1,721,051 research outputs found
Propofol up2date-Part 2: Patient Groups, unwanted Effects and Sucession Substance Fospropofol
No full textPropofol is a common hypnotic agent in anaesthesiology and intensive care medicine and for procedural sedation as well. Despite the intensive usage the full potential, pharmacokinetic and -dynamic abilities, interactions and side effects of the substance may not be realized by all providers. Additionally there is dispute and unwarranted myth about the substance. Propofol is a highly potent hypnotic with a wide range of (un)desired effects. This article is reviewing the diversity of the substance in clinical practice
Review
No full textPostoperative bleeding might become a serious problem in the management of cardiac surgical patients, with marked medical and economic impact. In these life-threatening situations, massive haemorrhage represents frequently a combination of surgical and coagulopathic bleeding. Surgical bleeding results from a definite source at the operation site and can be corrected using surgical standard techniques. Acute coagulopathies, in contrast, result from impaired thrombin formation, and require optimized therapeutical strategies. Effective pharmacological treatment will be complicated by the presence of ventricular assist devices (VAD), which necessarily imply effective anticoagulation. In episodes of uncontrolled coagulopathic bleeding, the application of recombinant activated factor VII (rFVIIa) as a effective haemostatic agent has become more and more popular. However, only very few data are available on its use in patients with VAD in place. We researched the PubMed-database for case reports about the use of rFVIIa in patients with VAD and summarized them. In addition, we report a case from our hospital. In all cases cessation of bleeding without any thrombembolic complications could be achieved. In cases of uncontrollable, non-surgical bleeding rFVIIa seems to be a therapeutical option even for patients with VAD
Recombinant activated factor VII (Novo7<sup>®</sup>) in patients with ventricular assist devices: Case report and review of the current literature
Get PDFAbstract Postoperative bleeding might become a serious problem in the management of cardiac surgical patients, with marked medical and economic impact. In these life-threatening situations, massive haemorrhage represents frequently a combination of surgical and coagulopathic bleeding. Surgical bleeding results from a definite source at the operation site and can be corrected using surgical standard techniques. Acute coagulopathies, in contrast, result from impaired thrombin formation, and require optimized therapeutical strategies. Effective pharmacological treatment will be complicated by the presence of ventricular assist devices (VAD), which necessarily imply effective anticoagulation. In episodes of uncontrolled coagulopathic bleeding, the application of recombinant activated factor VII (rFVIIa) as a effective haemostatic agent has become more and more popular. However, only very few data are available on its use in patients with VAD in place. We researched the PubMed-database for case reports about the use of rFVIIa in patients with VAD and summarized them. In addition, we report a case from our hospital. In all cases cessation of bleeding without any thrombembolic complications could be achieved. In cases of uncontrollable, non-surgical bleeding rFVIIa seems to be a therapeutical option even for patients with VAD.</p
Predicting restoration of kidney function during CRRT-free intervals
Get PDFAbstract Background Renal failure is common in critically ill patients and frequently requires continuous renal replacement therapy (CRRT). CRRT is discontinued at regular intervals for routine changes of the disposable equipment or for replacing clogged filter membrane assemblies. The present study was conducted to determine if the necessity to continue CRRT could be predicted during the CRRT-free period. Materials and methods In the period from 2003 to 2006, 605 patients were treated with CRRT in our ICU. A total of 222 patients with 448 CRRT-free intervals had complete data sets and were used for analysis. Of the total CRRT-free periods, 225 served as an evaluation group. Twenty-nine parameters with an assumed influence on kidney function were analyzed with regard to their potential to predict the restoration of kidney function during the CRRT-free interval. Using univariate analysis and logistic regression, a prospective index was developed and validated in the remaining 223 CRRT-free periods to establish its prognostic strength. Results Only three parameters showed an independent influence on the restoration of kidney function during CRRT-free intervals: the number of previous CRRT cycles (medians in the two outcome groups: 1 vs. 2), the "Sequential Organ Failure Assessment"-score (means in the two outcome groups: 8.3 vs. 9.2) and urinary output after the cessation of CRRT (medians in two outcome groups: 66 ml/h vs. 10 ml/h). The prognostic index, which was calculated from these three variables, showed a satisfactory potential to predict the kidney function during the CRRT-free intervals; Receiver operating characteristic (ROC) analysis revealed an area under the curve of 0.798. Conclusion Restoration of kidney function during CRRT-free periods can be predicted with an index calculated from three variables. Prospective trials in other hospitals must clarify whether our results are generally transferable to other patient populations.</p
Influence of continuous renal replacement therapy on cardiac output measurement using thermodilution techniques
No full textBackground. Acute renal failure (ARF) ranks among the most frequent complications in critically ill patients and continuous renal replacement therapy (CRRT) is a typical treatment regimen in intensive care patients. Contributing factors to ART, such as septic shock and hemodynamic instability require extended hemodynamic monitoring, and the simultaneous use of CRRT and cardiac output measurement is common. In view of this, a systematic analysis of the interaction between CRRT and cardiac output measurements by thermodilution is warranted. Cardiac output (CO) is commonly measured with thermodilution-based methods in critically ill patients. The methods are accurate but the measurements are affected by inconstant indicator volumes or changes in blood temperature. Because continuous renal replacement therapy (CRRT) may alter blood volume and temperature, we investigated its effect on thermodilution-based CO measurement. Methods. Thirty-two intensive care patients with both CRRT and CO monitoring were studied. Hemodynamic parameters were first measured in quintuple with bolus injections of cold saline during CRRT. Further five measurements were performed after CRRT had been shut off, and a final five measurements were performed after it had been restarted. Fifty measurement series were performed in patients with a pulmonary artery catheter and 25 in patients using a transpulmonary rhermodilution method (PiCCO(center dot)). Results. The first measurements in each series after switching CRRT off or on deviated most markedly from the average. When these measurements were excluded, the averaged CO values with and without CRRT differed significantly but by <7% (P<0.05). Conclusion. Substantial measurement error was only observed immediately after CRRT was switched off or on. Subsequent CO measurements did not depend on the CRRT status. Interrupting CRRT before measuring CO is not generally recommended, however, if interrupted, it is crucial to wait for blood temperature to reach a steady state before initiating the first measurements. (Minerva Anestesiol 2012;78315-21
Modifying a kidney injury score by including perioperative data Comparison of three predictive scores
No full textAt present, several scores have been developed to assess the risk of acute kidney injury (AKI) after cardiac surgery, and every score represents a compromise between the completeness of the factors and the early evaluation of the AKI risk. This study examined whether the predictive reliability of an AKI risk score can be significantly improved by applying not only preoperative risk factors but also intraoperative and postoperative parameters for the calculation of the score. Three scores were deduced from the data of 662 patients undergoing cardiac surgery; these were based on preoperative (score 1), pre- and intraoperative (score 2) or on pre-, intra- and postoperative parameters (score 3). Sensitivity and specificity for the prediction of an AKI were determined from a validation population comprising 529 additional patients. AKI occurred in 455 patients (38.2%). Sensitivity and specificity of the scores were 60.9% and 67.6% (score 1), 60.4% and 68.2% (score 2) and 66.8% and 64.8% (score 3). The inclusion of intra- and postoperative parameters into a predictive model does not significantly improve the ability to identify patients at risk of AKI. As scores based on preoperative parameters allow for the earliest possible risk stratification, they should be preferred in clinical practice
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