Enhanced recovery after low- and medium-risk liver transplantation. A single-center prospective observational cohort study.

BACKGROUND & AIMS: Few studies have fully applied an enhanced recovery after surgery (ERAS) protocol to liver transplantation (LT). Our aim was to assess the effects of a comprehensive ERAS protocol in our cohort of low- and medium-risk LT patients. METHODS: The ERAS protocol included pre-, intra-, and post-operative steps. During the five-year study period, 181 LT were performed in our institution. Two cohorts were identified: low risk patients (n = 101) had a laboratory model for end-stage liver disease (MELD) score of 20 points or less at the time of LT, received a liver from a donor after brain death, and had a balance of risk score of 9 points or less; medium-risk patients (n = 15) had identical characteristics except for a higher MELD score (21-30 points). In addition, we analyzed the remaining patients (n = 65) who were transplanted over the same study period separately using the ERAS protocol. RESULTS: The low-risk cohort showed a low need for packed red blood cells transfusion (median: 0 units) and renal replacement therapy (1%), as well as a short length of stay both in the intensive care unit (13 h) and in the hospital (4 days); morbidity during one-year follow-up, and probability of surviving to one year (89.30%) and five years (76.99%) were in line with well-established reference data. Similar findings were observed in the medium-risk cohort. CONCLUSIONS: This single-center prospective observational cohort study provides evidence that ERAS is feasible and safe for low- and medium-risk LT.

[The metoclopramide effect on enteral nutrition tolerance and mechanical ventilation associated pneumonia in neuro critically ill patients]. / Efecto de la metoclopramida sobre la tolerancia enteral y la neumonía asociada a ventilación mecánica en pacientes neurocríticos.

INTRODUCTION: The use of procinéticos in the critical patient with nutrition enteral, they have as aim reduce the increase of the gastric residue (RG). We evaluate his efficiency in the improvement of the intake enteral and on the reduction in the incident gastrointestinal complications (CGI) and pneumonia, in critical patients, with neurological injury Aims: To evaluate the effects in the administration metoclopramide (MCG), during the first five days with enteral nutrition, versus control (GC), on the volume of administered diet, gastrointestinal complications and the incidence of mechanical ventilation associated pneumonia (NAVM), in neuro-critically patients (NC) of traumatic and vascular aetiology. Prospective, closed-label, randomized study performed in an intensive Care Unit. Methords: 150 adult neuro-critical patients (NC) were admitted of consecutive form and 109 were randomly and two groups 58 MCG y 51 GC. The primary outcomes was the nutritional: the volume of administered diet (VAD); mean efficacious volume (MEV) measured in three consecutive periods of time; the gastrointestinal complications (GIC), and the rate of partial and definitive suspension of the diet. Infecction: incidence of ventilator associated pneumonia NAVM; and of secondary outcomes were: the duration of mechanical ventilation, length of ICU and hospital stay, and incidence the serious sequelae, and 30 days mortality. RESULTS: Differences were not observed in the severity variables between groups on admission. A significant increase was observed in the global values and in the first five days of (p < 0.03) of the VEM in the group of MCG. The values of the global VDA and during three phases of study, the number CGI, the rate of partial and definitive suspensions of the diet, and number of NAVM, were similar in both not significant groups. Neither differences were observed in the overall analysis secondary variables. CONCLUSIONS: The metoclopramida in the NC, it is not effective in the decrease of the CGI, in the doses and time of treatment reflected in the study.

Introducción: El uso de procinéticos en el paciente crítico con nutrición enteral, tienen como objetivo el reducir el aumento del residuo gástrico (RG). Analizamos su eficacia en la mejoría del aporte enteral y sobre la reducción en la incidencia complicaciones gastrointestinales (CGI) y neumonía, en pacientes críticos, con lesión neurológica Objetivos: Medir los efectos en la administración metoclopramida (MCG) durante los primeros cinco días con nutrición enteral, versus control (GC), sobre el volumen de dieta enteral administrada, el número de complicaciones gastrointestinales y la incidencia de neumonía asociada a ventilación mecánica (NAVM); en enfermos neurocríticos de etiología traumática y vascular. Métodos: De los 150 pacientes NC ingresados de forma consecutiva, 109 fueron aleatorizados en dos grupos: 58 MCG y 51 GC. Los objetivos primarios fueron: nutricionales: el volumen de dieta administrada (VDA), el volumen eficaz (VEM), el número de complicaciones gastrointestinales (CGI) y la tasa de suspensión temporal y definitiva de la dieta. Infecciosos: incidencia de neumonía asociada a ventilación mecánica (NAVM). Fueron objetivos secundarios: la duración de la ventilación mecánica, la estancia en UCI y hospitalaria, la secuela neurológica grave al alta y la mortalidad a los 30 días. Resultados: No se observaron diferencias en los parámetros de gravedad entre grupos al ingreso. Un incremento significativo fue observado en el análisis global y a los cinco días (p < 0,03) del VEM en el grupo de MCG. Los valores del VDA global y durante las dos fases de estudio, el número de CGI y el número de suspensiones parciales y definitivas de la dieta o el número de NAVM fueron similares en ambos grupos, no significativos. Tampoco se observaron diferencias en los diferentes objetivos secundarios Conclusión: El uso de metoclopramida en el enfermo neurocrítico, no es eficaz en la disminución de las CGI, en las dosis y tiempo de tratamiento reflejados en el estudio.

Efecto de la metoclopramida sobre la tolerancia enteral y la neumonía asociada a ventilación mecánica en pacientes neurocríticos / The metoclopramide effect on enteral nutrition tolerance and mechanical ventilation associated pneumonia in neuro critically ill patients

Introducción: El uso de procinéticos en el paciente crítico con nutrición enteral, tienen como objetivo el reducir el aumento del residuo gástrico (RG). Analizamos su eficacia en la mejoría del aporte enteral y sobre la reducción en la incidencia complicaciones gastrointestinales (CGI) y neumonía, en pacientes críticos, con lesión neurológica Objetivos: Medir los efectos en la administración metoclopramida (MCG) durante los primeros cinco días con nutrición enteral, versus control (GC), sobre el volumen de dieta enteral administrada, el número de complicaciones gastrointestinales y la incidencia de neumonía asociada a ventilación mecánica (NAVM); en enfermos neurocríticos de etiología traumática y vascular. Métodos: De los 150 pacientes NC ingresados de forma consecutiva, 109 fueron aleatorizados en dos grupos: 58 MCG y 51 GC. Los objetivos primarios fueron: nutricionales: el volumen de dieta administrada (VDA), el volumen eficaz (VEM), el número de complicaciones gastrointestinales (CGI) y la tasa de suspensión temporal y definitiva de la dieta. Infecciosos: incidencia de neumonía asociada a ventilación mecánica (NAVM). Fueron objetivos secundarios: la duración de la ventilación mecánica, la estancia en UCI y hospitalaria, la secuela neurológica grave al alta y la mortalidad a los 30 días. Resultados: No se observaron diferencias en los parámetros de gravedad entre grupos al ingreso. Un incremento significativo fue observado en el análisis global y a los cinco días (p < 0,03) del VEM en el grupo de MCG. Los valores del VDA global y durante las dos fases de estudio, el número de CGI y el número de suspensiones parciales y definitivas de la dieta o el número de NAVM fueron similares en ambos grupos, no significativos. Tampoco se observaron diferencias en los diferentes objetivos secundarios Conclusión: El uso de metoclopramida en el enfermo neurocrítico, no es eficaz en la disminución de las CGI, en las dosis y tiempo de tratamiento reflejados en el estudio (AU)

Introduction: The use of procinéticos in the critical patient with nutrition enteral, they have as aim reduce the increase of the gastric residue (RG). We evaluate his efficiency in the improvement of the intake enteral and on the reduction in the incident gastrointestinal complications (CGI) and pneumonia, in critical patients, with neurological injury Aims: To evaluate the effects in the administration metoclopramide (MCG), during the first five days with enteral nutrition, versus control (GC), on the volume of administered diet, gastrointestinal complications and the incidence of mechanical ventilation associated pneumonia (NAVM), in neuro-critically patients (NC) of traumatic and vascular aetiology. Prospective, closed-label, randomized study performed in an intensive Care Unit. Methods: 150 adult neuro-critical patients (NC) were admitted of consecutive form and 109 were randomly and two groups 58 MCG y 51 GC. The primary outcomes was the nutritional: the volume of administered diet (VAD); mean efficacious volume (MEV) measured in three consecutive periods of time; the gastrointestinal complications (GIC), and the rate of partial and definitive suspension of the diet. Infecction: incidence of ventilator associated pneumonia NAVM; and of secondary outcomes were: the duration of mechanical ventilation, length of ICU and hospital stay, and incidence the serious sequelae, and 30 days mortality. Results: Differences were not observed in the severity variables between groups on admission. A significant increase was observed in the global values and in the first five days of (p < 0.03) of the VEM in the group of MCG. The values of the global VDA and during three phases of study, the number CGI, the rate of partial and definitive suspensions of the diet, and number of NAVM, were similar in both not significant groups. Neither differences were observed in the overall analysis secondary variables. Conclusions: The metoclopramida in the NC, it is not effective in the decrease of the CGI, in the doses and time of treatment reflected in the study (AU)