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  1. Article ; Online: The 2023 Sir David Cuthbertson Lecture. A fluid journey: Experiments that influenced clinical practice.

    Lobo, Dileep N

    Clinical nutrition (Edinburgh, Scotland)

    2023  Volume 42, Issue 11, Page(s) 2270–2281

    Abstract: This review summarises some of my work on fluid and electrolyte balance over the past 25 years and shows how the studies have influenced clinical practice. Missing pieces in the jigsaw are filled in by summarising the work of others. The main theme is ... ...

    Abstract This review summarises some of my work on fluid and electrolyte balance over the past 25 years and shows how the studies have influenced clinical practice. Missing pieces in the jigsaw are filled in by summarising the work of others. The main theme is the biochemical, physiological and clinical problems caused by inappropriate use of saline solutions including the hyperchloraemic acidosis caused by 0.9% saline. The importance of accurate and near-zero fluid balance in clinical practice is also emphasised. Perioperative fluid and electrolyte therapy has important effects on clinical outcome in a U-shaped dose response fashion, in which excess or deficit progressively increases complications and worsens outcome. Salt and water overload, with weight gain in excess of 2.5 kg worsens surgical outcome, impairs gastrointestinal function and increases the risk of anastomotic dehiscence. Hyperchloraemic acidosis caused by overenthusiastic infusion of 0.9% saline leads to adverse outcomes and dysfunction of many organ systems, especially the kidney. Salt and water deficit causes similar adverse effects as fluid overload at the cellular level and also leads to worse outcomes. Serum albumin is shown to be affected mainly by dilution and inflammation and is not a good nutritional marker. These findings have been incorporated in the British consensus Guidelines on Intravenous Fluid Therapy for Adult Surgical Patients (GIFTASUP) and National Institute for Health and Care Excellence (NICE) guidelines on intravenous fluid therapy in adults in hospital and are helping change clinical practice and improve outcomes.
    MeSH term(s) Adult ; Humans ; Saline Solution ; Fluid Therapy/adverse effects ; Water-Electrolyte Balance/physiology ; Sodium Chloride ; Acidosis/etiology ; Water
    Chemical Substances Saline Solution ; Sodium Chloride (451W47IQ8X) ; Water (059QF0KO0R)
    Language English
    Publishing date 2023-10-03
    Publishing country England
    Document type Journal Article ; Review ; Research Support, Non-U.S. Gov't
    ZDB-ID 604812-2
    ISSN 1532-1983 ; 0261-5614
    ISSN (online) 1532-1983
    ISSN 0261-5614
    DOI 10.1016/j.clnu.2023.09.029
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    In stock of ZB MED Cologne/Königswinter

    Zs.A 1774: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)

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  2. Article ; Online: Exploring the need for reconsideration of trial design in perioperative outcomes research: a narrative review.

    Kehlet, Henrik / Lobo, Dileep N

    EClinicalMedicine

    2024  Volume 70, Page(s) 102510

    Abstract: Enhanced recovery after surgery" is a multimodal effort to control perioperative pathophysiology and improve outcome. However, despite advances in perioperative care, postoperative complications and the need for hospitalisation and prolonged recovery ... ...

    Abstract "Enhanced recovery after surgery" is a multimodal effort to control perioperative pathophysiology and improve outcome. However, despite advances in perioperative care, postoperative complications and the need for hospitalisation and prolonged recovery continue to be challenging. This is further complicated by procedure-specific and patient-associated risk factors, given the increase in the number of elderly and frail patients with multiple comorbidities undergoing surgery. This paper is a critical assessment of current methodology for trials in perioperative medicine. We make a plea to reconsider the design of future interventional trials to improve surgical outcome, based upon studies of potentially effective interventions, but often without improvements in recovery. The complexity of perioperative pathophysiology necessitates a procedure- and patient-specific approach whenever outcome is assessed or interventions are planned. With improved understanding of perioperative pathophysiology, the way to improve outcomes looks promising, provided that knowledge and established enhanced recovery programmes are integrated in trial design.
    Funding: None.
    Language English
    Publishing date 2024-02-29
    Publishing country England
    Document type Journal Article ; Review
    ISSN 2589-5370
    ISSN (online) 2589-5370
    DOI 10.1016/j.eclinm.2024.102510
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  3. Article ; Online: The clinical significance of hypoalbuminaemia.

    Allison, Simon P / Lobo, Dileep N

    Clinical nutrition (Edinburgh, Scotland)

    2024  Volume 43, Issue 4, Page(s) 909–914

    Abstract: Albumin is a relatively small molecule with a radius of 7.5 nm and a molecular weight of 65 kDa. It is the most abundant protein in plasma, accounting for 60-75% of its oncotic pressure. Its concentration in plasma is merely one static measurement ... ...

    Abstract Albumin is a relatively small molecule with a radius of 7.5 nm and a molecular weight of 65 kDa. It is the most abundant protein in plasma, accounting for 60-75% of its oncotic pressure. Its concentration in plasma is merely one static measurement reflecting a dynamic and complex system of albumin physiology, and is the net result of several different processes, one or more of which may become deranged by disease or its treatment. It is also unsurprising that hypoalbuminaemia has proved to be an indicator of morbidity and mortality risk since the underlying conditions which cause it, including protein energy malnutrition, crystalloid overload, inflammation, and liver dysfunction are themselves risk factors. In some cases, its underlying cause may require treatment but mostly it is just a parameter to be monitored and used as one measure of clinical progress or deterioration. While malnutrition, associated with a low protein intake, may be a contributory cause of hypoalbuminaemia, in the absence of inflammation and/or dilution with crystalloid its development in response to malnutrition alone is slow compared with the rapid change caused by inflammatory redistribution or dilution with crystalloids. Other significant causes include liver dysfunction and serous losses. These causal factors may occur singly or in combination in any particular case. Treatment is that of the underlying causes and associated conditions such as a low plasma volume, not of hypoalbuminaemia per se.
    MeSH term(s) Humans ; Hypoalbuminemia/etiology ; Clinical Relevance ; Albumins ; Inflammation/complications ; Malnutrition/complications ; Crystalloid Solutions ; Liver Diseases/complications
    Chemical Substances Albumins ; Crystalloid Solutions
    Language English
    Publishing date 2024-02-22
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 604812-2
    ISSN 1532-1983 ; 0261-5614
    ISSN (online) 1532-1983
    ISSN 0261-5614
    DOI 10.1016/j.clnu.2024.02.018
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  4. Article ; Online: People with diabetes undergoing surgery: Level of knowledge of fluid prescribing in trainees in diabetes.

    Dhatariya, Ketan / Lobo, Dileep N

    Diabetic medicine : a journal of the British Diabetic Association

    2024  , Page(s) e15324

    Language English
    Publishing date 2024-03-29
    Publishing country England
    Document type Journal Article
    ZDB-ID 605769-x
    ISSN 1464-5491 ; 0742-3071 ; 1466-5468
    ISSN (online) 1464-5491
    ISSN 0742-3071 ; 1466-5468
    DOI 10.1111/dme.15324
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    Zs.A 1954: Show issues Location:
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  5. Article: A pen in the liver.

    Barrie, Jenifer / Lobo, Dileep N

    Radiology case reports

    2022  Volume 17, Issue 10, Page(s) 3992–3995

    Abstract: A 24-year-old woman with anxiety, depression, and emotionally unstable personality disorder was referred to a tertiary center 2 weeks after ingesting multiple foreign bodies. She had undergone a laparoscopic cholecystectomy and a laparotomy for ... ...

    Abstract A 24-year-old woman with anxiety, depression, and emotionally unstable personality disorder was referred to a tertiary center 2 weeks after ingesting multiple foreign bodies. She had undergone a laparoscopic cholecystectomy and a laparotomy for extraction of ingested foreign bodies several years ago. A sagittal CT scan view showed a ballpen and a hair clip in the stomach. A coronal view demonstrated that a second ballpen had penetrated the duodenal wall to enter the liver parenchyma. There was no free intraperitoneal air or fluid or evidence of abscess formation. At laparotomy, a toothbrush, a broken spoon and a ballpen were extracted from the stomach via an anterior gastrotomy. The duodenum was adherent to the liver but the second ballpen had migrated into the distal duodenum, with the tip in the proximal jejunum. This was extracted via an enterotomy and the fistula was not interfered with. The enterotomy and gastrotomy were closed with 3-0 polydioxanone sutures. The hair clip had passed spontaneously and was not detected on intraoperative fluoroscopy. She made an uneventful recovery and postoperative liver function tests remained in the normal range. This is only the fourth reported case of a pen fistulizing between the upper gastrointestinal tract and the liver.
    Language English
    Publishing date 2022-08-17
    Publishing country Netherlands
    Document type Case Reports
    ZDB-ID 2406300-9
    ISSN 1930-0433
    ISSN 1930-0433
    DOI 10.1016/j.radcr.2022.07.096
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  6. Article: A recurrent retrohepatic abscess secondary to a dropped appendicolith.

    Sheikh, Shahzeb / Kaur, Muskan / Zaitoun, Abed M / Lobo, Dileep N

    Radiology case reports

    2024  Volume 19, Issue 3, Page(s) 1176–1180

    Abstract: Appendicoliths can drop into the peritoneal cavity during the course of an appendicectomy, or more commonly as a result of perforated appendicitis. We report the case of a patient with a history of recurrent retrohepatic abscesses over 7-year period due ... ...

    Abstract Appendicoliths can drop into the peritoneal cavity during the course of an appendicectomy, or more commonly as a result of perforated appendicitis. We report the case of a patient with a history of recurrent retrohepatic abscesses over 7-year period due to a retained appendicolith and review the literature on perihepatic abscesses caused by retained appendicoliths. The abscess had been drained percutaneously 4 times without retrieval of the appendicolith and eventually the patient needed a laparotomy, drainage of the abscess, and extraction of the appendicolith. Treatment of abscesses secondary to dropped appendicoliths may be percutaneous, laparoscopic, or via conventional open surgery, but it is important to retrieve the appendicolith if recurrent abscess formation is to be avoided.
    Language English
    Publishing date 2024-01-04
    Publishing country Netherlands
    Document type Case Reports
    ZDB-ID 2406300-9
    ISSN 1930-0433
    ISSN 1930-0433
    DOI 10.1016/j.radcr.2023.12.040
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  7. Article ; Online: Fragility, Spin, and Interpretation of Randomized Clinical Trials.

    Lobo, Dileep N

    Critical care medicine

    2019  Volume 47, Issue 3, Page(s) 486–488

    MeSH term(s) Anesthesia ; Anesthesiology ; Critical Care ; Humans ; Randomized Controlled Trials as Topic ; Reproducibility of Results
    Language English
    Publishing date 2019-02-04
    Publishing country United States
    Document type Editorial ; Comment
    ZDB-ID 197890-1
    ISSN 1530-0293 ; 0090-3493
    ISSN (online) 1530-0293
    ISSN 0090-3493
    DOI 10.1097/CCM.0000000000003604
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    Zs.A 1261: Show issues Location:
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  8. Article ; Online: Improving outcomes with a little EFFORT.

    Lobo, Dileep N

    Lancet (London, England)

    2019  Volume 393, Issue 10188, Page(s) 2278–2280

    MeSH term(s) Humans ; Inpatients ; Nutritional Support
    Language English
    Publishing date 2019-04-25
    Publishing country England
    Document type Journal Article ; Comment
    ZDB-ID 3306-6
    ISSN 1474-547X ; 0023-7507 ; 0140-6736
    ISSN (online) 1474-547X
    ISSN 0023-7507 ; 0140-6736
    DOI 10.1016/S0140-6736(18)32856-3
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  9. Article ; Online: Bowel Preparation for Colorectal Surgery: Have All Questions Been Answered?

    Ljungqvist, Olle / Lobo, Dileep N

    JAMA surgery

    2021  Volume 157, Issue 1, Page(s) 41–42

    MeSH term(s) Colorectal Surgery ; Digestive System Surgical Procedures ; Elective Surgical Procedures ; Humans
    Language English
    Publishing date 2021-10-20
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 2701841-6
    ISSN 2168-6262 ; 2168-6254
    ISSN (online) 2168-6262
    ISSN 2168-6254
    DOI 10.1001/jamasurg.2021.5273
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  10. Article ; Online: The effect of diabetes mellitus on perioperative outcomes after colorectal resection: a national cohort study.

    Gysling, Savannah / Lewis-Lloyd, Christopher A / Lobo, Dileep N / Crooks, Colin J / Humes, David J

    British journal of anaesthesia

    2024  

    Abstract: Background: Diabetes mellitus is a significant modulator of postoperative outcomes and is an important risk factor in the patient selection process. We aimed to investigate the effect of diabetes mellitus and use of insulin on outcomes after colorectal ... ...

    Abstract Background: Diabetes mellitus is a significant modulator of postoperative outcomes and is an important risk factor in the patient selection process. We aimed to investigate the effect of diabetes mellitus and use of insulin on outcomes after colorectal resection using a national cohort.
    Methods: Adults with a recorded colorectal resection in England between 2010 and 2020 were identified from Hospital Episode Statistics data linked to the Clinical Practice Research Database. The primary outcome was 90-day mortality. Secondary outcomes included hospital length of stay (LOS) and readmission within 90 days.
    Results: Of the 106 139 (52 875, 49.8% male) patients included, diabetes mellitus was prevalent in 10 931 (10.3%), 2145 (19.6%) of whom had a record of use of insulin. Unadjusted 90-day mortality risk was 5.7%, with an increased adjusted hazard ratio (aHR) for people with diabetes mellitus (aHR 1.28, 95% confidence interval [CI] 1.19-1.37, P<0.001). This risk was higher in both people with diabetes using insulin (aHR 1.51, 95% CI 1.31-1.74, P<0.001) and not using insulin (aHR 1.22, 95% CI 1.13-1.33, P<0.001), compared with those without diabetes. Ninety-day readmission occurred in 20 542 (19.4%) patients and this was more likely in those with diabetes mellitus (aHR 1.23, 95% CI 1.18-1.29, P<0.001). Median (inter-quartile range) LOS was 8 (5-15) days and was higher in people with diabetes mellitus (adjusted time ratio 1.10, 95% CI 1.08-1.11, P<0.001).
    Conclusions: People with diabetes mellitus undergoing colorectal resection are at a higher risk of 90-day mortality, prolonged LOS, and 90-day readmission, with use of insulin associated with additional risk.
    Language English
    Publishing date 2024-05-16
    Publishing country England
    Document type Journal Article
    ZDB-ID 80074-0
    ISSN 1471-6771 ; 0007-0912
    ISSN (online) 1471-6771
    ISSN 0007-0912
    DOI 10.1016/j.bja.2024.04.010
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