MP31-05 TOWARDS GOAL-DIRECTED ANESTHESIA DECISION-MAKING IN KIDNEY TRANSPLANTATION
Notice bibliographique
Résumé
You have accessJournal of UrologyCME1 Apr 2023MP31-05 TOWARDS GOAL-DIRECTED ANESTHESIA DECISION-MAKING IN KIDNEY TRANSPLANTATION Rohit Malyala, Anna-Lisa Nguyen, Erika Escamilla, Lucie Hammond, Sasha Vozynuk, Hana Mehdic, and Christopher Nguan Rohit MalyalaRohit Malyala More articles by this author , Anna-Lisa NguyenAnna-Lisa Nguyen More articles by this author , Erika EscamillaErika Escamilla More articles by this author , Lucie HammondLucie Hammond More articles by this author , Sasha VozynukSasha Vozynuk More articles by this author , Hana MehdicHana Mehdic More articles by this author , and Christopher NguanChristopher Nguan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003264.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Intraoperative hemodynamics are understood to influence the incidence of delayed graft function (DGF), defined as the need for dialysis within one week of transplant. However, there is limited evidence on best practices in anesthesia, pressor use, and fluid management in transplant recipients. We aim to characterize features of intra-operative anesthesia courses in order to determine whether such parameters associate with DGF. METHODS: 671 kidney transplant recipients were included from surgeries performed at a single academic medical centre (Vancouver General Hospital, 2014-2020) based on availability of the anesthetic record, operative note, and discharge summary. The anesthetic records comprised medications and fluids administered (including quantities, timing, and rate of administration), and hemodynamics throughout the procedure, in 5 minute intervals. Information on major time points such as timing of vascular clamp, anastomosis, etc. were obtained from post-operative notes. Repeated univariate logistic regression after feature extraction of time-series variables was used for hypothesis testing. RESULTS: 142 DGF events were captured in our cohort (62/294 NDD; 80/167 DCD; 11/210 LD). Notably, diastolic blood pressure and mean arterial pressure throughout the operation were substantially lower in DGF recipients (average DBP: p=0.001, average MAP: p=0.002). Limiting analysis to DCD/NDD grafts, intraoperative hypotension expressed as the lowest intraoperative MAP post-anastomosis was significantly associated with DGF incidence, with greater hypotension susceptibility noted in DCD over NDD grafts. An interaction logistic terms regression analysis between lowest post-anastomosis MAP and pressor use was also performed, which indicated that DGF incidence in both DCDs and NDDs was lower in low-MAP patients (<65mmHg) when pressors were used, but that DGF incidence was higher in patients where pressors were used if the lowest intra-operative MAP was above 65 mmHg. CONCLUSIONS: We have collated a highly granular transplant anesthesia dataset depicting a preliminary view into intraoperative hemodynamics and decision-making. Future steps include further interrogation of the data and prospective study to inform goal-directed anesthesia. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e431 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rohit Malyala More articles by this author Anna-Lisa Nguyen More articles by this author Erika Escamilla More articles by this author Lucie Hammond More articles by this author Sasha Vozynuk More articles by this author Hana Mehdic More articles by this author Christopher Nguan More articles by this author Expand All Advertisement PDF downloadLoading ...
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,034 | 0,079 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,002 | 0,001 |
| Études des sciences et des technologies | 0,002 | 0,002 |
| Communication savante | 0,010 | 0,004 |
| Science ouverte | 0,003 | 0,010 |
| Intégrité de la recherche | 0,006 | 0,012 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,136 | 0,084 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».