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2.
Scand J Immunol ; 94(2): e13045, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33891354

RESUMO

There is limited knowledge of influenza-specific immune responses and their kinetics in critically ill patients. We investigated humoral and cellular immune responses after critical influenza A/H1N1 infection and hypothesized that dysfunctionality or absence of immune responses could contribute to more severe illness. We followed 12 patients hospitalized with severe influenza infection; the majority admitted to intensive care unit (ICU). Blood samples were collected at days 10 and 19 and at 5 months. Antibody responses to surface glycoproteins haemagglutinin (HA) and neuraminidase (NA) of A/H1N1pdm09 were quantified by haemagglutination inhibition (HAI), microneutralization (MN), Enzyme-linked immunosorbent assay (ELISA) and Enzyme-linked lectin assay (ELLA). Influenza-specific antibody levels and avidity were measured separately for head and stalk domains of H1. Cytokine secreting CD4+ and CD8+ T cell responses to conserved influenza epitopes (M1, NP and PB1) were analysed by FluoroSpot. Overall, the patients retained a high level of functional HA- and NA-specific antibodies over the study period. During the acute phase (up to 3 weeks from symptom onset), antibodies specific to H1 stalk increased earlier and were present in higher amount compared with H1 head-specific antibodies. The NA-specific antibodies and the non-neutralizing HA-specific antibody response for H1 head and H1 full-length showed a significant decline from acute to convalescent phase. Despite high total IgG concentrations, avidity to H1 head and H1 full-length protein remained low at all time points. Similarly, CD8+ T cell responses were continuously measured at low levels. In conclusion, our study found that critically ill patients were characterized by low HA-specific antibody avidity and CD8+ T cell response.


Assuntos
Imunidade Celular/imunologia , Imunidade Humoral/imunologia , Vírus da Influenza A Subtipo H1N1/imunologia , Influenza Humana/imunologia , Adulto , Idoso , Anticorpos Antivirais/imunologia , Formação de Anticorpos/imunologia , Linfócitos T CD4-Positivos/imunologia , Linfócitos T CD8-Positivos/imunologia , Estado Terminal , Feminino , Glicoproteínas de Hemaglutininação de Vírus da Influenza/imunologia , Humanos , Vacinas contra Influenza/imunologia , Masculino , Pessoa de Meia-Idade
3.
Future Cardiol ; 17(8): 1321-1326, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-33876965

RESUMO

COVID-19 infection primarily causes severe pneumonia complicated by acute respiratory distress syndrome and multiorgan failure requiring a ventilator support. We present a case of a 55-year-old male, admitted with COVID-19. He was obese but had no other medical conditions. His blood pressure was measured by his general physician on several occasions in the past, all values being normal (<140/90 mmHg). He developed multiorgan failure, requiring vasopressor and ventilator support for 17 days. A prone positioning improved the arterial oxygenation, and reduced the need for supplemental oxygen. After recovery, he showed persistently elevated blood pressure and sinus tachycardia both in clinic and out-of-clinic. The activation of the renin-angiotensin-aldosterone and sympathetic systems, volume-overload, hyperreninemia and cytokine storm might have contributed to the exaggerated cardiovascular response.

4.
Case Rep Crit Care ; 2021: 6676407, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33763260

RESUMO

Spontaneous splenic rupture is a life-threatening condition leading to a rapidly progressing hypovolemic shock due to intra-abdominal blood loss, with a mortality rate of about 10%. Spontaneous splenic rupture can be caused by widely different disorders including acute and chronic infections, neoplastic disorders, and inflammatory noninfectious disorders. In this case report, we present a 67-year-old male patient with hemorrhagic shock caused by an acute bleeding from the splenic artery. The patient was massively transfused with blood products and fluids and underwent laparotomy for hemostatic control and clinical stabilization. Multiorgan involvement by amyloid light-chain amyloidosis (AL-amyloidosis) caused by plasma cell dyscrasia, specifically with infiltration of the spleen artery, was found to be the underlying cause of his life-threatening bleeding. Based on this case, we discuss the features of serious spleen bleeding, massive transfusion therapy in the intensive care setting, and AL-amyloidosis pathophysiology and treatment.

6.
Crit Care ; 24(1): 2, 2020 01 02.
Artigo em Inglês | MEDLINE | ID: mdl-31898523

RESUMO

BACKGROUND: Acute kidney injury (AKI) is a common complication in burn patients admitted to the intensive care unit (ICU) associated with increased morbidity and mortality. Our primary aim was to review incidence, risk factors, and outcomes of AKI in burn patients admitted to the ICU. Secondary aims were to review the use of renal replacement therapy (RRT) and impact on health care costs. METHODS: We conducted a systematic search in PubMed, UpToDate, and NICE through 3 December 2018. All reviews in Cochrane Database of Systematic Reviews except protocols were added to the PubMed search. We searched for studies on AKI according to Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (RIFLE); Acute Kidney Injury Network (AKIN); and/or Kidney Disease: Improving Global Outcomes (KDIGO) criteria in burn patients admitted to the ICU. We collected data on AKI incidence, risk factors, use of RRT, renal recovery, length of stay (LOS), mortality, and health care costs. RESULTS: We included 33 observational studies comprising 8200 patients. Overall study quality, scored according to the Newcastle-Ottawa scale, was moderate. Random effect model meta-analysis revealed that the incidence of AKI among burn patients in the ICU was 38 (30-46) %. Patients with AKI were almost evenly distributed in the mild, moderate, and severe AKI subgroups. RRT was used in 12 (8-16) % of all patients. Risk factors for AKI were high age, chronic hypertension, diabetes mellitus, high Total Body Surface Area percent burnt, high Abbreviated Burn Severity Index score, inhalation injury, rhabdomyolysis, surgery, high Acute Physiology and Chronic Health Evaluation II score, high Sequential Organ Failure Assessment score, sepsis, and mechanical ventilation. AKI patients had 8.6 (4.0-13.2) days longer ICU LOS and higher mortality than non-AKI patients, OR 11.3 (7.3-17.4). Few studies reported renal recovery, and no study reported health care costs. CONCLUSIONS: AKI occurred in 38% of burn patients admitted to the ICU, and 12% of all patients received RRT. Presence of AKI was associated with increased LOS and mortality. TRIAL REGISTRATION: PROSPERO (CRD42017060420).


Assuntos
Injúria Renal Aguda/etiologia , Queimaduras/complicações , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/fisiopatologia , Queimaduras/epidemiologia , Queimaduras/fisiopatologia , Humanos , Incidência , Unidades de Terapia Intensiva/organização & administração
8.
Am J Nephrol ; 50(4): 312-319, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31480045

RESUMO

BACKGROUND: Intensive care unit (ICU) patients with acute kidney injury requiring renal replacement therapy (RRT) are considered at high risk of gastrointestinal (GI) bleeding and stress ulcer prophylaxis (SUP) is often prescribed. We aimed to assess the incidence of GI bleeding and effects of SUP in these patients. METHODS: We assessed GI bleeding in ICU patients receiving RRT at baseline (and at any time in the ICU) and effects of prophylactic pantoprazole versus placebo in the international SUP in the ICU (SUP-ICU) trial. All analyses were conducted according to a published protocol and statistical analysis plan. RESULTS: Data of 3,291 acutely admitted adult ICU patients with one or more risk factors for GI bleeding randomized to pantoprazole or placebo intravenously once daily during ICU stay (until ICU discharge, death, or a maximum of 90 days) were analyzed. Some 20 out of 258 (7.8%, 95% CI 4.5-11.1%) and 52 out of 568 (9.2%, 95% CI 6.8-11.6%) of the patients receiving RRT at baseline and at any time in ICU, respectively, developed clinically important GI bleeding in the ICU. We did not observe statistically significant differences in the intervention effect (pantoprazole vs. placebo) in the proportion of patients with clinically important GI bleeding, clinically important events, infectious adverse events, use of interventions to stop GI bleeding, or 90-day mortality in patients with versus without RRT at baseline. CONCLUSIONS: In adult ICU patients receiving RRT at baseline, we observed high incidences of clinically important GI bleeding, but did not observe effects of pantoprazole versus placebo in this subgroup.


Assuntos
Injúria Renal Aguda/terapia , Cuidados Críticos/organização & administração , Hemorragia Gastrointestinal/prevenção & controle , Nefropatias/terapia , Pantoprazol/uso terapêutico , Terapia de Substituição Renal/efeitos adversos , Injúria Renal Aguda/complicações , Idoso , Infecções por Clostridium/complicações , Infecção Hospitalar/prevenção & controle , Feminino , Hemorragia Gastrointestinal/complicações , Humanos , Unidades de Terapia Intensiva , Nefropatias/complicações , Masculino , Pessoa de Meia-Idade , Úlcera Péptica/prevenção & controle , Modelos de Riscos Proporcionais , Fatores de Risco , Resultado do Tratamento
9.
Acta Anaesthesiol Scand ; 63(10): 1346-1356, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31441031

RESUMO

BACKGROUND: The aetiology and risk factors for clinically important gastrointestinal bleeding (CIB) in adult ICU patients may differ according to the onset of CIB, which could affect the balance between benefits and harms of stress ulcer prophylaxis (SUP). METHODS: We assessed the time to CIB in the Stress Ulcer Prophylaxis in the Intensive Care Unit (SUP-ICU) trial. We assessed if associations between baseline characteristics including allocation to SUP and CIB changed during time in the ICU, specifically in the later (after day 2) compared to the earlier (first 2 days) period, using Cox models adjusted for SAPS II and allocation to SUP. Additionally, we described baseline characteristics and CIB episodes stratified by earlier/later/no CIB and 90-day mortality status. RESULTS: Clinically important gastrointestinal bleeding occurred in 110/3291 (3.3%) patients after a median of 6 (interquartile range 2-13) days; 25.5% of the episodes occurred early. Higher SAPS II was consistently associated with increased risk of CIB (hazard ratio (HR) 1.03, 95% confidence interval (CI) 1.01-1.05 in the earlier period vs HR 1.02, 95% CI 1.01-1.03 in the later period; P = .37); university hospital admission was associated with decreased risk of earlier CIB (HR 0.30, 95% CI 0.14-0.63); this significantly increased in the later period (to HR 0.85, 95% CI 0.53-1.37; P = .02). Patients with later compared to earlier CIB received more transfusions and had more diagnostic/therapeutic procedures for CIB. CONCLUSIONS: Clinically important gastrointestinal bleeding mostly occurred more than 2 days after randomization. University hospital admission was associated with significantly decreased risk of CIB in the earlier period only.


Assuntos
Hemorragia Gastrointestinal/etiologia , Úlcera Péptica/prevenção & controle , Estresse Psicológico/complicações , Idoso , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Escala Psicológica Aguda Simplificada , Fatores de Tempo
10.
Acta Anaesthesiol Scand ; 63(9): 1184-1190, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31282567

RESUMO

BACKGROUND: The long-term effects of stress ulcer prophylaxis with pantoprazole are unknown in ICU patients. We report 1-year mortality outcome in the Stress Ulcer Prophylaxis in the Intensive Care Unit (SUP-ICU) trial. METHODS: In the SUP-ICU trial, acutely admitted adult ICU patients at risk of gastrointestinal bleeding were randomised to intravenous pantoprazole 40 mg vs placebo (saline) once daily during their ICU stay. We assessed mortality at 1 year and did sensitivity analyses according to the trial protocol and statistical analysis plan. RESULTS: A total of 3261 of the 3291 patients with available data (99.1%) were followed up at 1 year after randomisation; 1635 were allocated to pantoprazole and 1626 to placebo. At 1 year after randomisation, 610 of 1635 patients (37.3%) had died in the pantoprazole group as compared with 601 of 1626 (37.0%) in the placebo group (relative risk, 1.01; 95% confidence interval 0.92-1.10). The results were consistent in the sensitivity analysis adjusted for baseline risk factors and in those of the per-protocol population. We did not observe heterogeneity in the effect of pantoprazole vs placebo on 1-year mortality in the predefined subgroups, that is, patients with and without shock, mechanical ventilation, liver disease, coagulopathy, high disease severity (SAPS II > 53) or in medical vs surgical ICU patients. CONCLUSION: We did not observe a difference in 1-year mortality among acutely admitted adult ICU patients with risk factors for gastrointestinal bleeding allocated to stress ulcer prophylaxis with pantoprazole or placebo during the ICU stay. (The SUP-ICU trial was funded by Innovation Fund Denmark and others; ClinicalTrials.gov number, NCT02467621).


Assuntos
Antiulcerosos/uso terapêutico , Hemorragia Gastrointestinal/mortalidade , Hemorragia Gastrointestinal/prevenção & controle , Pantoprazol/uso terapêutico , Úlcera Péptica/mortalidade , Úlcera Péptica/prevenção & controle , Idoso , Antiulcerosos/administração & dosagem , Cuidados Críticos , Método Duplo-Cego , Feminino , Seguimentos , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pantoprazol/administração & dosagem , Úlcera Péptica/complicações , Fatores de Risco , Escala Psicológica Aguda Simplificada , Resultado do Tratamento
11.
Br J Anaesth ; 123(1): e50-e64, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31130272

RESUMO

Suspected perioperative allergic reactions are rare but can be life-threatening. The diagnosis is difficult to make in the perioperative setting, but prompt recognition and correct treatment is necessary to ensure a good outcome. A group of 26 international experts in perioperative allergy (anaesthesiologists, allergists, and immunologists) contributed to a modified Delphi consensus process, which covered areas such as differential diagnosis, management during and after anaphylaxis, allergy investigations, and plans for a subsequent anaesthetic. They were asked to rank the appropriateness of statements related to the immediate management of suspected perioperative allergic reactions. Statements were selected to represent areas where there is a lack of consensus in existing guidelines, such as dosing of epinephrine and fluids, the management of impending cardiac arrest, and reactions refractory to standard treatment. The results of the modified Delphi consensus process have been included in the recommendations on the management of suspected perioperative allergic reactions. This paper provides anaesthetists with an overview of relevant knowledge on the immediate and postoperative management of suspected perioperative allergic reactions based on current literature and expert opinion. In addition, it provides practical advice and recommendations in areas where consensus has been lacking in existing guidelines.


Assuntos
Hipersensibilidade Imediata/terapia , Complicações Intraoperatórias/terapia , Complicações Pós-Operatórias/terapia , Humanos , Hipersensibilidade Imediata/diagnóstico , Internacionalidade , Complicações Intraoperatórias/diagnóstico , Complicações Pós-Operatórias/diagnóstico
12.
Intensive Care Med ; 45(5): 609-618, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30863936

RESUMO

PURPOSE: In the subgroup of patients with Simplified Acute Physiology Score (SAPS) II > 53 in the Stress Ulcer Prophylaxis in Intensive Care Unit (SUP-ICU) trial, there was interaction (P = 0.049) suggesting increased mortality in patients allocated to pantoprazole as compared with placebo. We aimed to explore this further. METHODS: The SUP-ICU trial allocated acutely admitted adults at risk of gastrointestinal bleeding to pantoprazole vs placebo. In this post hoc study, we repeated all the preplanned analyses of SUP-ICU in patients with baseline SAPS II > 53. RESULTS: A total of 1140 patients had a complete SAPS II > 53 and were included. At 90 days, 272/579 patients (47%) assigned to pantoprazole had died, as compared with 229/558 patients (41%) assigned to placebo [relative risk 1.13; 95% confidence interval (CI) 1.00-1.29]. This was supported by sensitivity analyses adjusted for risk factors and those in the per-protocol population. When accounting for patients with incomplete SAPS II in two additional analyses, the relative risk was 1.08; 95% CI 0.96-1.22 and 1.10; 95% CI 0.97-1.25. This was also observed for the secondary outcome days alive without life support. There were no differences between the intervention groups in the other secondary outcomes. CONCLUSIONS: In this post hoc analysis of patients with high disease severity included in the SUP-ICU trial, we observed higher 90-day mortality and fewer days alive without life support with pantoprazole vs placebo. Some of this may have been explained by missing SAPS II data, but further research is needed to draw firm conclusions. CLINICALTRIALS.GOV: ClinicalTrials.gov No. NCT02467621.


Assuntos
Pantoprazol/uso terapêutico , Gravidade do Paciente , Profilaxia Pré-Exposição/normas , Adulto , Estado Terminal/terapia , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Mortalidade , Pantoprazol/normas , Placebos , Profilaxia Pré-Exposição/métodos , Escala Psicológica Aguda Simplificada , Resultado do Tratamento
13.
Br J Anaesth ; 123(1): e104-e109, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30916025

RESUMO

Simulation-based education is often highlighted as a method to prepare health personnel to handle clinical emergencies through repeated training and the design of supports. As one of the most common clinical emergencies in anaesthesia, anaphylaxis is often included in simulation scenarios at both graduate and postgraduate levels. Case reviews of anaphylaxis management continue to identify deficiencies in clinical responses. We evaluated the evidence to support the use of simulation to address these deficiencies. We undertook a comprehensive review of the MEDLINE and Embase databases with MESH terms 'Anaphylaxis', 'Anaesthesia', 'Simulation training', and variations of these terms. Articles were also searched from reference lists in the identified papers. A total of 39 articles on perioperative anaphylaxis simulation were identified, with most focusing on the clinical skills of individuals. However, anaphylaxis scenarios are also being used in assessment of teams and in the evaluation of broader system performance. Many countries mandate simulation training and competency assessment at graduate and postgraduate levels: despite this, none of the articles linked simulation training or assessment with improved patient management or outcomes. We found evidence that in situ simulation and use of cognitive aids lead to improved teamwork and task performace. Quantitative and qualitative evidence for simulation-based perioperative training is limited. Future studies should investigate whether simulation training in perioperative anaphylaxis, particularly in situ simulation, translates into improved patient management and outcomes.


Assuntos
Anafilaxia/terapia , Anestesiologia/educação , Competência Clínica , Complicações Intraoperatórias/terapia , Simulação de Paciente , Complicações Pós-Operatórias/terapia , Educação em Enfermagem , Humanos
15.
Tidsskr Nor Laegeforen ; 139(3)2019 02 12.
Artigo em Inglês, Norueguês | MEDLINE | ID: mdl-30754951

RESUMO

BAKGRUNN: I 2002 ble Forskerlinjen opprettet for tidlig å rekruttere medisinstudenter til forskning. Vi ønsket å kartlegge hvor mange tidligere forskerlinjestudenter fra Universitetet i Bergen som fortsatte å forske og identifisere faktorer som var assosiert med videre forskning. MATERIALE OG METODE: Alle studenter innrullert i forskerlinjeprogrammet ved Universitetet i Bergen siden oppstart i 2002 som var uteksaminert fra medisinstudiet innen juni 2017 ble kontaktet per e-post med en elektronisk spørreundersøkelse. Vi undersøkte om deltagerne holdt på med eller hadde gjennomført doktorgrad, antall publiserte artikler, tid siden siste publisering, akademisk undervisning og veiledning samt nåværende stilling på universitet eller høyskole. RESULTATER: Totalt 102 av 148 (69 %) besvarte spørreundersøkelsen. Av disse hadde 68 % gått videre med doktorgrad, 38 % var involvert i akademisk undervisning eller veiledning og 29 % var ansatt i en akademisk stilling. Samlet hadde deltagerne i median publisert fire artikler. Kvinner hadde større sannsynlighet for å gå videre med doktorgrad enn menn. Det samme hadde de som publiserte minst én artikkel før fullført medisinstudium, og de som ikke hadde mottatt regelmessig veiledning som forskerlinjestudent. Det var ingen sammenheng mellom det å fullføre Forskerlinjen og det å gå videre med doktorgrad. FORTOLKNING: Mange medisinstudenter som har gått Forskerlinjen ved Universitetet i Bergen fortsetter med forskning etter fullført studium. Dette gjelder også de som ikke fullfører linjen.


Assuntos
Pesquisa Biomédica/educação , Educação Médica , Pesquisadores/estatística & dados numéricos , Dissertações Acadêmicas como Assunto , Adulto , Escolha da Profissão , Educação de Pós-Graduação/estatística & dados numéricos , Docentes de Medicina/estatística & dados numéricos , Feminino , Humanos , Masculino , Noruega , Publicações/estatística & dados numéricos , Distribuição por Sexo , Estudantes de Medicina , Inquéritos e Questionários , Ensino/estatística & dados numéricos
17.
Acta Anaesthesiol Scand ; 63(2): 154-160, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30203491

RESUMO

BACKGROUND: Cerebral gas embolism is a complication of several medical procedures and occurs when gas enters the cerebral circulation. Knowledge about etiology and outcome in affected patients is limited, and prospective trials on management and treatment are hardly feasible. Case reports are therefore an important source of information. METHODS: A systematic literature search was conducted in June 2016 and May 2018, supplemented by a manual search. Titles and abstracts were systematically assessed for eligibility, followed by full-text screening for included papers. Screening and data extraction were performed independently by two researchers. Cases of cerebral gas embolism due to any iatrogenic cause were included. Criteria for exclusion were: animal studies, non-cerebral localization, extravascular gas only, and non-iatrogenic causes. 264 cases reported in 189 papers were included. RESULTS: A broad range of procedures leading to iatrogenic cerebral gas embolism (ICGE) were identified and a comprehensive list is presented in this article. Procedures were mostly reported as conducted correctly, but procedure related error, patient activity, or defective equipment were also reported as causes. Neurological, neuropsychological, and cardiopulmonary symptoms were common. The diagnosis was frequently based on or confirmed by radiology, usually CT. Hyperbaric oxygen therapy was applied in a large number of cases. CONCLUSION: The reported causes, symptoms and signs, and outcomes of ICGE vary significantly, and awareness of the condition in the medical community is essential. A standardized method of reporting could facilitate higher quality research in the field.


Assuntos
Embolia Aérea/terapia , Doença Iatrogênica , Embolia Aérea/epidemiologia , Embolia Aérea/etiologia , Humanos , Período Perioperatório , Resultado do Tratamento
19.
Scand J Trauma Resusc Emerg Med ; 26(1): 64, 2018 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-30107855

RESUMO

BACKGROUND: Studies show increased mortality among severely injured patients not met by trauma team. Proper triage is important to ensure that all severely injured patients receive vital trauma care. In 2017 a new national trauma plan was implemented in Norway, which recommended the use of a modified version of "Guidelines for Field Triage of Injured Patients" to identify severely injured patients. METHODS: A retrospective study of 30,444 patients admitted to Haukeland University Hospital in 2013, with ICD-10 injury codes upon discharge. The exclusion criteria were department affiliation considered irrelevant when identifying trauma, patients with injuries that resulted in Injury Severity Score < 15, patients that did receive trauma team, and patients admitted > 24 h after time of injury. Information from patient records of every severely injured patient admitted in 2013 was obtained in order to investigate the sensitivity of the new guidelines. RESULTS: Trauma team activation was performed in 369 admissions and 85 patients were identified as major trauma. Ten severely injured patients did not receive trauma team resuscitation, resulting in an undertriage of 10.5%. Nine out of ten patients were men, median age 54 years. Five patients were 60 years or older. All of the undertriaged patients experienced fall from low height (< 4 m). Traumatic brain injury was seen in six patients. Six patients had a Glasgow Coma Scale score ≤ 13. The new trauma activation guidelines had a sensitivity of 95.0% in our 2013 trauma population. The degree of undertriage could have been reduced to 4.0% had the guidelines been implemented and correctly applied. CONCLUSIONS: The rate of undertriage at Haukeland University Hospital in 2013 was above the recommendations of less than 5%. Use of the new trauma guidelines showed increased triage precision in the present trauma population.


Assuntos
Hospitais Universitários , Índices de Gravidade do Trauma , Triagem/normas , Adulto , Idoso , Serviços Médicos de Emergência , Feminino , Escala de Coma de Glasgow , Humanos , Classificação Internacional de Doenças , Masculino , Pessoa de Meia-Idade , Noruega , Estudos Retrospectivos , Fatores de Tempo , Triagem/métodos , Ferimentos e Lesões/classificação , Adulto Jovem
20.
J Trauma Acute Care Surg ; 84(6S Suppl 1): S120-S124, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29462086

RESUMO

BACKGROUND: Intraosseous (IO) vascular access is increasingly used as an emergency tool for achieving access to the systemic circulation in critically ill patients. The role of IO transfusion of blood in damage control resuscitation is however questionable due to possible inadequate flow rate and hemolysis. Some experts claim that IO transfusion is contraindicated. In this study, we have challenged this statement by looking at flow rates of autologous fresh whole blood reinfusion and hemolysis using two of the commonly used Food and Drug Administration-approved and Conformité Européenne (CE)-marked sternal needles. Additionally, the success rate of sternal access between the two devices is evaluated. METHODS: Volunteer professional military personnel, were enrolled prospectively in a nonrandomized observational study design. We collected 450 mL of autologous whole blood from each participant. Participants were divided into the following three groups of 10: Tactically Advanced Lifesaving IO Needle (T.A.L.O.N.) IO, FAST1 IO, and intravenous group. The reinfusion was done by gravity only. Blood sampling was performed before blood collection and 30 minutes after reinfusion. Investigation of hemolysis was performed by measurements of haptoglobin and lactate dehydrogenase. Success rate was evaluated by correct aspiration of bone marrow. RESULTS: Median reinfusion rate was 46.2 mL/min in the FAST1 group, 32.4 mL/min in the T.A.L.O.N. group, and 74.1 mL/min in the intravenous group. Blood samples from all participants were within normal ranges. There was no statistically significant difference in haptoglobin and lactate dehydrogenase between the groups. In the FAST1 group, 1 (9%) of 11 procedures failed. In the T.A.L.O.N. group, 4 (29%) of 14 procedures failed. CONCLUSION: Although preferable, achieving peripheral venous access in the bleeding patient is a major problem. Our findings suggest that fresh whole-blood transfusion through the IO route is safe, reliable, and provide sufficient flow for resuscitation. LEVEL OF EVIDENCE: Therapeutic/Care management study, level III.


Assuntos
Coleta de Amostras Sanguíneas/métodos , Transfusão de Sangue Autóloga/métodos , Infusões Intraósseas , Ressuscitação , Esterno , Adulto , Preservação de Sangue , Emergências , Feminino , Hemólise , Humanos , Infusões Intraósseas/efeitos adversos , Infusões Intraósseas/métodos , Infusões Intravenosas , Masculino , Agulhas , Estudos Prospectivos , Ressuscitação/métodos , Adulto Jovem
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