) phases and more fresh frozen plasma (13.6 +/- 17.6 mL/kg vs 6.2 +/- 10.2 mL/kg; P = .012) during the neohepatic phase. They also were more likely to be hypotensive (P < .05) and to receive norepinephrine infusion more often (44% vs 22%; P < .05) intra-operatively. More patients in this group were mechanically ventilated in the intensive care unit (56% vs 31%; P = .035). There were no significant differences between the groups in postoperative acute renal dysfunction, graft rejection or loss, infections, length of intensive care stay, and mortality (P > .05). Conclusions: High graft weight-to-body-weight ratio is associated with adverse metabolic and hemodynamic changes during the intraoperative and early postoperative periods. These results emphasize the importance of using an appropriately sized graft in liver transplant.