Review
Gastroenterology & Hepatology
Yong Lv, Daiming Fan, Guohong Han
Summary: Liver diseases, especially viral hepatitis, have a major impact in China and globally. Portal hypertension is the most severe complication of chronic liver diseases, and TIPS is an effective treatment for these complications. This review focuses on the history, current application, and management of TIPS complications in China.
LIVER INTERNATIONAL
(2023)
Article
Gastroenterology & Hepatology
Li Ma, Jingqin Ma, Wen Zhang, Qingxin Liu, Zihan Zhang, Minjie Yang, Jiaze Yu, Xin Zhou, Shiyao Chen, Jian Wang, Jianjun Luo, Zhiping Yan
Summary: In cirrhotic patients with variceal bleeding, delayed PPG has a higher predictive power for variceal rebleeding than immediate PPG.
HEPATOLOGY INTERNATIONAL
(2023)
Article
Medicine, General & Internal
Yonghua Bi, Jianzhuang Ren, Xinwei Han, Kefeng Guo, Xueliang Tu
Summary: This study compared the safety and efficacy of cTIPS and TIPS in cirrhotic patients with CTPV after conventional TIPS failure. Retrospective analysis of cirrhotic patients diagnosed with CTPV and treated with cTIPS or TIPS was conducted. The clinical outcomes, long-term survival rates, and patency rates were compared between the two groups. cTIPS was found to be safe and effective in these patients.
Review
Gastroenterology & Hepatology
Sern Wei Yeoh, Hong Kuan Kok
Summary: The use of TIPSS in patients with PVT is becoming more common and has shown positive outcomes. While technically challenging, TIPSS can effectively reduce portal hypertensive complications in PVT patients and should no longer be considered a contraindication. High-volume specialist centers are recommended for performing TIPSS in PVT patients to minimize procedural risks.
JOURNAL OF DIGESTIVE DISEASES
(2021)
Article
Multidisciplinary Sciences
Yang Chen, Chongtu Yang, Songjiang Huang, Jiacheng Liu, Yingliang Wang, Chen Zhou, Tongqiang Li, Chaoyang Wang, Shuguang Ju, Yaowei Bai, Wei Yao, Bin Xiong
Summary: Thrombocytopenia, the most frequent hematologic disorder in cirrhosis patients, is perceived as a contributing factor for bleeding events. However, this study found no statistically significant difference in bleeding rates after TIPS between the normal platelet count group and the thrombocytopenia group. Platelet count was not associated with bleeding events after TIPS, suggesting that thrombocytopenia should not be considered an absolute contraindication for TIPS in cirrhosis patients.
SCIENTIFIC REPORTS
(2023)
Article
Biology
Lingyu Jiang, Hao Han, Jian Yang, Runxin Fang, Ying Xin, Qiang Chen, Jing Yao, Zhiyong Li
Summary: This study investigated the effects of different stent insertion positions and diameters on the outcomes of TIPS surgery. The results showed that the stent insertion position had minimal impact on hemodynamic indexes and shunt effect. However, a larger diameter stent was found to improve the shunt effect compared to a smaller diameter one. Nevertheless, the higher risk of hepatic encephalopathy associated with the larger stent diameter suggested the use of a 6mm diameter stent.
COMPUTERS IN BIOLOGY AND MEDICINE
(2023)
Review
Radiology, Nuclear Medicine & Medical Imaging
Guang-Peng Zhou, Yi-Zhou Jiang, Li-Ying Sun, Zhi-Jun Zhu
Summary: Early transjugular intrahepatic portosystemic shunt (TIPS) placement in cirrhotic patients with acute variceal bleeding (AVB) has shown to significantly reduce mortality, control bleeding, and prevent rebleeding without increasing the risk of hepatic encephalopathy. The survival benefit of early TIPS was observed in high-risk patients, supporting its wider utilization in clinical practice.
EUROPEAN RADIOLOGY
(2021)
Review
Medicine, General & Internal
Ziyao Cheng, Jiayu Ju, Qingliang Zhu, Mingming Deng, Hailong Zhang
Summary: This case report discusses a patient with cirrhosis who developed intrahepatic hematoma and hepatic pseudoaneurysm due to hepatic artery injury after TIPSS. The report highlights the importance of paying attention to these complications and implementing early-stage prevention measures.
Article
Medicine, General & Internal
Hong-Liang Wang, Wei-Jie Lu, Yue-Lin Zhang, Chun-Hui Nie, Tan-Yang Zhou, Guan-Hui Zhou, Tong-Yin Zhu, Bao-Quan Wang, Sheng-Qun Chen, Zi-Niu Yu, Li Jing, Jun-Hui Sun
Summary: This study found that the presence or absence of portal vein thrombosis did not affect the survival rate or incidence of shunt dysfunction in cirrhosis patients undergoing TIPS treatment. Risk factors for mortality included age, MELD score, and refractory ascites.
FRONTIERS IN MEDICINE
(2021)
Review
Medicine, General & Internal
Sasidharan Rajesh, Shobhit Singh, Cyriac Abby Philips
Summary: This article provides a concise yet comprehensive overview of the role and placement scenarios of TIPS in patients with chronic non-malignant PVT, with or without underlying liver disease, supported by exemplary instances from the authors' experience.
Review
Gastroenterology & Hepatology
Hae Lim Lee, Sung Won Lee
Summary: Transjugular intrahepatic portosystemic shunt (TIPS) is an effective intervention to relieve portal hypertension and its complications. Careful patient selection and assessment can lead to excellent outcomes despite potential adverse events after TIPS implementation.
CLINICAL AND MOLECULAR HEPATOLOGY
(2022)
Article
Gastroenterology & Hepatology
Paola Ponzo, Daniela Campion, Martina Rizzo, Michele Roma, Gian Paolo Caviglia, Ilaria Giovo, Felice Rizzi, Silvia Bonetto, Giorgio Maria Saracco, Carlo Alessandria
Summary: The study found that TIPS can significantly improve renal function in patients with HRS-CKD in the early postoperative period, and this improvement is maintained throughout the follow-up period. The improvement is observed in every CKD stage, and TIPS also improves the control of ascites significantly. There is no significant difference in transplant-free survival rate regardless of the baseline CKD stage.
DIGESTIVE AND LIVER DISEASE
(2022)
Article
Gastroenterology & Hepatology
Jun Tie, Xiaoyuan Gou, Chuangye He, Kai Li, Xulong Yuan, Wenyuan Jia, Jing Niu, Na Han, Jiao Xu, Ying Zhu, Wenlan Wang
Summary: This study aimed to evaluate the efficacy and safety of transcollateral TIPS in the treatment of refractory variceal bleeding with cavernous transformation of the portal vein (CTPV). The results showed that transcollateral TIPS was as effective as portal vein recanalization-transjugular intrahepatic portosystemic shunt (PVR-TIPS) in terms of rebleeding rate, overall survival, shunt dysfunction, and operation-related complications. However, the rate of overt hepatic encephalopathy (OHE) was significantly lower in the transcollateral TIPS group.
HEPATOLOGY INTERNATIONAL
(2023)
Article
Biochemistry & Molecular Biology
Quan Chen, Li Bao, Zhendong Yue, Lei Wang, Zhenhua Fan, Fuquan Liu
Summary: This study found significant changes in metabolites in the peripheral and portal veins after TIPS, with some lipid metabolites significantly correlated with liver function parameters. Elevated and depleted metabolites were mainly enriched in amino acid metabolism. In addition, 9 portal metabolites showed good predictive value for post-TIPS liver function decline, and 12 portal metabolites showed good predictive value for hepatic encephalopathy.
FRONTIERS IN MOLECULAR BIOSCIENCES
(2023)
Article
Surgery
Pietro Addeo, Caroline Schaaf, Francois Faitot, Alfonso Terrone, Olivier Julliard, Camille Besch, Lawrence Serfaty, Philippe Bachellier
Summary: This systematic review examined the outcomes of liver transplantation with misplaced transjugular intrahepatic portosystemic shunt. It was found that in most cases, the misplaced shunt could be successfully removed with low mortality and good postoperative outcomes. However, some patients required additional surgical interventions postoperatively and certain complications were observed.
Article
Anesthesiology
Bernd Saugel, Elisa-Johanna Bebert, Luisa Briesenick, Phillip Hoppe, Gillis Greiwe, Dongsheng Yang, Chao Ma, Edward J. Mascha, Daniel Sessler, Dorothea E. Rogge
Summary: It is still unclear which hemodynamic mechanism contributes the most to hypotension after general anesthesia induction. This study found that arterial pressure and systemic vascular resistance index decreased significantly during anesthesia induction, while heart rate, stroke volume index, and cardiac index remained stable.
JOURNAL OF CLINICAL MONITORING AND COMPUTING
(2022)
Article
Anesthesiology
Moritz Flick, Phillip Hoppe, Jasmin Matin Mehr, Luisa Briesenick, Karim Kouz, Gillis Greiwe, Juergen Fortin, Bernd Saugel
Summary: The study validated the reliability of the PPVCNAP algorithm for pulse pressure variation, showing moderate absolute and predictive agreement between PPVCNAP and PPVINV when applied on the same arterial blood pressure waveform.
JOURNAL OF CLINICAL MONITORING AND COMPUTING
(2022)
Article
Gastroenterology & Hepatology
Sebastian Rasch, Eva-Maria Pichlmeier, Veit Phillip, Ulrich Mayr, Roland M. Schmid, Wolfgang Huber, Tobias Lahmer
Summary: The qSOFA score shows potential in predicting ICU admission and organ failure in acute pancreatitis. By combining respiratory rate, mental status, blood urea nitrogen, and C-reactive protein into the ERAP score, it can accurately predict severity, ICU admission, multi-organ dysfunction syndrome, and mortality in acute pancreatitis.
DIGESTIVE DISEASES AND SCIENCES
(2022)
Letter
Anesthesiology
Kamal Maheshwari, Bernd Saugel
JOURNAL OF CLINICAL ANESTHESIA
(2022)
Article
Anesthesiology
Phillip Hoppe, Christian Burfeindt, Philip C. Reese, Luisa Briesenick, Moritz Flick, Karim Kouz, Hans Pinnschmidt, Alexander Hapfelmeier, Daniel Sessler, Bernd Saugel
Summary: This study found that chronic arterial hypertension and nocturnal blood pressure non-dipping are independent risk factors for postinduction and intraoperative hypotension in non-cardiac surgery patients. Adding information on these factors improves the accuracy of hypotension prediction models based on preoperative clinical information.
JOURNAL OF CLINICAL ANESTHESIA
(2022)
Article
Medicine, General & Internal
Athanasios Chalkias, Nikolaos Papagiannakis, Bernd Saugel, Moritz Flick, Konstantina Kolonia, Zacharoula Angelopoulou, Dimitrios Ragias, Dimitra Papaspyrou, Aikaterini Bouzia, Nicoletta Ntalarizou, Konstantinos Stamoulis, Aikaterini Kyriakaki, Jesper Eugen-Olsen, Eleni Laou, Eleni Arnaoutoglou
Summary: This study found that elevated preoperative plasma suPAR levels were associated with intraoperative impairment of sublingual microvascular perfusion in patients undergoing major non-cardiac surgery. Specifically, higher suPAR levels were correlated with lower De Backer score, Consensus PPV, and Consensus PPV (small) during surgery.
JOURNAL OF CLINICAL MEDICINE
(2022)
Article
Anesthesiology
Kristen K. Thomsen, Linda Krause, Philipp Breitfeld, Karim Kouz, Jochen Herrmann, Viorel Chindris, Bernd Saugel, Leonie Schulte-Uentrop
PEDIATRIC ANESTHESIA
(2023)
Editorial Material
Anesthesiology
Bernd Saugel, Kristen K. Thomsen, Kamal Maheshwari
Summary: 'Goal-directed haemodynamic therapy' refers to different treatment strategies that adjust interventions based on predefined haemodynamic targets. However, these strategies differ significantly in terms of the underlying target variables and values, potentially leading to different treatment outcomes. Therefore, it is an oversimplification to lump diverse and complex haemodynamic treatment strategies under the term 'goal-directed haemodynamic therapy', and we should refrain from using this imprecise umbrella term.
BRITISH JOURNAL OF ANAESTHESIA
(2023)
Article
Anesthesiology
Karim Kouz, Lennart Brockmann, Lea Malin Timmermann, Alina Bergholz, Moritz Flick, Kamal Maheshwari, Daniel I. Sessler, Linda Krause, Bernd Saugel
Summary: Using machine learning, specifically hierarchical clustering, we identified six distinct endotypes of intraoperative hypotension, including myocardial depression, bradycardia, vasodilation with cardiac index increase, vasodilation without cardiac index increase, hypovolemia, and mixed type. These findings may facilitate more targeted treatment for intraoperative hypotension.
BRITISH JOURNAL OF ANAESTHESIA
(2023)
Letter
Anesthesiology
Gillis Greiwe, Bernd Saugel, Leonie Schulte-Uentrop
ANESTHESIA AND ANALGESIA
(2023)
Review
Critical Care Medicine
Kristen K. Thomsen, Karim Kouz, Bernd Saugel
Summary: The measurement of cardiac output (CO) using pulse wave analysis (PWA) is an important method in patients with circulatory shock. PWA methods can be classified into invasive, minimally invasive, and noninvasive systems, and require optimal arterial pressure waveform signals for accurate monitoring. Noninvasive PWA methods are generally not recommended in critically ill patients. PWA monitoring systems can be used to track stroke volume and CO continuously in real-time to evaluate fluid responsiveness or therapeutic interventions.
CURRENT OPINION IN CRITICAL CARE
(2023)
Article
Anesthesiology
Gillis Greiwe, Moritz Flick, Alexander Hapfelmeier, Martin S. Winkler, Rainer Nitzschke, Daniel Frings, Bernd Saugel
Summary: The study aims to assess the agreement between CO measured by PRAM and CO measured by TTE in adult patients with vvECMO therapy. The results indicate that PRAM-CO and TTE-CO show clinically acceptable agreement in these patients.
EUROPEAN JOURNAL OF ANAESTHESIOLOGY
(2023)
Article
Critical Care Medicine
Raphael Romano Bruno, Jakob Wollborn, Karl Fengler, Moritz Flick, Christian Jung, Sebastian Allgaeuer, Holger Thiele, Mara Schemmelmann, Johanna Hornemann, Helene Mathilde Emilie Moecke, Filiz Demirtas, Lina Palici, Marcus Franz, Bernd Saugel, Eduardo Kattan, Daniel De Backer, Jan Bakker, Glenn Hernandez, Malte Kelm, Christian Jung
Summary: This study aimed to determine whether considering sublingual microcirculatory perfusion variables improves the 30-day mortality in shock patients in the ICU. Results showed that although more patients in the intervention group had adjustments in medication or fluids within the next hour, there was no significant difference in microcirculatory values 24 hours later and 30-day mortality. Thus, integrating sublingual microcirculatory perfusion variables in the therapy plan did not improve patient survival.
INTENSIVE CARE MEDICINE
(2023)
Letter
Anesthesiology
Matthew R. Bright, Victoria Eley
ANESTHESIA AND ANALGESIA
(2023)
Review
Critical Care Medicine
Michael R. Pinsky, Maurizio Cecconi, Michelle S. Chew, Daniel De Backer, Ivor Douglas, Mark Edwards, Olfa Hamzaoui, Glenn Hernandez, Greg Martin, Xavier Monnet, Bernd Saugel, Thomas W. L. Scheeren, Jean-Louis Teboul, Jean-Louis Vincent
Summary: Hemodynamic monitoring plays a crucial role in acute care settings, but its effectiveness is hard to measure. This review summarizes the effectiveness of monitoring-linked resuscitation strategies, including process-specific monitoring, personalized resuscitation approaches, and machine learning methods. Future clinical trials should focus on process-specific monitoring to improve patient outcomes.
