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Porcine model characterizing various parameters assessing the outcome after acetaminophen intoxication induced acute liver failure

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World Journal of Gastroenterology 2017年第9期23卷 1576-1585页

作者： Karolin Thiel Wilfried klingert kathrin klingert Matthias H Morgalla Martin U Schuhmann Pamela Leckie Yalda Sharifi Nathan A Davies Rajiv Jalan Andreas Peter Christian Grasshoff Alfred Konigsrainer Martin Schenk Christian Thiel Department of General Visceral and Transplant SurgeryTuebingen University Hospital Department of Anaesthesiology Tuebingen University Hospital Department of Neurosurgery Tuebingen University Hospital Institute for Liver and Digestive Health University College London Division of Endocrinology DiabetologyAngiologyNephrologyPathobiochemistry and Clinical ChemistryDepartment of Internal MedicineTuebingen University Hospital

AIM To investigate the changes of hemodynamic and laboratory parameters during the course of acute liver failure following acetaminophen *** Eight pigs underwent a midline laparotomy following jejunal catheter placement for further acetaminophen intoxication and positioning of a portal vein Doppler flow-probe. Acute liver failure was realized by intrajejunal acetaminophen administration in six animals, two animals were sham operated. All animals were invasively monitored and received standardized intensive care support throughout the study. Portal blood flow, hemodynamic and ventilation parameters were continuously recorded. Laboratory parameters were analysed every eight hours. Liver biopsies were sampled every 24 h following intoxication and upon *** Acute liver failure (ALF) occurred after 28 ± 5 h resulted in multiple organ failure and death despite maximal support after further 21 ± 1 h (study end). Portal blood flow (baseline 1100 ± 156 m L/min) increased to a maximum flow of 1873 ± 175 m L/min at manifestation of ALF, which was significantly elevated(P 0.01).CONCLUSION Declining portal blood flow and subsequent severe thrombocytopenia after acetaminophen intoxication precede fatality in a porcine acute liver failure model.

关键词： Acetaminophen 沉醉尖锐的肝失败门血流动 Thrombocytopenia 动物模型猪的模型

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Algorithm-based arterial blood sampling recognition increasing safety in point-of-care diagnostics

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World Journal of Critical Care Medicine 2017年第3期6卷 172-178页

作者： Jorg Peter Wilfried klingert kathrin klingert Karolin Thiel Daniel Wulff Alfred Konigsrainer Wolfgang Rosenstiel Martin Schenk Department of Computer Engineering University of Tübingen Department of General Visceral and Transplant Surgery University Hospital Tübingen Department of Anesthesiology and Intensive Care Medicine University Hospital Tübingen

AIM To detect blood withdrawal for patients with arterial blood pressure monitoring to increase patient safety and provide better sample *** Blood pressure information obtained from a patient monitor was fed as a real-time data stream to an experimental medical framework. This framework was connected to an analytical application which observes changes in systolic, diastolic and mean pressure to determine anomalies in the continuous data stream. Detection was based on an increased mean blood pressure caused by the closing of the withdrawal three-way tap and an absence of systolic and diastolic measurements during this manipulation. For evaluation of the proposed algorithm, measured data from animal studies in healthy pigs were *** Using this novel approach for processing real-time measurement data of arterial pressure monitoring, the exact time of blood withdrawal could be successfully detected retrospectively and in real-time. The algorithm was able to detect 422 of 434(97%) blood withdrawals for blood gas analysis in the retrospective analysis of 7 study trials. Additionally, 64 sampling events for other procedures like laboratory and activated clotting time analyses were detected. The proposed algorithm achieved a sensitivity of 0.97, a precision of 0.96 and an F1 score of *** Arterial blood pressure monitoring data can be used toperform an accurate identification of individual blood samplings in order to reduce sample mix-ups and thereby increase patient safety.

关键词： Blood withdrawal detection Sample dating algorithm Arterial blood gas analysis Patient monitoring Point-of-care diagnostics

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