scholarly journals Single-dose pharmacokinetics of the cholesteryl sulfate complex of amphotericin B in critically ill patients with cholestatic liver failure

Critical Care ◽  
2008 ◽  
Vol 12 (Suppl 2) ◽  
pp. P23
Author(s):  
S Weiler ◽  
M Joannidis ◽  
R Bellmann-Weiler ◽  
R Bellmann
Keyword(s):  
Single Dose ◽  
Liver Failure ◽  
Amphotericin B ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Sulfate Complex ◽  
Cholesteryl Sulfate

Point-of-Care Echocardiography and Hemodynamic Monitoring in Cirrhosis and Acute-on-Chronic Liver Failure in the COVID-19 Era

2021 ◽  
pp. 088506662098828
Author(s):  
Madhumita Premkumar ◽  
Kamal Kajal ◽  
Anand V. Kulkarni ◽  
Ankur Gupta ◽  
Smita Divyaveer
Keyword(s):  
Intensive Care ◽  
Liver Failure ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Point Of Care ◽  
Kidney Injury ◽  
Regional Wall Motion ◽  
Chronic Liver ◽  
Chronic Liver Failure ◽  
Evidenced Based

Point-of-Care (POC) transthoracic echocardiography (TTE) is transforming the management of patients with cirrhosis presenting with septic shock, acute kidney injury, hepatorenal syndrome and acute-on-chronic liver failure (ACLF) by correctly assessing the hemodynamic and volume status at the bedside using combined echocardiography and POC ultrasound (POCUS). When POC TTE is performed by the hepatologist or intensivist in the intensive care unit (ICU), and interpreted remotely by a cardiologist, it can rule out cardiovascular conditions that may be contributing to undifferentiated shock, such as diastolic dysfunction, myocardial infarction, myocarditis, regional wall motion abnormalities and pulmonary embolism. The COVID-19 pandemic has led to a delay in seeking medical treatment, reduced invasive interventions and deferment in referrals leading to “collateral damage” in critically ill patients with liver disease. Thus, the use of telemedicine in the ICU (Tele-ICU) has integrated cardiology, intensive care, and hepatology practices across the spectrum of ICU, operating room, and transplant healthcare. Telecardiology tools have improved bedside diagnosis when introduced as part of COVID-19 care by remote supervision and interpretation of POCUS and echocardiographic data. In this review, we present the contemporary approach of using POC echocardiography and offer a practical guide for primary care hepatologists and gastroenterologists for cardiac assessment in critically ill patients with cirrhosis and ACLF. Evidenced based use of Tele-ICU can prevent delay in cardiac diagnosis, optimize safe use of expert resources and ensure timely care in the setting of critically ill cirrhosis, ACLF and liver transplantation in the COVID-19 era.

The ten tips to manage critically ill patients with acute-on-chronic liver failure

2018 ◽  
Vol 44 (11) ◽  
pp. 1932-1935 ◽  
Author(s):  
Valentin Fuhrmann ◽  
Tony Whitehouse ◽  
Julia Wendon
Keyword(s):  
Liver Failure ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Chronic Liver ◽  
Chronic Liver Failure

scholarly journals Pharmacokinetics of Amphotericin B Colloidal Dispersion in Critically Ill Patients with Cholestatic Liver Disease

2012 ◽  
Vol 56 (10) ◽  
pp. 5414-5418 ◽  
Author(s):  
Stefan Weiler ◽  
Elisabeth Überlacher ◽  
Julia Schöfmann ◽  
Eva Stienecke ◽  
Stefan Dunzendorfer ◽  
...  
Keyword(s):  
Steady State ◽  
Liver Disease ◽  
Amphotericin B ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Normal Liver ◽  
Colloidal Dispersion ◽  
Cholestatic Liver Disease ◽  
Normal Liver Function ◽  
Standard Dosage

ABSTRACTThe pharmacokinetics of lipid-bound and liberated amphotericin B (AMB) was assessed in 11 critically ill patients with cholestatic liver disease (CSLD) and in 9 subjects with normal liver function treated with AMB colloidal dispersion (ABCD). Exposure to lipid-bound AMB was higher in patients with CSLD. Levels of liberated AMB were elevated by CSLD only after the first dose, whereas its pharmacokinetics was unaffected at steady state. The standard dosage of ABCD is probably adequate for patients with CSLD.

Balanced haemostasis with both hypo- and hyper-coagulable features in critically ill patients with acute-on-chronic-liver failure

2018 ◽  
Vol 43 ◽  
pp. 54-60 ◽  
Author(s):  
Caleb Fisher ◽  
Vishal C. Patel ◽  
Sidsel Hyldgaard Stoy ◽  
Arjuna Singanayagam ◽  
Jelle Adelmeijer ◽  
...  
Keyword(s):  
Liver Failure ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Chronic Liver ◽  
Chronic Liver Failure

scholarly journals Risk factors for death among critically ill patients with acute renal failure

2006 ◽  
Vol 124 (5) ◽  
pp. 257-263 ◽  
Author(s):  
Geraldo Bezerra da Silva Júnior ◽  
Elizabeth De Francesco Daher ◽  
Rosa Maria Salani Mota ◽  
Francisco Albano Menezes
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Mechanical Ventilation ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Intensive Care ◽  
Liver Failure ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Urine Volume

CONTEXT AND OBJECTIVE: Acute renal failure is a common medical problem, with a high mortality rate. The aim of this work was to investigate the risk factors for death among critically ill patients with acute renal failure. DESIGN AND SETTING: Retrospective cohort at the intensive care unit of Hospital Universitário Walter Cantídio, Fortaleza. METHODS: Survivors and non-survivors were compared. Univariate and multivariate analyses were performed to establish risk factors for death. RESULTS: Acute renal failure occurred in 128 patients (33.5%), with mean age of 49 ± 20 years (79 males; 62%). Death occurred in 80 (62.5%). The risk factors most frequently associated with death were hypotension, sepsis, nephrotoxic drug use, respiratory insufficiency, liver failure, hypovolemia, septic shock, multiple organ dysfunction, need for vasoactive drugs, need for mechanical ventilation, oliguria, hypoalbuminemia, metabolic acidosis and anemia. There were negative correlations between death and: prothrombin time, hematocrit, hemoglobin, systolic blood pressure, diastolic blood pressure, arterial pH, arterial bicarbonate and urine volume. From multivariate analysis, the independent risk factors for death were: need for mechanical ventilation (OR = 3.15; p = 0.03), hypotension (OR = 3.48; p = 0.02), liver failure (OR = 5.37; p = 0.02), low arterial bicarbonate (OR = 0.85; p = 0.005), oliguria (OR = 3.36; p = 0.009), vasopressor use (OR = 4.83; p = 0.004) and sepsis (OR = 6.14; p = 0.003). CONCLUSIONS: There are significant risk factors for death among patients with acute renal failure in intensive care units, which need to be identified at an early stage for early treatment.

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