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1.
Obstet Gynecol Surv ; 78(1): 69-74, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36607202

RESUMO

Importance: Adrenal hemorrhage in pregnancy is rare. The prevalence of pregnant patients whose pregnancies are complicated by preeclampsia or eclampsia is hypothesized to be slightly higher than the 0.4% to 1.1% occurrence rate in the nonpregnant population. However, the mortality rate of adrenal hemorrhage is reportedly as high as 15%. Therefore, it is critical for obstetric providers to have basic knowledge on the presentation, diagnosis, and management of adrenal hemorrhage in the pregnant population so that prompt diagnosis can be made. Objective: This review highlights incidence, pathophysiology, risk factors, diagnosis, management, and complications of adrenal hemorrhage in the peripartum period. Evidence Acquisition: A literature search was undertaken by our research university librarian using the search engines of PubMed, CINAHL, and EMBASE (Medline items removed). The search terms used included "adrenal hemorrhage" OR "adrenal gland hemorrhage" AND "pregnancy" OR "maternal." The search was limited to articles in English, and the years searched were from January 1, 2015 to December 31, 2021. Results: There were 130 abstracts identified, and 30 of the articles were ultimately used as the basis for this review. Presenting signs and symptoms of adrenal hemorrhage were typically abdominal, back, and flank pain. Diagnosis was typically made with ultrasound and computed tomography or magnetic resonance imaging without contrast for confirmation. Management options include conservative management versus surgical management with adrenalectomy or interventional radiology embolization in the unstable patient. For patients with evidence of adrenal insufficiency, steroid replacement was used. Most patients with adrenal hemorrhage in the literature had unilateral adrenal hemorrhage; however, several cases of bilateral adrenal hemorrhage have been reported. Patients with bilateral adrenal hemorrhage were more likely to require steroids for adrenal insufficiency. There are no known contraindications to vaginal delivery in this group of patients, and patients who were managed conservatively were often able to continue the pregnancy to term. Conclusions: Early recognition and management are integral in decreasing the morbidity and mortality associated with adrenal hemorrhage. Relevance Statement: This is an evidence-based review of adrenal hemorrhage in pregnancy and how to diagnose and manage a pregnancy complicated by adrenal hemorrhage.


Assuntos
Doenças das Glândulas Suprarrenais , Insuficiência Adrenal , Pré-Eclâmpsia , Feminino , Humanos , Doenças das Glândulas Suprarrenais/complicações , Doenças das Glândulas Suprarrenais/diagnóstico , Doenças das Glândulas Suprarrenais/terapia , Hemorragia/terapia , Hemorragia/complicações , Ultrassonografia/efeitos adversos , Insuficiência Adrenal/complicações
2.
Crit Care ; 27(1): 25, 2023 01 17.
Artigo em Inglês | MEDLINE | ID: mdl-36650557

RESUMO

BACKGROUND: In-hospital acute resuscitation in trauma has evolved toward early and balanced transfusion resuscitation with red blood cells (RBC) and plasma being transfused in equal ratios. Being able to deliver this ratio in prehospital environments is a challenge. A combined component, like leukocyte-depleted red cell and plasma (RCP), could facilitate early prehospital resuscitation with RBC and plasma, while at the same time improving logistics for the team. However, there is limited evidence on the clinical benefits of RCP. OBJECTIVE: To compare prehospital transfusion of combined RCP versus RBC alone or RBC and plasma separately (RBC + P) on mortality in trauma bleeding patients. METHODS: Data were collected prospectively on patients who received prehospital transfusion (RBC + thawed plasma/Lyoplas or RCP) for traumatic hemorrhage from six prehospital services in England (2018-2020). Retrospective data on patients who transfused RBC from 2015 to 2018 were included for comparison. The association between transfusion arms and 24-h and 30-day mortality, adjusting for age, injury mechanism, age, prehospital heart rate and blood pressure, was evaluated using generalized estimating equations. RESULTS: Out of 970 recruited patients, 909 fulfilled the study criteria (RBC + P = 391, RCP = 295, RBC = 223). RBC + P patients were older (mean age 42 vs 35 years for RCP and RBC), and 80% had a blunt injury (RCP = 52%, RBC = 56%). RCP and RBC + P were associated with lower odds of death at 24-h, compared to RBC alone (adjusted odds ratio [aOR] 0.69 [95%CI: 0.52; 0.92] and 0.60 [95%CI: 0.32; 1.13], respectively). The lower odds of death for RBC + P and RCP vs RBC were driven by penetrating injury (aOR 0.22 [95%CI: 0.10; 0.53] and 0.39 [95%CI: 0.20; 0.76], respectively). There was no association between RCP or RBC + P with 30-day survival vs RBC. CONCLUSION: Prehospital plasma transfusion for penetrating injury was associated with lower odds of death at 24-h compared to RBC alone. Large trials are needed to confirm these findings.


Assuntos
Serviços Médicos de Emergência , Ferimentos e Lesões , Humanos , Adulto , Transfusão de Eritrócitos , Transfusão de Componentes Sanguíneos , Estudos Retrospectivos , Plasma , Hemorragia/terapia , Ressuscitação , Eritrócitos , Inglaterra , Ferimentos e Lesões/complicações , Ferimentos e Lesões/terapia
3.
J Med Case Rep ; 17(1): 17, 2023 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-36650590

RESUMO

BACKGROUND: Dengue is still a recurrent challenge to the global population, without specific antiviral therapy. Clinical management strategies are aimed to mitigate the deaths. The use of blood products in dengue is recommended mainly in cases of bleeding. CASE PRESENTATION: We prospectively collected data on Sri Lankan dengue cases in the Teaching Hospital, Peradeniya, Sri Lanka from 2017, and selected ten severe cases where blood transfusions were involved in the management. The series comprises seven females and three males, with a median age of 36 years (range 12-53 years). All patients were critically ill at the time of blood transfusion, with dramatic stabilization of vital parameters after the transfusions. Only one patient had detectable bleeding, while five patients had occult blood loss as indicated by dropping hematocrit. Even though four patients had stable hematocrit, they had metabolic acidosis. Two patients had a very high increase of hepatic transaminases along with acidosis. Two patients had myocarditis with dropping hematocrit, suggestive of occult bleeding. CONCLUSIONS: Clinical deterioration despite fluid management commonly occurs due to occult bleeding in dengue infection. Blood transfusion is lifesaving in such cases of blood loss, acidosis, and severe hepatic damage. The mechanism of this effect needs an explanation, such as enhanced oxygen delivery to the tissues and hemostasis to hypothesize a few possibilities.


Assuntos
Dengue , Dengue Grave , Masculino , Feminino , Humanos , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Dengue Grave/complicações , Dengue Grave/terapia , Hemorragia/etiologia , Hemorragia/terapia , Transfusão de Sangue , Fígado , Testes de Função Hepática , Sri Lanka , Dengue/complicações , Dengue/terapia
5.
Pediatr Blood Cancer ; 70(1): e30019, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36165683

RESUMO

This brief report aims to evaluate the treatment outcome of transarterial embolization in ruptured hepatoblastoma complicated with acute intra-abdominal hemorrhage. Three children (mean age 6 years) with high-risk hepatoblastoma presented with rupture and acute intra-abdominal hemorrhage. In addition to aggressive fluid resuscitation and blood product support, super-selective embolization of the arteries with active bleeding or pseudoaneurysm was performed using calibrated gelfoam particles, with a technical success rate of 100%. Hemodynamic status and hemoglobin level were normalized in all patients within 2 days postembolization. The 30-day survival rate was 100%. No major complication was detected apart from mild elevation of alanine transaminase.


Assuntos
Embolização Terapêutica , Hepatoblastoma , Neoplasias Hepáticas , Criança , Humanos , Hepatoblastoma/complicações , Hepatoblastoma/terapia , Esponja de Gelatina Absorvível/uso terapêutico , Hemorragia/etiologia , Hemorragia/terapia , Resultado do Tratamento , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/terapia , Estudos Retrospectivos
6.
ASAIO J ; 68(12): 1529-1535, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36469449

RESUMO

Bleeding and thromboembolic events are common during veno-venous extracorporeal membrane oxygenation (vvECMO). It is unknown whether these complications are driven by the ECMO system itself, multiorgan-failure, or both. The aim of this study was to assess the prevalence of bleeding and thromboembolic events in patients with isolated respiratory failure. Patients with vvECMO were retrospectively included from March 2009 to October 2017. Exclusion included any organ failure other than respiratory. Major bleeding was defined as a decrease in hemoglobin ≥2 g/dl per 24 hours, the requirement for transfusion of ≥2 packed red blood cell concentrates per 24 hours, any retroperitoneal, pulmonary, central nervous system bleeding, or bleeding requiring surgery. Thromboembolic events were assessed by duplex sonography or CT scan. Of 601 patients, 123 patients with a mean age of 49 ± 15 years and a median Sepsis-related Organ Failure Assessment score of 8 (7-9) were eligible for the analysis. Major bleeding was observed in 73%; 35% of all bleedings occurred on the day of or after ECMO initiation. A more pronounced decrease of PaCO2 after ECMO initiation was seen in patients with intracranial bleeding (ICB) compared with those without. Thromboembolic events were noted in 30%. The levels of activated prothrombin time, fibrinogen, platelet count, or D-dimers affected neither bleeding nor the prevalence of thromboembolic events.


Assuntos
Oxigenação por Membrana Extracorpórea , Insuficiência Respiratória , Tromboembolia , Humanos , Adulto , Pessoa de Meia-Idade , Oxigenação por Membrana Extracorpórea/efeitos adversos , Estudos Retrospectivos , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Hemorragia/epidemiologia , Hemorragia/etiologia , Hemorragia/terapia , Testes de Coagulação Sanguínea , Tromboembolia/epidemiologia , Tromboembolia/etiologia
7.
Khirurgiia (Mosk) ; (12): 11-19, 2022.
Artigo em Russo | MEDLINE | ID: mdl-36469464

RESUMO

OBJECTIVE: To investigate the results of therapeutic and prophylactic endovascular hemostasis of spontaneous bleeding into soft tissues of abdominal, chest wall and retroperitoneal space in patients with COVID-19. MATERIAL AND METHODS: We retrospectively studied 35 patients with COVID-19 complicated by spontaneous bleeding into soft tissues of abdominal, chest wall and retroperitoneal space. According to CT data, the volume of hematoma was 1193.4±706.1 ml. In all patients, CT signs of ongoing bleeding were detected. Moreover, contrast agent extravasation in all phases of examination was established in 15 patients. In other ones, extravasation was detected in late phases or study phase was not identified. All patients underwent angiography. Ongoing bleeding was detected in 12 (34.3%) patients (group 1). They underwent embolization of the target vessel. In 23 patients, bleeding was not established during angiography. Of these, 13 ones underwent prophylactic embolization (group 2). No embolization was carried out in 10 patients (group 3). All groups differed in hematoma localization and COVID-19 severity. RESULTS: Fourteen (40%) patients died in postoperative period. Mortality was similar in all groups. The most common cause of death was progressive respiratory failure following pneumonia. The last one was established by autopsy in 10 (71.4%) patients. CONCLUSION: Angiography confirmed MR signs of contrast agent extravasation in 34.3% of patients. In case of extravasation in all CT phases, ongoing bleeding was confirmed in 66.7% of patients. Endovascular embolization is effective for arterial bleeding into soft tissues. However, large-scale studies are needed to assess the effect of this technique on survival.


Assuntos
COVID-19 , Embolização Terapêutica , Parede Torácica , Humanos , Espaço Retroperitoneal , Meios de Contraste , COVID-19/complicações , COVID-19/diagnóstico , Estudos Retrospectivos , Hemorragia/diagnóstico , Hemorragia/etiologia , Hemorragia/terapia , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/métodos , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Tomografia Computadorizada por Raios X
8.
Nephrol Ther ; 18(7): 627-633, 2022 Dec.
Artigo em Francês | MEDLINE | ID: mdl-36511293

RESUMO

INTRODUCTION: In haemodialysis patients the length of bleeding times after fistula cannulation is an easy and fairly used method of monitoring vascular access. In the most cases, compression is performed manually by nurses and the use of haemostatic dressing is common. As data in the literature are scares, we have decided to develop a quality improvement program in our hemodialysis center to manage this issue. MATERIAL AND METHODS: After informed consent, 35 hemodialysis outpatients were selected in order to study the bleeding time using haemostatic dressing or not during two weeks in a cross over schema. The dialysis schedule was unchanged and comparative analysis of parameters such as blood flow rate or anticoagulant treatment were done between the groups. RESULTS: Compression times with and without hemostatic dressing were not different (12.6 min and 12.9 min, respectively). Patients with an anticoagulation during the dialysis session greater than 0.35 IU/kg/session had a longer bleeding time (12.75 min vs 11.75 min; P=0.008). CONCLUSION: In our evaluation, the use of haemostatic dressings is not associated with a real shorter bleeding time. Their use generate an additional cost estimated on average at 164 euros/year/patient. Patients and team realized that compression time is important for fistula monitoring and using compresses does not really increase this time.


Assuntos
Fístula Arteriovenosa , Derivação Arteriovenosa Cirúrgica , Hemostáticos , Humanos , Melhoria de Qualidade , Diálise Renal , Hemorragia/etiologia , Hemorragia/terapia , Resultado do Tratamento
9.
Tex Heart Inst J ; 49(6)2022 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-36515932

RESUMO

BACKGROUND: The failure rate of vascular closure devices remains a significant cause of major vascular complications in contemporary transcatheter aortic valve implantation practice. METHODS: This research aimed to evaluate use of the Angio-Seal device in a bailout context in the setting of incomplete hemostasis following use of dual Perclose ProGlide devices in patients undergoing transfemoral transcatheter aortic valve implantation. A total of 185 patients undergoing transfemoral transcatheter aortic valve implantation with either dual Per-close ProGlide (n = 139) or a combination of dual Perclose ProGlide and Angio-Seal (n = 46) were retrospectively analyzed. The baseline, procedural characteristics, and all outcomes (defined according to Valve Academic Research Consortium-2 criteria) were compared. RESULTS: No significant differences were seen between the dual Perclose ProGlide vs dual Perclose ProGlide+Angio-Seal groups with regard to the in-hospital Valve Academic Research Consortium-2 primary end points of major vascular complications (n = 13 [9.4%] vs n = 2 [4.3%]; P = .36), minor vascular complications (n = 13 [9.4%] vs n = 8 [14.7%]; P = .14), major bleeding (n = 16 [11.5%] vs n = 2 [4.3%]; P = .25), and minor bleeding (n = 9 [6.5%] vs n = 5 [10.9%]; P = .34), with higher rates of hematoma in the dual Perclose ProGlide+Angio-Seal group (n = 4 [2.9%] vs n = 5 [10.9%]; P = .044). CONCLUSION: Finding from the current study suggest that adjunctive Angio-Seal deployment may be feasible and safe, especially in patients with incomplete hemostasis following dual Perclose ProGlide use, and can be an optimal "bailout" procedure.


Assuntos
Hemorragia , Técnicas Hemostáticas , Substituição da Valva Aórtica Transcateter , Dispositivos de Oclusão Vascular , Humanos , Artéria Femoral/cirurgia , Estudos Retrospectivos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/instrumentação , Resultado do Tratamento , Dispositivos de Oclusão Vascular/efeitos adversos , Hemorragia/etiologia , Hemorragia/terapia
10.
Medicine (Baltimore) ; 101(50): e32130, 2022 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-36550833

RESUMO

This study is to investigate the hemorrhagic cystitis (HC) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) without in vitro T-cell depletion. Patients receiving allo-HSCT in 2019 were enrolled. The occurrence and clinical characteristics of HC after HLA-identical HSCT and haploidentical HSCT were retrospectively analyzed. BK, JC, cytomegalovirus, and other viruses were monitored when HC occurred. Conventional HC treatment was performed. Additionally, 5 cases of severe refractory HC were treated with adipose-derived mesenchymal stem cell (ADSC) besides conventional HC treatment. Totally, 54 patients with allo-HSCT were enrolled, including 12 cases with HLA-identical HSCT and 42 cases with haploidentical HSCT. Among them, 17 developed late-onset HC (LOHC). There was no early-onset HC. The median onset time was 33.5 (9-189) days, with a median duration of 19 (5-143) days. There were 8 cases of grade III HC and 2 cases of grade IV HC. The cumulative incidence of LOHC in 54 patients was 29.6%, and the cumulative incidence of LOHC in 42 patients with haploidentical HSCT was 40.5%. The 1-year expected progression-free survival (PFS) of 26 patients without HC was 86.6%, and the 1-year expected PFS of 16 HC patients was 74.5%. However, there was no statistically significant difference (P = .326). The urine BK virus of 14 patients was positive, with the lowest of 1.98 × 105 copies/mL, and the highest of 8.96 × 105 copies/mL. For the 5 patients with severe refractory HC, the lowest infusion dose of ADSC was 0.9 × 106/kg and the highest was 1.4 × 106/kg. All 5 patients were cured. The incidence of LOHC is higher after haploidentical HSCT. LOHC is positively correlated with urine BK virus. LOHC has no obvious effect on the overall PFS of patients. ADSC infusion has a good therapeutic effect on severe and prolonged LOHC.


Assuntos
Cistite , Transplante de Células-Tronco Hematopoéticas , Humanos , Estudos Retrospectivos , Hemorragia/terapia , Hemorragia/complicações , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Cistite/etiologia , Cistite/terapia , Cistite/epidemiologia , Linfócitos T
11.
Scand J Trauma Resusc Emerg Med ; 30(1): 72, 2022 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-36514084

RESUMO

INTRODUCTION: Pre-hospital emergency medical teams can transfuse blood products to patients with suspected major traumatic haemorrhage. Common transfusion triggers based on physiological parameters have several disadvantages and are largely unvalidated in guiding pre-hospital transfusion. The addition of pre-hospital lactate (P-LACT) may overcome these challenges. To date, the clinical utility of P-LACT to guide pre-hospital blood transfusion is unclear. METHODS: A retrospective analysis of patients with suspected major traumatic haemorrhage attended by Air Ambulance Charity Kent Surrey Sussex (KSS) between 8 July 2017 and 31 December 2019. The primary endpoint was the accuracy of P-LACT to predict the requirement for any in-hospital (continued) transfusion of blood product. RESULTS: During the study period, 306 patients with suspected major traumatic haemorrhage were attended by KSS. P-LACT was obtained in 194 patients. In the cohort 103 (34%) patients were declared Code Red. A pre-hospital transfusion was commenced in 124 patients (41%) and in-hospital transfusion was continued in 100 (81%) of these patients, in 24 (19%) patients it was ceased. Predictive probabilities of various lactate cut-off points for requirement of in-hospital transfusion are documented. The highest overall proportion correctly classified patients were found for a P-LACT cut-point of 5.4 mmol/L (76.50% correctly classified). Based on the calculated predictive probabilities, optimal cut-off points were derived for both the exclusion- and inclusion of the need for in-hospital transfusion. A P-LACT < 2.5 mmol/L had a sensitivity of 80.28% and a negative likelihood ratio [LR-] of 0.37 for the prediction of in-hospital transfusion requirement, whereas a P-LACT of 6.0 mmol/L had a specificity of 99.22%, [LR-] = 0.78. CONCLUSION: Pre-hospital lactate measurements can be used to predict the need for (continued) in-hospital blood products in addition to current physiological parameters. A simple decision support tool derived in this study can help the clinician interpret pre-hospital lactate results and guide pre-hospital interventions in the major trauma patient.


Assuntos
Serviços Médicos de Emergência , Ácido Láctico , Humanos , Estudos Retrospectivos , Sistemas Automatizados de Assistência Junto ao Leito , Serviços Médicos de Emergência/métodos , Transfusão de Sangue/métodos , Hemorragia/diagnóstico , Hemorragia/etiologia , Hemorragia/terapia , Hospitais
12.
Hamostaseologie ; 42(6): 400-408, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36549292

RESUMO

OBJECTIVES: Detailed and decisive information about the patients' coagulation status is important in various emergency situations. Conventional global coagulation testing strategies are often used to provide a quick overview, but several limitations particularly in the trauma setting are well described. With the introduction of direct oral anticoagulations (DOACs), a milestone for several disease entities resulting in overall improved outcomes could be reached, but at the same time providing new diagnostic challenges for the emergency situation. DESIGN: As an alternative to conventional coagulation tests, there is increasing clinical and scientific interest in the use of early whole blood strategies to provide goal-directed coagulation therapies (GDCT) and hemostatic control in critically ill patients. Viscoelastic hemostatic assays (VHAs) were therefore introduced to several clinical applications and may provide as a bedside point-of-care method for faster information on the underlying hemostatic deficiency. CONCLUSION: The use of VHA-based algorithms to guide hemostatic control in emergency situations now found its way to several international guidelines for patients at risk of bleeding. With this qualitative review, we would like to focus on VHA-based GDCT and review the current evidence for its use, advantages, and challenges in the two different clinical scenarios of trauma and intracerebral bleeding/stroke management.


Assuntos
Transtornos da Coagulação Sanguínea , Hemostáticos , Humanos , Testes de Coagulação Sanguínea/métodos , Coagulação Sanguínea , Hemostasia , Hemorragia/diagnóstico , Hemorragia/terapia , Transtornos da Coagulação Sanguínea/diagnóstico , Transtornos da Coagulação Sanguínea/terapia , Hemostáticos/uso terapêutico , Tromboelastografia/métodos
13.
Cochrane Database Syst Rev ; 11: CD013551, 2022 11 21.
Artigo em Inglês | MEDLINE | ID: mdl-36408876

RESUMO

BACKGROUND: Coagulopathy following cardiac surgery is associated with considerable blood product transfusion and high morbidity and mortality. The treatment of coagulopathy following cardiac surgery is challenging, with the replacement of clotting factors being based on transfusion of fresh frozen plasma (FFP). Prothrombin complex concentrate (PCCs) is an alternative method to replace clotting factors and warrants evaluation. PCCs are also an alternative method to treat refractory ongoing bleeding post-cardiac surgery compared to recombinant factor VIIa (rFVIIa) and also warrants evaluation.   OBJECTIVES: Assess the benefits and harms of PCCs in people undergoing cardiac surgery who have coagulopathic non-surgical bleeding. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE, Embase and Conference Proceedings Citation Index-Science (CPCI-S) on the Web of Science on 20 April 2021. We searched Clinicaltrials.gov (www. CLINICALTRIALS: gov), and the World Health Organisation (WHO) International Clinical Trials Registry Platform (ICTRP; apps.who.int/trialsearch/), for ongoing or unpublished trials. We checked the reference lists for additional references. We did not limit the searches by language or publication status. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and non-randomised trials (NRSs).  DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane.   MAIN RESULTS: Eighteen studies were included  (4993 participants). Two were RCTs (151 participants) and 16 were NRSs. Both RCTs had low risk of bias (RoB) in almost all domains. Of the 16 NRSs, 14 were retrospective cohort analyses with one prospective study and one case report. The nine studies used in quantitative analysis were judged to have critical RoB, three serious and three moderate.   1. PCC versus standard treatment Evidence from RCTs showed PCCs are likely to reduce the number of units transfused compared to standard care (MD -0.89, 95% CI -1.78 to 0.00; participants = 151; studies = 2; moderate-quality evidence). Evidence from NRSs agreed with this, showing that PCCs may reduce the mean number of units transfused compared to standard care but the evidence is uncertain (MD -1.87 units, 95% CI -2.53 to -1.20; participants = 551; studies = 2; very low-quality evidence). There was no evidence from RCTs showing a difference in the incidence of red blood cell (RBC) transfusion compared to standard care (OR 0.53, 95% CI 0.20 to 1.40; participants = 101; studies = 1; low-quality evidence). Evidence from NRSs disagreed with this, showing that PCCs may reduce the mean number of units transfused compared to standard care but the evidence is uncertain (OR 0.54, 95% CI 0.30 to 0.98; participants = 1046; studies = 4; low-quality evidence). There was no evidence from RCTs showing a difference in the number of thrombotic events with PCC compared to standard care (OR 0.68 95% CI 0.20 to 2.31; participants = 152; studies = 2; moderate-quality evidence). This is supported by NRSs, showing that PCCs may have no effect on the number of thrombotic events compared to standard care but the evidence is very uncertain (OR 1.32, 95% CI 0.87 to 1.99; participants = 1359; studies = 7; very low-quality evidence). There was no evidence from RCTs showing a difference in mortality with PCC compared to standard care  (OR 0.53, 95% CI 0.12 to 2.35; participants = 149; studies = 2; moderate-quality evidence). This is supported by evidence from NRSs, showing that PCCs may have little to no effect on mortality compared to standard care but the evidence is very uncertain (OR 1.02, 95% CI 0.69 to 1.51; participants = 1334; studies = 6; very low-quality evidence). Evidence from RCTs indicated that there was little to no difference in postoperative bleeding (MD -107.05 mLs, 95% CI -278.92 to 64.83; participants = 151, studies = 2; low-quality evidence).  PCCs may have little to no effect on intensive care length of stay (RCT evidence: MD -0.35 hours, 95% CI -19.26 to 18.57; participants = 151; studies = 2; moderate-quality evidence) (NRS evidence: MD -18.00, 95% CI -43.14 to 7.14; participants = 225; studies = 1; very low-quality evidence) or incidence of renal replacement therapy (RCT evidence: OR 0.72, 95% CI 0.14 to 3.59; participants = 50; studies = 1; low-quality evidence) (NRS evidence: OR 1.46, 95% CI 0.71 to 2.98; participants = 684; studies = 2; very low-quality evidence). No studies reported on additional adverse outcomes.   2. PCC versus rFVIIa For this comparison, all evidence was provided from NRSs.  PCC likely results in a large reduction of RBCs transfused intra-operatively in comparison to rFVIIa (MD-4.98 units, 95% CI -6.37 to -3.59; participants = 256; studies = 2; moderate-quality evidence).  PCC may have little to no effect on the incidence of RBC units transfused comparative to rFVIIa; evidence is very uncertain (OR 0.16, 95% CI 0.02 to 1.56; participants = 150; studies = 1; very low-quality evidence). PCC may have little to no effect on the number of thrombotic events comparative to rFVIIa; evidence is very uncertain (OR 0.51, 95% CI 0.23 to 1.16; participants = 407; studies = 4; very low-quality evidence). PCC may have little to no effect on the incidence of mortality (OR 1.07, 95% CI 0.38 to 3.03; participants = 278; studies = 3; very low-quality evidence) or intensive care length of stay comparative to rFVIIa (MD -40 hours, 95% CI -110.41 to 30.41; participants = 106; studies = 1; very low-quality evidence); evidence is very uncertain . PCC may reduce bleeding (MD -674.34 mLs, 95% CI -906.04 to -442.64; participants = 150; studies = 1; very low-quality evidence) and incidence of renal replacement therapy (OR 0.29, 95% CI 0.12 to 0.71; participants = 106; studies = 1; very low-quality evidence) comparative to rFVIIa; evidence is very uncertain. No studies reported on other adverse events.  AUTHORS' CONCLUSIONS: PCCs could potentially be used as an alternative to standard therapy for coagulopathic bleeding post-cardiac surgery compared to FFP as shown by moderate-quality evidence and it may be an alternative to rFVIIa in refractory non-surgical bleeding but this is based on moderate to very low quality of evidence.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Hemorragia , Humanos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Transfusão de Eritrócitos , Hemorragia/etiologia , Hemorragia/terapia
14.
Sci Rep ; 12(1): 19871, 2022 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-36400820

RESUMO

Delayed bleeding is a major issue in patients with high-grade splenic injuries who receive non-operative management (NOM). While only few studies addressed the clinical manifestations of delayed bleeding in these patients. We reviewed the patients with high-grade splenic injuries presented with delayed bleeding, defined as the need for salvage procedures following NOM. There were 138 patients received NOM in study period. Fourteen of 107 patients in the SAE group and 3 of 31 patients in the non-embolization group had delayed bleeding. Among the 17 delayed bleeding episodes, 6 and 11 patients were salvaged by splenectomy and SAE, respectively. Ten (58.9%, 10/17) patients experienced bleeding episodes in the intensive care unit (ICU), whereas seven (41.1%, 7/17) experienced those in the ward or at home. The clinical manifestations of delayed bleeding were a decline in haemoglobin levels (47.1%, 8/17), hypotension (35.3%, 6/17), tachycardia (47.1%, 8/17), new abdominal pain (29.4%, 5/17), and worsening abdominal pain (17.6%, 3/17). For the bleeding episodes detected in the ICU, a decline in haemoglobin (60%, 6/10) was the main manifestation. New abdominal pain (71.43%, 5/7) was the main presentation when the patients left the ICU. In conclusion, abdominal pain was the main early clinical presentation of delayed bleeding following discharge from the ICU or hospital.


Assuntos
Traumatismos Abdominais , Embolização Terapêutica , Ferimentos não Penetrantes , Humanos , Ferimentos não Penetrantes/terapia , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/métodos , Baço/lesões , Traumatismos Abdominais/terapia , Hemorragia/etiologia , Hemorragia/terapia , Dor Abdominal/etiologia , Ruptura
15.
Scand J Trauma Resusc Emerg Med ; 30(1): 60, 2022 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-36411460

RESUMO

BACKGROUND: Maxillofacial fractures can lead to massive oronasal bleeding; however, surgical hemostasis and packing procedures can be challenging owing to complex facial anatomy. Only a few studies investigated maxillofacial fractures with massive oronasal hemorrhage. However, thus far, no studies have reported a protocolized management approach for maxillofacial trauma from a single center. This study aimed to evaluate the effectiveness of protocolized management for maxillofacial fractures with oronasal bleeding. METHODS: Patients were identified from the National Cheng University Hospital trauma registry from 2010 to 2020. We included patients with a face Abbreviated Injury Scale (AIS) score of > 3 and active oronasal bleeding. Patients' characteristics were compared between the angiography and non-angiography groups and between survivors and nonsurvivors. RESULTS: Forty-nine patients were included. Among them, 34 (69%) underwent angiography, of whom 21 received arterial embolization. Forty-seven patients (96%) successfully achieved hemostasis by adhering to the treatment protocol at our institution. Compared with the non-angiography group, the angiography group had significantly more patients requiring oral intubation (97% vs. 53%, P < 0.001), Glasgow Coma Scale < 9 (GCS; 79% vs. 27%, P < 0.001), head AIS > 3 (65% vs. 13%, P = 0.001), higher Injury Severity Score (ISS; 43 [33-50] vs. 22 [18-27], P < 0.001), higher incidence of cardiopulmonary resuscitation (CPR; 41% vs. 0%, P = 0.002), higher mortality rate (35% vs. 7%, P = 0.043), and more units of packed red blood cells (PRBC) transfused within 24 h (12 [6-20] vs. 2 [0-4], P < 0.001). The nonsurvivor group had significantly more patients with hypotension (62% vs. 8%; P < 0.001), higher need for CPR (85% vs. 8%; P < 0.001), head AIS > 3 (92% vs. 33%; P < 0.001), skull base fracture (100% vs. 64%; P = 0.011), GCS score < 9 (100% vs. 50%; P = 0.003), higher ISS (50 [43-57] vs. 29 [19-48]; P < 0.001), and more units of PRBC transfused within 24 h (18 [13-22] vs. 6 [2-12]; P = 0.001) than the survivor group. More patients underwent angiography in the nonsurvivor group than in the survivor group (92% vs. 61%; P = 0.043). Among embolized vessels, the internal maxillary artery (65%) was the most common bleeding site. Hypoxic encephalopathy accounted for 92% of deaths. CONCLUSIONS: Protocol-guided management effectively optimizes outcomes in patients with maxillofacial bleeding.


Assuntos
Fraturas Ósseas , Hemorragia , Humanos , Hemorragia/etiologia , Hemorragia/terapia , Escala Resumida de Ferimentos , Escala de Gravidade do Ferimento , Escala de Coma de Glasgow
16.
Rev Med Liege ; 77(11): 637-643, 2022 Nov.
Artigo em Francês | MEDLINE | ID: mdl-36354224

RESUMO

Platelet transfusion is commonly used for the prevention of bleeding in central thrombocytopenia. It is estimated that 7-34 % of chronically transfused patients become progressively refractory until they no longer have an increase in post-transfusion platelet count. In this case, and in the presence of bleeding, a therapeutic option is continuous transfusion (CT) of platelet concentrates (PC). We performed a retrospective study of patients at the University Hospital of Liege who received a CT between 01/01/2019 and 31/12/2020. We explored the etiology, immune or non-immune, of the refractory state and analyzed the clinical and biological evolution after TC. In our cohort, 13 patients received CT during the study period; for 8 of them, the refractory state was explained by non-immune causes. The mean platelet count increased during CT and in 61 % of cases, an improvement in bleeding symptomatology was obtained.


La transfusion plaquettaire est couramment utilisée pour la prévention des saignements en cas de thrombopénie centrale. On estime que 7 à 34 % des patients transfusés chroniquement deviennent progressivement réfractaires jusqu'à ne plus présenter d'augmentation de la numération plaquettaire post-transfusionnelle. Dans ce cas, et en présence de saignements, une option thérapeutique correspond à la transfusion continue (TC) de concentrés plaquettaires (CP). Nous avons réalisé une étude rétrospective sur les patients du CHU de Liège ayant reçu une TC entre le 01/01/2019 et le 31/12/2020. Nous avons exploré l'étiologie, immune ou non immune, de l'état réfractaire et analysé l'évolution clinique et biologique après TC. Dans notre cohorte, 13 patients ont bénéficié de TC durant la période étudiée; pour 8 d'entre eux, l'état réfractaire s'expliquait par des causes non immunes. La numération plaquettaire moyenne a augmenté durant la TC et, dans 61 % des cas, une amélioration de la symptomatologie hémorragique a été obtenue.


Assuntos
Transfusão de Plaquetas , Trombocitopenia , Humanos , Transfusão de Plaquetas/efeitos adversos , Estudos Retrospectivos , Plaquetas , Trombocitopenia/terapia , Contagem de Plaquetas , Hemorragia/etiologia , Hemorragia/terapia
17.
Taiwan J Obstet Gynecol ; 61(6): 1061-1064, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36427975

RESUMO

OBJECTIVE: Cervical pregnancy is a rare type of ectopic pregnancy. When the pregnancy is terminated, it will sometimes lead to persistent bleeding. In some cases, hysterectomy is inevitable and the patient loses fertility. Therefore, early diagnosis and targeted management with systemic or local injection of methotrexate is the first-line treatment. Multiple interventions of cervical pregnancy were used to prevent massive hemorrhage, including dilatation and curettage, laparoscopic resection, hysteroscopic resection combined with uterine artery embolization, or uterine artery clip. CASE REPORT: We report a case of cervical pregnancy with a high beta-hCG level accompanied by a visible fetal heartbeat that was successfully treated with hysteroscopic cervical tissue resection and balloon compression combined with systemic administration of methotrexate. CONCLUSION: Efficacy and safety with preserved fertility were important issues in the management of cervical pregnancy. We provide a safe, simple and effective treatment of cervical pregnancy.


Assuntos
Abortivos não Esteroides , Oclusão com Balão , Gravidez Ectópica , Embolização da Artéria Uterina , Gravidez , Feminino , Humanos , Metotrexato/uso terapêutico , Abortivos não Esteroides/uso terapêutico , Gravidez Ectópica/tratamento farmacológico , Gravidez Ectópica/cirurgia , Hemorragia/terapia
18.
Can J Urol ; 29(5): 11276-11283, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36245196

RESUMO

INTRODUCTION: Hemorrhagic cystitis (HC) is a morbid condition for patients and can be challenging for urologists to manage. There are many potential contributing etiologies and the severity of bleeding can be variable. It is important to consider each clinical scenario when formulating management strategies in order to provide the highest quality of care to patients. We provide a review of the literature including diagnosis and treatment options. MATERIALS AND METHODS: We performed a literature search on PubMed using the following keywords: hemorrhagic cystitis, cystitis, gross hematuria, intractable hematuria. We considered all available published articles with no specific inclusion or exclusion criteria for the purposes of this review. RESULTS: We reviewed a total of 41 articles and identified a broad differential diagnosis for intractable hemorrhagic cystitis including infection, chemical exposure, malignancy, nephropathy, trauma, radiation therapy, and idiopathic etiology. Depending on the severity of bleeding, many treatments have been described. These range from conservative strategies (bladder fulguration and continuous irrigation) to more extreme and morbid therapies (intravesical instillations, embolization, and urinary diversion). CONCLUSION: Hemorrhagic cystitis is a relatively common and can be a difficult condition to manage for urologists. It is important to understand the etiology and available treatments options in order to best treat our patients. We provide a comprehensive and thorough review of the literature and propose a stepwise treatment approach.


Assuntos
Cistite , Hematúria , Administração Intravesical , Cistite/diagnóstico , Cistite/etiologia , Cistite/terapia , Hematúria/etiologia , Hematúria/terapia , Hemorragia/etiologia , Hemorragia/terapia , Humanos , Bexiga Urinária
19.
Shock ; 58(4): 275-279, 2022 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-36256624

RESUMO

ABSTRACT: Introduction: Time is an essential element in outcomes of trauma patients. The relationship of time to treatment in management of noncompressible torso hemorrhage (NCTH) with resuscitative endovascular balloon occlusion of the aorta (REBOA) or resuscitative thoracotomy (RT) has not been previously described. We hypothesized that shorter times to intervention would reduce mortality. Methods: A review of the Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery registry from 2013 to 2022 was performed to identify patients who underwent emergency department aortic occlusion (AO). Multivariate logistic regression was used to examine the impact of time to treatment on mortality. Results: A total of 1,853 patients (1,245 [67%] RT, 608 [33%] REBOA) were included. Most patients were male (82%) with a median age of 34 years (interquartile range, 30). Median time from injury to admission and admission to successful AO were 31 versus 11 minutes, respectively. Patients who died had shorter median times from injury to successful AO (44 vs. 72 minutes, P < 0.001) and admission to successful AO (10 vs. 22 minutes, P < 0.001). Multivariate logistic regression demonstrated that receiving RT was the strongest predictor of mortality (odds ratio [OR], 6.6; 95% confidence interval [CI], 4.4-9.9; P < 0.001). Time from injury to admission and admission to successful AO were not significant. This finding was consistent in subgroup analysis of RT-only and REBOA-only populations. Conclusions: Despite expedited interventions, time to aortic occlusion did not significantly impact mortality. This may suggest that rapid in-hospital intervention was often insufficient to compensate for severe exsanguination and hypovolemia that had already occurred before emergency department presentation. Selective prehospital advanced resuscitative care closer to the point of injury with "scoop and control" efforts including hemostatic resuscitation warrants special consideration.


Assuntos
Oclusão com Balão , Procedimentos Endovasculares , Hemostáticos , Choque Hemorrágico , Humanos , Masculino , Adulto , Feminino , Escala de Gravidade do Ferimento , Ressuscitação , Hemorragia/terapia , Tronco , Serviço Hospitalar de Emergência , Choque Hemorrágico/terapia
20.
Rozhl Chir ; 101(9): 452-455, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36257804

RESUMO

INTRODUCTION: The medical and social interest in the SARS-CoV-2 infection is currently high. This infection can, in severe cases, be accompanied by a series of complications, such as thromboembolic disease or pulmonary parenchymal haemorrhage. CASE REPORTS: The paper presents two rare cases of massive intrathoracic haemorrhage caused by pulmonary parenchymal haemorrhage and exacerbated by full anticoagulant treatment of thromboembolic disease. RESULTS: In both cases, the haemorrhage originated in the left lower lobe and was life threatening, requiring urgent anatomical lung resection - left lower lobectomy. CONCLUSIONS: The combinaion of anticoagulant therapy and thromboembolic events related to COVID-19 can cause, in rare cases, massive pulmonary haemorrhage. This rare complication proved lethal in one out of two of the cases described in this paper. An imminent and adequate reaction is necessary when the first signs of haemorrhage appear.


Assuntos
COVID-19 , Humanos , Recém-Nascido , COVID-19/complicações , Anticoagulantes/efeitos adversos , SARS-CoV-2 , Pulmão , Hemorragia/etiologia , Hemorragia/terapia
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