Utility of Basal Regional Oximetry Saturation for the Diagnosis of Acute Tubular Necrosis in the Early Postoperative Period Following Kidney Transplantation.

INTRODUCTION: Adequate perfusion and oxygenation to a renal graft after transplantation are essential for its viability. Regional renal oximetry (RSrO2) through near-infrared spectroscopy shows real-time oxygen content of the graft. METHODS: A prospective study was conducted. We enrolled consecutive patients undergoing renal transplant from deceased donors from January 2015 to February 2016. RSrO2 was continuously measured for 24 hours, analyzed, and correlated with other clinical data such as hemoglobin, mixed central venous oxygen saturation (ScvO2), blood pressure, central venous pressure, diuresis, and blood lactate. Severity disease scales, cold and warm ischemia times were also measured, as well as the pulsatility index (PI) and resistive index (RI) by Doppler-dúplex ultrasound (DUS) at 24 hours. A statistical analysis with IBM SPSS version 22 (IBM, Armonk, NY) using a Pearson correlation was carried out. RESULTS: RSrO2 could anticipate serious arterial and bleeding events showing a maintained decrease >10% from basal data. A significant correlation was found between RSrO2 with lactate at 8 and 24 hours (P = .005 and P = .000 respectively), as well as with initial diuresis at hour 3 (P = .010), initial ScvO2 (P = .010), Sequential Organ Failure Assessment (P = .015), and warm ischemia (P = .035). A significant correlation was also detected between cold ischemia, RI, and diuresis (P = .037 and P = .049 respectively). No correlation was found between RSrO2 and DUS data. CONCLUSION: RSrO2 is a useful tool for initial kidney transplant grafts monitoring and could give early warnings regarding bleeding and arterial thrombosis. RSrO2 is found to have a correlation with initial diuresis, blood lactate, and ScvO2. No matching data with Doppler was found.

Utility of Basal Regional Oximetry as an Early Predictor of Graft Failure After Liver Transplant.

INTRODUCTION: Adequate perfusion and oxygenation to liver graft after transplantation is essential for its viability. Hepatic oximetry (hepatic tissue oxygenation [LSrO2]) through near infrared spectroscopy (NIRS) can help by showing real time oxygen content of the graft. METHODS: In this prospective study, we enrolled 50 consecutive patients undergoing liver transplant surgery from deceased donors. Liver NIRS (LSrO2) was continuously measured for 24 hours then analyzed and correlated with other clinical data such as hemoglobin (Hb), mixed venous oxygen saturation, cardiac index (CI), central venous pressure, arterial gases, diuresis, blood lactate, liver biochemistry, and normalized index ratio (INR). Severity disease scales and cold-warm ischemia time were also measured, as well as Doppler ultrasound (DUS) at hour 24. A statistical analysis with IBM SPSS 22 using Pearson correlation was carried out. RESULTS: LSrO2 could anticipate serious bleeding and hemodynamic events showing a decrease >10% from basal data. We found a significant correlation between LSrO2 with CI at 3 hours (P=.044), hemoglobin (Hb) at hour 3 and 24 (P = .004 and P = .002, respectively), and with Apache II (P=.041). A significant correlation was also detected between cold ischemia and INR at hour 24 (P=.016). No correlation of LSrO2 was found with lactate, liver biochemistry, and DUS data.

[Construction and validation of a severity of illness index of patients hospitalized in clinical areas]. / Construcción y validación de un índice de gravedad para pacientes hospitalizados en áreas clínicas.

Severity of illness indexes for hospitalized patients are frequently used for the assessment of hospital performance. The purpose here was to develop and validate a quantitative index for clinical areas which could measure severity of illness during hospitalization period and would be easy to obtain from the information contained in a regular clinical chart. The construction included item selection and search for items weights. Experts and literature were consulted and 74 clinical records provided empirical information. The result was the proposal of an index with two alternatives: one quantitative and the other ordinal with four levels of severity. Validation included four aspects of validity, general reliability, interrater agreement and internal consistency. Sixteen specialized physicians assessed content and face validity. One hundred clinical records of discharged patients were used to assess criterion, construct validity and reliability. Results show satisfactory validity in almost all aspects. The reliability coefficient was 0.95, Kappa coefficient was 0.4 for the ordinal index and correlation coefficients over 0.93 for the quantitative one. The index is ready for current applications in this context although some suggestions for future improvements were also included.

[Variations in the postoperative length of stay according to patient characteristics in a general surgery service]. / Variaciones del tiempo de estancia postoperatoria según las características de los pacientes en un servicio de cirugía general.

With the purpose of identifying factors that explain variations in length of postoperative stay in a general surgery unit, information from 666 clinical records of discharged alive patients was collected. Factors related to the surgical procedure, the severity of the disease and the medical team together with sociodemographic characteristics of the patients were analyzed. Statistical analysis was based on analysis of variance and multiple linear regression. Variables with statistically significant regression coefficients (p < 0.001) were in this order: severity of complications, type of intervention, need for reintervention and severity of diagnosis. Sixty-seven percent of length of stay variation was explained by the included variables. Results allow to suggest an evaluation procedure which takes into account patient and operation characteristics.