ABSTRACT
PURPOSE OF REVIEW: This clinical review focuses on the nutritional management of surgical patients with a severe postoperative complication. These patients having a succession of aggressions are at high risk of malnutrition. Our aim, following ICU patient studies, was to report the elements that could be applied for these patients. RECENT FINDINGS: Although early enteral nutrition is recommended, recent data focus more on parenteral nutrition. Because these patients probably had a poor nutritional intake for several days, the prescription of parenteral nutrition would appear to be valid in cases of inadequate or impossible enteral nutrition. Lipid emulsion decreasing long-chain triglyceride intake should be used. Moreover, administration of fish oil should be considered. Intravenous glutamine, decreasing new infections and hospital length of stay, should be prescribed only in patients without shock. Several studies and meta-analyses have suggested that a parenteral selenium supplementation in a severe patient can reduce mortality. SUMMARY: In severe surgical complicated patients, special care must be taken vis-à-vis nutritional intake. Such patients are likely to have an energy deficit and are at high risk of malnutrition. Nutritional assistance is necessary and should be quickly implemented with the usual recommendations.
Subject(s)
Lipids/administration & dosage , Parenteral Nutrition , Postoperative Complications/diet therapy , Surgical Procedures, Operative , Enteral Nutrition , Fish Oils/administration & dosage , Glutamine/administration & dosage , Humans , Selenium/administration & dosageABSTRACT
BACKGROUND: Kidney disease is a frequent but underestimated complication in patients suffering from intestinal failure (IF) treated by long-term home parenteral nutrition (HPN). The evolution in glomerular filtration rate (GFR) over time is poorly characterized. The current equations for estimating GFR have limited precision. No study has specifically investigated the reliability of recent creatinine-based estimated GFR (eGFR) equations in this population. The aim of this study was to evaluate the renal function decline under home parenteral nutrition (HPN) with a gold standard method and compare the performances of routinely used eGFR equations. METHODS: Forty patients with HPN and two or more GFR measurements were retrospectively studied. The renal function decline was calculated by the slope drawn between the successive measured GFRs (mGFRs). The performances of the Modification of Diet in Renal Disease, Chronic Kidney Disease Epidemiology Collaboration, full age spectrum and revised Lund-Malmö equations were compared with reference methods (inulin or iohexol clearance). RESULTS: The mean mGFR was 78 ± 28 mL/min/1.73 m2. The annual decline of mGFR was -1.9 mL/min/1.73 m2/year. No predisposing factor was identified to predict impairment in renal function. eGFR formulas grossly overestimated mGFR and had a low level of accuracy. CONCLUSIONS: Patients with IF are at significant risk for impaired renal function. In this population, the tested eGFR equations were inaccurate. However, monitoring kidney function with mGFR remains important in these patients, as their GFR regularly declines and no specific risk factor has yet been identified.
ABSTRACT
Long-term parenteral nutrition (PN) may induce bone complications. Tridimensional bone imaging techniques such as high-resolution peripheral quantitative computed tomography (HR-pQCT) allow the assessment of both compartmental volumetric densities and microarchitecture. Our aim was to evaluate these parameters in children and teenagers receiving long-term PN. This cross-sectional, case-control study included children older than 9 years undergoing PN for at least 2 years. They were age-, gender- and puberty-matched with healthy controls (1:2). Evaluation included biological assessment of bone metabolism (serum calcium, phosphate, and albumin; urinary calcium and creatinine; 25-OH vitamin D, osteocalcin and PTH), dual X-ray absorptiometry (DXA) and HR-pQCT at the ultradistal tibia and radius. Results are presented as median [range]. Eleven patients (3 girls) with a median age of 16 [9-19] years were included. Bone parameters assessed by HR-pQCT at the ultradistal radius and tibia were similar in patients and controls. Parathyroid hormone (PTH) levels were higher (14 [7-115] vs 16 [12-27]) and osteocalcin levels were lower (44 [15-65] vs 65 [38-142]) in patients than in controls, although within the normal range. Conclusions: there were no differences for compartmental bone densities and microarchitecture in patients undergoing chronic PN. Further longitudinal studies are required to confirm these quite reassuring preliminary results.
Subject(s)
Bone and Bones/metabolism , Parenteral Nutrition, Total , Absorptiometry, Photon , Adolescent , Bone Density , Bone Diseases, Metabolic/therapy , Bone and Bones/diagnostic imaging , Bone and Bones/ultrastructure , Case-Control Studies , Child , Cross-Sectional Studies , Female , Humans , Male , Osteocalcin/blood , Parathyroid Hormone/blood , Pilot Projects , Radius/diagnostic imaging , Radius/metabolism , Radius/ultrastructure , Tibia/diagnostic imaging , Tibia/metabolism , Tibia/ultrastructure , Tomography, X-Ray Computed , Young AdultABSTRACT
This document is a summary of the French intergroup guidelines regarding the nutrition and physical activity (PA) management in digestive oncology. This collaborative work was produced under the auspices of all French medical and surgical societies involved in digestive oncology, nutrition and supportive care. It is based on published guidelines, recent literature review and expert opinions. Recommendations are graded according to the level of evidence. Malnutrition affects more than half of patients with digestive cancers and is often underdiagnosed. It has multiple negative consequences on survival, quality of life and risk of treatment complications. Consequently, in addition to anticancer treatments, supportive care including nutritional support and PA plays a central role in the management of digestive cancers. It is crucial to detect malnutrition (diagnostic criteria updated in 2019) early, to prevent it and to act against it at all stages of the cancer and at all times of the care pathway. In this context, we proposed recommendations for the evaluation and management in nutrition and PA in digestive oncology for each stage of the disease (perioperative setting, during radiation therapy, during systemic treatments, at the palliative phase, after cancer). Guidelines for nutrition and PA management aim at increasing awareness about malnutrition in oncology. They are continuously evolving and need to be regularly updated.
Subject(s)
Quality of Life , Societies, Medical , Endopeptidases , Exercise , Follow-Up Studies , HumansABSTRACT
BACKGROUND: There is a need for close communication with relatives of patients dying in the intensive care unit (ICU). We evaluated a format that included a proactive end-of-life conference and a brochure to see whether it could lessen the effects of bereavement. METHODS: Family members of 126 patients dying in 22 ICUs in France were randomly assigned to the intervention format or to the customary end-of-life conference. Participants were interviewed by telephone 90 days after the death with the use of the Impact of Event Scale (IES; scores range from 0, indicating no symptoms, to 75, indicating severe symptoms related to post-traumatic stress disorder [PTSD]) and the Hospital Anxiety and Depression Scale (HADS; subscale scores range from 0, indicating no distress, to 21, indicating maximum distress). RESULTS: Participants in the intervention group had longer conferences than those in the control group (median, 30 minutes [interquartile range, 19 to 45] vs. 20 minutes [interquartile range, 15 to 30]; P<0.001) and spent more of the time talking (median, 14 minutes [interquartile range, 8 to 20] vs. 5 minutes [interquartile range, 5 to 10]). On day 90, the 56 participants in the intervention group who responded to the telephone interview had a significantly lower median IES score than the 52 participants in the control group (27 vs. 39, P=0.02) and a lower prevalence of PTSD-related symptoms (45% vs. 69%, P=0.01). The median HADS score was also lower in the intervention group (11, vs. 17 in the control group; P=0.004), and symptoms of both anxiety and depression were less prevalent (anxiety, 45% vs. 67%; P=0.02; depression, 29% vs. 56%; P=0.003). CONCLUSIONS: Providing relatives of patients who are dying in the ICU with a brochure on bereavement and using a proactive communication strategy that includes longer conferences and more time for family members to talk may lessen the burden of bereavement. (ClinicalTrials.gov number, NCT00331877.)
Subject(s)
Bereavement , Communication , Family/psychology , Pamphlets , Professional-Family Relations , Stress Disorders, Post-Traumatic/prevention & control , Terminally Ill , Aged , Aged, 80 and over , Anxiety/epidemiology , Depression/epidemiology , Female , Humans , Intensive Care Units , Male , Middle Aged , Stress Disorders, Post-Traumatic/epidemiology , Terminally Ill/psychology , Visitors to Patients/psychologyABSTRACT
To date, there are no recommendations about screening plasma vitamin C concentration and adjust its supplementation in patients on long-term home parenteral nutrition (HPN). The aim of this study was to evaluate vitamin C status and determine if a commercial multivitamin preparation (CMVP) containing 125 mg of vitamin C is sufficient in stable patients on HPN. All clinically stable patients receiving HPN or an intravenous fluid infusion at least two times per week for at least 6 months, hospitalized for nutritional assessment, were retrospectively included, for a total of 186 patients. We found that 29% of the patients had vitamin C insufficiency (i.e., <25 µmol/L). In univariate analysis, C-reactive protein (CRP) (p = 0.002) and intake of only 125 mg of vitamin C (p = 0.001) were negatively associated with vitamin C levels, and duration of follow-up in our referral center (p = 0.009) was positively associated with vitamin C levels. In multivariate analysis, only CRP (p = 0.001) and intake of 125 mg of vitamin C (p < 0.0001) were independently associated with low plasma vitamin C concentration. Patients receiving only CMVP with a low plasma vitamin C level significantly received personal compounded HPN (p = 0.008) and presented an inflammatory syndrome (p = 0.002). Vitamin C insufficiency is frequent in individuals undergoing home parenteral nutrition; therefore, there is a need to monitor plasma vitamin C levels, especially in patients on HPN with an inflammatory syndrome and only on CMVP.
Subject(s)
Ascorbic Acid Deficiency/etiology , Ascorbic Acid Deficiency/prevention & control , Ascorbic Acid/administration & dosage , Ascorbic Acid/blood , Eating/physiology , Monitoring, Physiologic , Nutrition Assessment , Nutritional Physiological Phenomena/physiology , Nutritional Status , Parenteral Nutrition, Home Total , Adult , Aged , Ascorbic Acid/analysis , Ascorbic Acid Deficiency/blood , Ascorbic Acid Deficiency/diagnosis , Biomarkers/blood , Female , Humans , Inflammation/etiology , Male , Middle Aged , Parenteral Nutrition, Home Total/adverse effects , Retrospective StudiesABSTRACT
OBJECTIVES: Some patients with short bowel syndrome (SBS) develop hyperphagic behavior. Such an increase in food intake stimulates intestinal adaptation and limits dependence on parenteral nutrition (PN). The aim of this study was to determine the factors modulating food consumption in patients with SBS. METHODS: The associations between oral energy intake (OEI) and anthropometric, metabolic, nutritional, and intestinal absorption-related characteristics were determined in a monocentric cohort of patients with SBS on PN with a stable nutritional status. Body composition was assessed by dual x-ray absorptiometry. Data were retrospectively collected from clinical records. RESULTS: After screening, 38 adult patients with a SBS on PN were included in this study. OEI ranged from 577 to 4054kcal/d. OEI correlated positively with weight, fat-free mass, handgrip strength, and resting energy expenditure (REE) and negatively with free triiodothyronine and C-reactive protein using Spearman correlation. Fat-free mass and thyroid-stimulating hormone remained positively correlated with OEI independently of all other parameters in a multilinear regression model. CONCLUSIONS: Fat-free mass is a strong predictor of OEI in patients with SBS on PN and without debilitating gastrointestinal symptoms. Increasing fat-free mass could be a way to stimulate OEI in these patients. Further studies are needed to assess this assumption.
Subject(s)
Body Composition/physiology , Hyperphagia/complications , Hyperphagia/physiopathology , Nutritional Status , Short Bowel Syndrome/complications , Short Bowel Syndrome/physiopathology , Absorptiometry, Photon , Adult , Aged , Cohort Studies , Energy Intake/physiology , Female , Hand Strength/physiology , Humans , Intestinal Absorption/physiology , Male , Middle AgedABSTRACT
Severe nutrition complications after bariatric surgery remain poorly described. The aim of this case series was to identify specific factors associated with nutrition complications after bariatric surgery and to characterize their nutrition disorders. We retrospectively reviewed all people referred to the clinical nutrition intensive care unit of our university hospital after bariatric surgery from January 2013 to June 2015. Twelve persons who required artificial nutrition supplies (ie, enteral nutrition or parenteral nutrition) were identified. Seven persons underwent a "one-anastomosis gastric bypass" (OAGB) or "mini gastric bypass," 2 underwent a Roux-en-Y gastric bypass, 2 had a sleeve gastrectomy, and 1 had an adjustable gastric band. This case series suggests that OAGB could overexpose subjects to severe nutrition complications requiring intensive nutrition care and therefore cannot be considered a "mini" bariatric surgery. Even if OAGB is often considered a simplified surgical technique, it obviously requires as the other standard bariatric procedures a close follow-up by experimented teams aware of its specific complications.
Subject(s)
Bariatric Surgery/adverse effects , Critical Care/methods , Nutrition Disorders/therapy , Nutrition Therapy/methods , Postoperative Care/methods , Female , Gastric Bypass/adverse effects , Gastric Bypass/methods , Hospitals, University , Humans , Male , Middle Aged , Nutrition Disorders/etiology , Nutritional Status , Obesity/surgery , Postoperative Complications/therapy , Retrospective Studies , Weight LossABSTRACT
BACKGROUND: Glucose absorption from starchy food has only been described with small amounts ingested ( approximately 20-75 g). OBJECTIVE: Our aim was to describe total plasma (Ra) and exogenous glucose (Ra(exo)) appearance, glucose release from the liver (HGP), and the metabolic response after ingestion of 5 g polished or parboiled rice/kg body mass. DESIGN: Gas exchange and urea excretion were monitored in 8 healthy subjects before (3.5 h) and after (8 h) ingestion of rice intrinsically labeled with (13)C; [6,6-(2)H(2)]glucose was infused for the measurement of Ra, Ra(exo), and HGP. RESULTS: Changes in plasma glucose, insulin, lactate, and free fatty acids and the increase in Ra(exo) and Ra ( approximately 200%) and the decrease in HGP ( approximately 90%) were not significantly different (P > 0.05) after ingestion of either rice. Glucose oxidation was not significantly different (111.6 +/- 8.2 compared with 89.0 +/- 11.3 g; P = 0.13), but fat oxidation was significantly lower (9.9 +/- 1.7 compared with 21.3 +/- 4.0 g; P < 0.05) after parboiled than after polished rice. The percentage of the glucose load that appeared in the circulation over 8 h was not significantly different after ingestion of polished (70.4 +/- 4.5%) or parboiled (63.8 +/- 2.0%) rice (P > 0.05). CONCLUSION: Although the starch in parboiled rice is less susceptible to digestion in vitro, exogenous glucose availability was not significantly different after ingestion of large amounts of polished or parboiled rice. Glucose absorption remains incomplete 8 h after ingestion of both types of rice.
Subject(s)
Blood Glucose/metabolism , Glucose/pharmacokinetics , Liver/metabolism , Oryza , Starch/metabolism , Adult , Area Under Curve , Biological Availability , Blood Glucose/analysis , Calorimetry, Indirect , Carbon Isotopes , Digestion , Fatty Acids, Volatile/metabolism , Glycemic Index , Humans , Insulin/blood , Intestinal Absorption , Male , Oryza/chemistry , Oxidation-Reduction , Starch/administration & dosage , Starch/pharmacokinetics , Urea/bloodABSTRACT
CONTEXT: Many physicians believe that the pulmonary artery catheter (PAC) is useful for the diagnosis and treatment of cardiopulmonary disturbances; however, observational studies suggest that its use may be harmful. OBJECTIVE: To determine the effects on outcome of the early use of a PAC in patients with shock mainly of septic origin, acute respiratory distress syndrome (ARDS), or both. DESIGN, SETTING, AND PATIENTS: A multicenter randomized controlled study of 676 patients aged 18 years or older who fulfilled the standard criteria for shock, ARDS, or both conducted in 36 intensive care units in France from January 30, 1999, to June 29, 2001. INTERVENTION: Patients were randomly assigned to either receive a PAC (n = 335) or not (n = 341). The treatment was left to the discretion of each individual physician. MAIN OUTCOME MEASURES: The primary end point was mortality at 28 days. The principal secondary end points were day 14 and 90 mortality; day 14 organ system, renal support, and vasoactive agents-free days; hospital, intensive care unit, and mechanical ventilation-free days at day 28. RESULTS: The 2 groups were similar at baseline. There were no significant differences in mortality with or without the PAC at day 14: 49.9% vs 51.3% (mortality relative risk [RR], 0.97; 95% confidence interval [CI], 0.84-1.13; P =.70); day 28: 59.4% vs 61.0% (RR, 0.97; 95% CI, 0.86-1.10; P =.67); or day 90: 70.7% vs 72.0% (RR, 0.98; 95% CI, 0.89-1.08; P =.71). At day 14, the mean (SD) number of days free of organ system failures with or without the PAC (2.3 [3.6] vs 2.4 [3.5]), renal support (7.4 [6.0] vs 7.5 [5.9]), and vasoactive agents (3.8 [4.8] vs 3.9 [4.9]) did not differ. At day 28, mean (SD) days in hospital with or without the PAC (0.9 [3.6] vs 0.9 [3.3]), in the intensive care unit (3.4 [6.8] vs 3.3 [6.9]), or mechanical ventilation use (5.2 [8.5] vs 5.0 [8.5]) did not differ. CONCLUSION: Clinical management involving the early use of a PAC in patients with shock, ARDS, or both did not significantly affect mortality and morbidity.
Subject(s)
Catheterization, Swan-Ganz , Respiratory Distress Syndrome/therapy , Shock/therapy , Adult , Catheterization, Swan-Ganz/adverse effects , Critical Illness/therapy , Female , Hospital Mortality , Humans , Intensive Care Units , Length of Stay , Male , Middle Aged , Proportional Hazards Models , Treatment OutcomeABSTRACT
BACKGROUND & AIMS: Central venous catheter-associated bloodstream infection (CBSI) is a serious complication in patients on home parenteral nutrition (HPN). The aim was to analyze the impact of taurolidine-citrate lock solution (TLS) on CBSI rate in HPN patients with a high risk of catheter infection. METHODS: This retrospective study compared CBSI rates 12 months before and 12 months after implementation of TLS. In the first period, only standardized strategies were used to reduce the CBSI rate. In the second period, TLS was injected into the catheter at the end of parenteral nutrition. The CBSI rate with a confident interval was calculated as Poisson event rates, and compared by testing for homogeneity of rates. RESULTS: 15 patients were included. During the 24 months, the CBSI rate was 6.58/1000 catheter-days in the first period and 1.09/1000 catheter-days in the second period (p < 0.001). In patients with TLS once a week (n = 8), the CBSI rate decreased from 4.8/1000 catheter-days to 1.37/1000 catheter-days (p = 0.02) and in patients with TLS after each TPN (n = 7), the CBSI rate decreased from 8.61/1000 catheter-days to 0.78/1000 catheter-days (p = 0.001). CONCLUSION: In HPN patients, TLS associated with standardized precautions significantly reduced the CBSI rate.
Subject(s)
Anti-Infective Agents/pharmacology , Catheter-Related Infections/prevention & control , Central Venous Catheters/microbiology , Parenteral Nutrition, Home , Secondary Prevention/methods , Taurine/analogs & derivatives , Thiadiazines/pharmacology , Adolescent , Adult , Aged , Enterobacter cloacae/drug effects , Enterobacter cloacae/pathogenicity , Escherichia coli/drug effects , Escherichia coli/pathogenicity , Female , Humans , Klebsiella pneumoniae/drug effects , Klebsiella pneumoniae/pathogenicity , Male , Middle Aged , Retrospective Studies , Solutions , Staphylococcus epidermidis/drug effects , Staphylococcus epidermidis/pathogenicity , Staphylococcus hominis/drug effects , Staphylococcus hominis/pathogenicity , Taurine/pharmacology , Young AdultSubject(s)
Antihypertensive Agents/adverse effects , Benzimidazoles/adverse effects , Biphenyl Compounds/adverse effects , Cholestasis/chemically induced , Cholestasis/therapy , Renal Dialysis , Tetrazoles/adverse effects , Antihypertensive Agents/administration & dosage , Benzimidazoles/administration & dosage , Biphenyl Compounds/administration & dosage , Blood Component Removal/methods , Extracorporeal Circulation , Humans , Male , Middle Aged , Serum Albumin , Tetrazoles/administration & dosageABSTRACT
The benefits of antibiotics treatments are not obvious at the end of life except for the symptomatic urinary infections. The numerous antibiotics prescribed raise economic and ecological problems in terms of bacterial resistances development and also in terms of quality of life. The control of symptoms has to be the main indication to prescribe antibiotics at the end of life. It is the general state, the prognostic of the patient, his wishes and those of his family, and his symptoms, controlled or not, that direct the decision to prescribe an antibiotic. Physicians must consider the objective of antibiotic treatment, the risk of side effects and the constraints related to this treatment before prescribing it for terminally ill people. They have to respect the bioethical principles, primarily the principles of beneficence, non-maleficience, and the respect to autonomy of the patient. In the event of decision of an antibiotic treatment at a patient at the end of the lifetime, the choice of this one must answer obviously the same requirements as in the other medical situations, within the framework of comprehensive and rigorous process.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Bacterial Infections/drug therapy , Palliative Care/methods , Patient Selection , Bacterial Infections/diagnosis , Bacterial Infections/epidemiology , Bacterial Infections/etiology , Comorbidity , Decision Making , Decision Trees , Drug Resistance, Bacterial , Humans , Infection Control , Palliative Care/ethics , Palliative Care/psychology , Patient Selection/ethics , Physician's Role , Prevalence , Principle-Based Ethics , Prognosis , Quality of Life/psychology , Research Design , Risk Factors , Survival Rate , Treatment OutcomeABSTRACT
OBJECTIVE: Glutamine (Gln)-supplemented total parenteral nutrition (TPN) improves clinical outcome after planned surgery, but the benefits of Gln-TPN for critically ill (intensive care unit; ICU) patients are still debated. DESIGN: Prospective, double-blind, controlled, randomized trial. SETTING: ICUs in 16 hospitals in France. PATIENTS: One-hundred fourteen ICU patients admitted for multiple trauma (38), complicated surgery (65), or pancreatitis (11). INTERVENTIONS: Patients were randomized to receive isocaloric isonitrogenous TPN via a central venous catheter providing 37.5 kcal and 1.5 g amino acids.kg-1.day-1 supplemented with either L-alanyl-L-glutamine dipeptide (0.5 g.kg-1.day-1; Ala-Gln group, n=58) or L-alanine+L-proline (control group, n=56) over at least 5 days. MEASUREMENTS AND MAIN RESULTS: Complicated clinical outcome was defined a priori by the occurrence of infectious complications (according to the criteria of the Centers for Disease Control and Prevention), wound complication, or death. The two groups were compared by chi-square test on an intention-to-treat basis. The two groups did not differ at inclusion for type and severity of injury (mean simplified acute physiology score II, 30 vs. 30.5; mean injury severity score, 44.9 vs. 42.3). Similar volumes of TPN were administered in both groups. Ala-Gln-supplemented TPN was associated with a lower incidence of complicated outcome (41% vs. 61%; p<.05), which was mainly due to a reduced infection rate per patient (mean, 0.45 vs. 0.71; p<.05) and incidence of pneumonia (10 vs. 19; p<.05). Early death rate during treatment and 6-month survival were not different. Hyperglycemia was less frequent (20 vs. 30 patients; p<.05) and there were fewer insulin-requiring patients (14 vs. 22; p<.05) in the Ala-Gln group. CONCLUSIONS: TPN supplemented with Ala-Gln dipeptide in ICU patients is associated with a reduced rate of infectious complications and better metabolic tolerance.
Subject(s)
Cross Infection/prevention & control , Dipeptides/therapeutic use , Glucose Intolerance/prevention & control , Glutamine/therapeutic use , Parenteral Nutrition, Total/methods , Analysis of Variance , Critical Care , Cross Infection/etiology , Dietary Supplements , Double-Blind Method , Female , France/epidemiology , Glucose Intolerance/etiology , Humans , Male , Middle Aged , Parenteral Nutrition, Total/adverse effects , Prospective Studies , Survival RateABSTRACT
PURPOSE: During liver transplantation, excessive blood losses are correlated with increased morbidity and mortality. Blood losses are particularly high in the case of urgent liver transplantation for fulminant hepatic failure (FHF). Recombinant activated factor VII (rFVIIa) has shown promise in treating the coagulopathy of liver disease. We review our experience with the use of rFVIIa in treating the coagulopathy of FHF during urgent liver transplantation. CLINICAL FEATURES: We report four patients with FHF who met King's College criteria for liver transplantation and in whom rFVIIa was used after conventional means for treating the associated coagulopathy had failed. In all patients, the coagulation defect was corrected by rFVIIa. However, thrombotic complications occurred in two patients (myocardial ischemia and portal vein thrombosis) and the implication of rFVIIa cannot be excluded. CONCLUSION: We conclude that rFVIIa is effective in the correction of the coagulopathy associated with FHF. However, thrombotic events are of concern and therefore, further studies are warranted to define the safety of rFVIIa in that setting.