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1.
J Spec Oper Med ; 21(3): 36-40, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34529802

RESUMO

BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a technique that uses internal clamping of the aorta to control abdominal, pelvic, or junctional bleeding. We created a course to train military physicians in both civilian prehospital use and battlefield use. To determine the effectiveness of this training, we conducted REBOA training for French military emergency physicians. METHODS: We trained 15 military physicians, organizing the training as follows: a half-day of theoretical training, a half-day of training on mannequins, a half-day on human corpses, and a half-day on a living pig. The primary endpoint was the success rate after training. We defined success as the balloon being inflated in zone 1 of a PryTime mannequin. The secondary endpoints were the progression of each trainee during the training, the difference between the median completion duration before and after training, the median post-training duration, and the median duration for the placement of the sheath introducer before and after training. RESULTS: Fourteen of the physicians (93%) correctly placed the balloon in the mannequin at the end of the training period. During the training, the success rate increased from 73% to 93% (p = .33). The median time for REBOA after training was only 222 seconds (interquartile range [IQR] 194-278), significantly faster than before training (330 seconds, IQR 260-360.5; p = .0033). We also found significantly faster sheath introducer placement (148 seconds, IQR 126-203 versus 145 seconds, IQR 115.5 - 192.5; p = .426). CONCLUSION: The training can be performed successfully and paves the way for the use of REBOA by emergency physicians in austere conditions.


Assuntos
Oclusão com Balão , Procedimentos Endovasculares , Médicos , Choque Hemorrágico , Animais , Aorta , Constrição , Humanos , Ressuscitação , Choque Hemorrágico/terapia , Suínos
2.
BMC Med Educ ; 21(1): 421, 2021 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-34364373

RESUMO

BACKGROUND: Access to safe surgery has been recognized as an indispensable component of universal health coverage. A competent anesthesia workforce is a prerequisite for safe surgical care. In Ethiopia, non-physician anesthetists are the main anesthesia service providers. The Government of Ethiopia implemented a program intervention to improve the quality of non-physician anesthetists' education, which included faculty development, curricula strengthening, student support, educational resources, improved infrastructure and upgraded regulations. This study aimed to assess changes following the implementation of this program. METHODS: A pre-and post-evaluation design was employed to evaluate improvement in the quality of non-physician anesthetists' education. A 10-station objective structured clinical examination (OSCE) was administered to graduating class anesthetists of 2016 (n = 104) to assess changes in competence from a baseline study performed in 2013 (n = 122). Moreover, a self-administered questionnaire was used to collect data on students' perceptions of the learning environment. RESULTS: The overall competence score of 2016 graduates was significantly higher than the 2013 class (65.7% vs. 61.5%, mean score difference = 4.2, 95% CI = 1.24-7.22, p < 0.05). Although we found increases in competence scores for 6 out of 10 stations, the improvement was statistically significant for three tasks only (pre-operative assessment, postoperative complication, and anesthesia machine check). Moreover, the competence score in neonatal resuscitation declined significantly from baseline (from 74.4 to 68.9%, mean score difference = - 5.5, 95% CI = -10.5 to - 0.5, p < 0.05). Initial gender-based performance differences disappeared (66.3% vs. 65.3%, mean score difference = - 1.0, 95% CI = - 6.11-3.9, p > 0.05 in favor of females), and female students scored better in some stations. Student perceptions of the learning environment improved significantly for almost all items, with the largest percentage point increase in the availability of instructors from 38.5 to 70.2% (OR = 3.76, 95% CI = 2.15-6.55, p < 0.05). CONCLUSION: The results suggest that the quality of non-physician anesthetists' education has improved. Stagnation in competence scores of some stations and student perceptions of the simulated learning environment require specific attention.


Assuntos
Bacharelado em Enfermagem , Ressuscitação , Competência Clínica , Currículo , Avaliação Educacional , Etiópia , Feminino , Humanos , Recém-Nascido
3.
BMC Med Educ ; 21(1): 436, 2021 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-34407810

RESUMO

BACKGROUND: The educational efficacy in neonatal resuscitation relies on the subject and teaching strategies. Therefore, it is imperative to test diverse educational methods if they are more instructive to engage students in active learning and practicing knowledge. Hence, the present study aims to investigate the efficacy of a pedagogical framework in neonatal resuscitation skill learning among nursing students in a resource-limited setting. METHODS: A single-blind randomized controlled trial was conducted between October 2020 to March 2021. Sixty nursing students in the 3rd and 4th year of professional training were randomly allocated to the pedagogy and the traditional group. The pedagogy group learned via 6-step LSPPDM (Learn, See, Practice, Prove, Do, Maintain) pedagogy including lectures, video, clinical observation, skill sessions under supervision, and self-directed practice. The traditional group learned through 2-step (Learn, Practice) method that included lectures and skill sessions under supervision. The outcomes measured included technical and non-technical skills in neonatal resuscitation. The technical skill deals with steps such as stimulation, ventilation, oxygenation, intubation, chest compression, medications, and reporting. Non-technical skills refer to teamwork skills that focus on the interaction between leader and helper. Both skills were measured through previously published validated tools two times before and after the intervention by blinded assessors in a simulated delivery room. RESULTS: Overall, the skill was significantly improved in both groups after intervention. Yet, the results showed that the mean difference of technical skill score in the pedagogy group (24.3 ± 3.5) was significantly higher (p <  0.001) compared to the traditional group (16.2 ± 2.4). Likewise, the mean difference of non-technical skill score in the pedagogy (36.9 ± 1.9) was highly significant (p <  0.001) compared to the traditional group (31.2 ± 1.7). CONCLUSIONS: The LSPPDM pedagogy was found more effective in enhancing technical and non-technical skills in neonatal resuscitation compared to the traditional method. The results of this study support the efficacy of the 6-step LSPPDM pedagogy in the education of nursing students regarding neonatal resuscitation in a resource-limited setting. TRIAL REGISTRATION: Prospectively registered at ClinicalTrials.gov ( NCT04748341 ).


Assuntos
Ressuscitação , Estudantes de Enfermagem , Competência Clínica , Humanos , Recém-Nascido , Aprendizagem , Método Simples-Cego
5.
J Pak Med Assoc ; 71(8): 1996-1999, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34418018

RESUMO

OBJECTIVE: To assess the improvement in knowledge of healthcare professionals after attending Neonatal Life Support training workshop. METHODS: The interventional study with secondary data was conducted in the Neonatology Department of the Children's Hospital and the Institute of Child Health, Lahore, Pakistan, using 2-year data of all the training workshops from 2017 to 2018. The participants were consultants, post-graduate residents, nurses, lady health visitors, lady health workers and rescue workers. Knowledge was tested through a true/false questionnaire regarding resuscitation skills both before and after the hands-on workshop. The score of each candidate was recorded on a results sheet. Baselines scores were compared with respective post-workshop test. Data was analysed using SPSS 20. RESULTS: Of the 52 workshops, 35(%) were conducted in 2017 and 17(%)in 2018, and of the 1350 particpants, 1080(81%) were doctors, 257(18%) were nurses and 13(1%) were paramedics and rescue workers. Mean overall baseline score was 71.96±8.38 compared to 86.60+/-5.48 post-intervention (p<0.001). CONCLUSIONS: The Neonatal Life Support training workshop resulted in significant gain in knowledge about neonatal resuscitation by healthcare professionals.


Assuntos
Médicos , Ressuscitação , Criança , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde , Humanos , Recém-Nascido , Inquéritos e Questionários
6.
Hematology ; 26(1): 601-611, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34411495

RESUMO

There has been renewed interest in the use of low titer group O whole blood (LTOWB) for the resuscitation of civilian casualties. LTOWB offers several advantages over conventional components such as providing balanced resuscitation in one bag that contains less additive/preservative solution than an equivalent volume of conventional components, is easier and faster to transfuse than multiple components, avoids blood product ratio confusion, contains cold stored platelets, and reduces donor exposures. The resurgence in its use in the resuscitation of civilian trauma patients has led to the publication of an increasing number of studies on its use, primarily amongst adult recipients but also in pediatric patients. These studies have indicated that hemolysis does not occur amongst adult and pediatric non-group O recipients of a modest quantity of LTOWB. The published studies to date on mortality have shown conflicting results with some demonstrating a reduction following LTOWB transfusion while most others have not shown a reduction; there have not been any studies to date that have found significantly increased overall mortality amongst LTOWB recipients. Similarly, when other clinical outcomes, such as venous thromboembolism, sepsis, hospital or intensive care unit lengths of stay are evaluated, LTOWB recipients have not demonstrated worse outcomes compared to conventional component recipients. While definitive proof of the trends in these morbidity and mortality outcomes awaits confirmation in randomized controlled trials, the evidence to date indicates the safety of transfusing LTOWB to injured civilians.


Assuntos
Transfusão de Sangue/métodos , Ressuscitação/métodos , Ferimentos e Lesões/terapia , Sistema ABO de Grupos Sanguíneos/sangue , Doadores de Sangue , Preservação de Sangue , Humanos , Reação Transfusional , Resultado do Tratamento , Ferimentos e Lesões/sangue
7.
BMJ Open ; 11(8): e048506, 2021 08 25.
Artigo em Inglês | MEDLINE | ID: mdl-34433598

RESUMO

OBJECTIVE: To assess the impact of mobile virtual reality (VR) simulations using electronic Helping Babies Breathe (eHBB) or video for the maintenance of neonatal resuscitation skills in healthcare workers in resource-scarce settings. DESIGN: Randomised controlled trial with 6-month follow-up (2018-2020). SETTING: Secondary and tertiary healthcare facilities. PARTICIPANTS: 274 nurses and midwives assigned to labour and delivery, operating room and newborn care units were recruited from 20 healthcare facilities in Nigeria and Kenya and randomised to one of three groups: VR (eHBB+digital guide), video (video+digital guide) or control (digital guide only) groups before an in-person HBB course. INTERVENTIONS: eHBB VR simulation or neonatal resuscitation video. MAIN OUTCOMES: Healthcare worker neonatal resuscitation skills using standardised checklists in a simulated setting at 1 month, 3 months and 6 months. RESULTS: Neonatal resuscitation skills pass rates were similar among the groups at 6-month follow-up for bag-and-mask ventilation (BMV) skills check (VR 28%, video 25%, control 22%, p=0.71), objective structured clinical examination (OSCE) A (VR 76%, video 76%, control 72%, p=0.78) and OSCE B (VR 62%, video 60%, control 49%, p=0.18). Relative to the immediate postcourse assessments, there was greater retention of BMV skills at 6 months in the VR group (-15% VR, p=0.10; -21% video, p<0.01, -27% control, p=0.001). OSCE B pass rates in the VR group were numerically higher at 3 months (+4%, p=0.64) and 6 months (+3%, p=0.74) and lower in the video (-21% at 3 months, p<0.001; -14% at 6 months, p=0.066) and control groups (-7% at 3 months, p=0.43; -14% at 6 months, p=0.10). On follow-up survey, 95% (n=65) of respondents in the VR group and 98% (n=82) in the video group would use their assigned intervention again. CONCLUSION: eHBB VR training was highly acceptable to healthcare workers in low-income to middle-income countries and may provide additional support for neonatal resuscitation skills retention compared with other digital interventions.


Assuntos
Asfixia Neonatal , Realidade Virtual , Competência Clínica , Eletrônica , Pessoal de Saúde/educação , Humanos , Lactente , Recém-Nascido , Ressuscitação
8.
Zhonghua Yi Xue Za Zhi ; 101(30): 2356-2359, 2021 Aug 10.
Artigo em Chinês | MEDLINE | ID: mdl-34404126

RESUMO

Fluid resuscitation is the cornerstone in the early treatment of severe acute pancreatitis(SAP). The endpoints of fluid therapy should be closely monitored early in the disease course by different methods, such as clinical status, pressure indicators, volume indicators, the maintain of microcirculation and the tissue oxygenation. To avoid volume overload that may lead to complications such as pulmonary edema and abdominal hypertension, it is critical to adjust the ratio of crystalloid-colloid and the speed of the liquid timely according to the dynamically assessment of fluid responsiveness and tolerance, the perfusion of macrocirculation and microcirculation and the stage of the fluid resuscitation, so as to improve the efficacy and safety of early fluid resuscitation in the treatment of SAP.


Assuntos
Pancreatite , Edema Pulmonar , Doença Aguda , Hidratação , Humanos , Monitorização Fisiológica , Pancreatite/terapia , Ressuscitação
9.
Trials ; 22(1): 511, 2021 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-34332617

RESUMO

BACKGROUND: Survival after out-of-hospital cardiac arrest (OHCA) is poor and dependent on high-quality cardiopulmonary resuscitation. Resuscitative endovascular balloon occlusion of the aorta (REBOA) may be advantageous in non-traumatic OHCA due to the potential benefit of redistributing the cardiac output to organs proximal to the aortic occlusion. This theory is supported by data from both preclinical studies and human case reports. METHODS: This multicentre trial will enrol 200 adult patients, who will be randomised in a 1:1 ratio to either a control group that receives advanced cardiovascular life support (ACLS) or an intervention group that receives ACLS and REBOA. The primary endpoint will be the proportion of patients who achieve return of spontaneous circulation with a duration of at least 20 min. The secondary objectives of this trial are to measure the proportion of patients surviving to 30 days with good neurological status, to describe the haemodynamic physiology of aortic occlusion during ACLS, and to document adverse events. DISCUSSION: Results from this study will assess the efficacy and safety of REBOA as an adjunctive treatment for non-traumatic OHCA. This novel use of REBOA may contribute to improve treatment for this patient cohort. TRIAL REGISTRATION: The trial is approved by the Regional Committee for Medical and Health Research Ethics in Norway (reference 152504) and is registered at ClinicalTrials.gov (reference NCT04596514) and as Universal Trial Number WHO: U1111-1253-0322.


Assuntos
Oclusão com Balão , Reanimação Cardiopulmonar , Procedimentos Endovasculares , Parada Cardíaca Extra-Hospitalar , Choque Hemorrágico , Adulto , Aorta , Oclusão com Balão/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Humanos , Estudos Multicêntricos como Assunto , Noruega , Parada Cardíaca Extra-Hospitalar/diagnóstico , Parada Cardíaca Extra-Hospitalar/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Ressuscitação , Choque Hemorrágico/terapia
10.
Artigo em Inglês | MEDLINE | ID: mdl-34281001

RESUMO

Preventable neonatal deaths due to prematurity, perinatal events, and infections are the leading causes of under-five mortality. The vast majority of these deaths are in resource-limited areas. Deaths due to infection have been associated with lack of access to clean water, overcrowded nurseries, and improper disinfection (reprocessing) of equipment, including vital resuscitation equipment. Reprocessing has recently come to heightened attention, with the COVID-19 pandemic bringing this issue to the forefront across all economic levels; however, it is particularly challenging in low-resource settings. In 2015, Eslami et al. published a letter to the editor in Resuscitation, highlighting concerns about the disinfection of equipment being used to resuscitate newborns in Kenya. To address the issue of improper disinfection, the global health nongovernment organization PATH gathered a group of experts and, due to lack of best-practice evidence, published guidelines with recommendations for reprocessing of neonatal resuscitation equipment in low-resource areas. The guidelines follow the gold-standard principle of high-level disinfection; however, there is ongoing concern that the complexity of the guideline would make feasibility and sustainability difficult in the settings for which it was designed. Observations from hospitals in Kenya and Malawi reinforce this concern. The purpose of this review is to discuss why proper disinfection of equipment is important, why this is challenging in low-resource settings, and suggestions for solutions to move forward.


Assuntos
COVID-19 , Desinfecção , Contaminação de Equipamentos , Feminino , Humanos , Recém-Nascido , Quênia , Malaui , Pandemias , Gravidez , Ressuscitação , SARS-CoV-2
11.
Transfusion ; 61 Suppl 1: S174-S182, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34269446

RESUMO

BACKGROUND: The Compensatory Reserve Measurement (CRM) is a novel method used to provide early assessment of shock based on arterial wave form morphology changes. We hypothesized that (1) CRM would be significantly lower in those trauma patients who received life-saving interventions compared with those not receiving interventions, and (2) CRM in patients who received interventions would recover after the intervention was performed. STUDY DESIGN AND METHODS: We captured vital signs along with analog arterial waveform data from trauma patients meeting major activation criteria using a prospective study design. Study team members tracked interventions throughout their emergency department stay. RESULTS: Ninety subjects met inclusion with 13 receiving a blood product and 10 a major airway intervention. Most trauma was blunt (69%) with motor vehicle collisions making up the largest proportion (37%) of injury mechanism. Patients receiving blood products had lower CRM values just prior to administration versus those who did not (50% versus 58%, p = .045), and lower systolic pressure (SBP; 95 versus 123 mmHg, p = .005), diastolic (DBP; 62 versus 79, p = .007), and mean arterial pressure (MAP; 75 versus 95, p = .006), and a higher pulse rate (HR; 101 versus 89 bpm, p = .039). Patients receiving an airway intervention had lower CRM values just prior to administration versus those who did not (48% versus 58%, p = .062); however, SBP, DBP, MAP, and HR were not statistically distinguishable (p ≥ .645). CONCLUSIONS: Our results support our hypotheses that the CRM distinguished those patients who received blood or an airway intervention from those who did not, and increased appropriately after interventions were performed.


Assuntos
Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/terapia , Adulto , Pressão Arterial , Pressão Sanguínea , Transfusão de Sangue , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Ressuscitação/métodos , Choque Traumático/diagnóstico , Choque Traumático/terapia , Ferimentos e Lesões/fisiopatologia
13.
J Orthop Trauma ; 35(Suppl 2): S24-S25, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34227598

RESUMO

Pelvic ring fractures range from low-energy falls in the elderly to high-energy mechanisms in young patients. These injuries can be a significant cause of morbidity and mortality and are frequently associated with additional injuries. Hemorrhage and resultant hemodynamic instability are often associated with high-energy injuries and require prompt management. Circumferential pelvic antishock sheeting is an effective and readily available tool for reducing pelvic volume at the accident scene or in the emergency department, while still allowing access to the abdomen and lower extremities for ongoing resuscitation. This article, and the associated instructional video, reviews the indications and proper technique for placing a pelvic sheet.


Assuntos
Fraturas Ósseas , Ossos Pélvicos , Idoso , Fraturas Ósseas/terapia , Hemorragia , Humanos , Ossos Pélvicos/cirurgia , Pelve , Ressuscitação
14.
Rev Lat Am Enfermagem ; 29: e3406, 2021.
Artigo em Inglês, Espanhol, Português | MEDLINE | ID: mdl-34231784

RESUMO

OBJECTIVE: to evaluate the acquisition of cognitive knowledge in cardiorespiratory resuscitation through training mediated by health simulation and to verify satisfaction with the teaching methodology design. METHOD: a study of quasi-experimental intervention, of the before and after type, with only one group. Population composed of medical students in the internship phase, nurses and resident physicians, nursing technicians and nurses of the institution's effective staff. Convenience sampling consisting of 91 participants. Data collected through the Sociodemographic and Educational Questionnaire, Knowledge Test and Simulation Design Scale. Data was organized in tables and analyzed based on absolute frequencies, measures of central tendency and dispersion, Cronbach's alpha reliability test, Wilcoxon's test. RESULTS: the increase in cognitive learning was 81.9%, being that for nursing technicians it was 117.8 %. Wilcoxon's test showed a significant increase (p<0.0001) in knowledge. The Simulation Design Scale, displayed 4.55 of global mean. Cronbach's alpha pointed good internal consistency (0.898). CONCLUSION: the health simulation was effective as a learning-teaching method in cardiorespiratory resuscitation, being effective in increasing knowledge in cardiorespiratory arrest, with a great level of design satisfaction.


Assuntos
Parada Cardíaca , Internato e Residência , Treinamento por Simulação , Competência Clínica , Simulação por Computador , Humanos , Reprodutibilidade dos Testes , Ressuscitação
15.
Scand J Trauma Resusc Emerg Med ; 29(1): 98, 2021 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-34281616

RESUMO

BACKGROUND: Self-Inflating Resuscitation Bags (SIRB) are common and essential tools in airway management and ventilation. They are often used in resuscitation and emergency anaesthesia outside the operating theatre. There is a common notion that all SIRBs applied with a tight sealed mask will deliver close to 100 % oxygen during spontaneous breathing. The aim of the study was to measure the oxygen delivery of six commonly used SIRBs in a mechanical spontaneous breathing adult in vitro model. METHODS: Three SIRBs of each of the six models were evaluated for oxygen delivery during simulated breathing with an adult mechanical lung. The test was repeated three times per device (54 tests in total). The breathing profile was fixed to a minute volume of 10 L/min, a tidal volume of 500 mL and the SIRBs supplied with an oxygen fresh gas flow of 15 L/min. The fraction of delivered oxygen (FDO2) was measured over a three-minute period. Average FDO2 was calculated and compared at 30, 60 and 90 s. RESULTS: At 90 s all models had reached a stable FDO2. Average FDO2 at 90 s; Ambu Oval Plus 99,5 %; Ambu Spur II 99,8 %; Intersurgical BVM Resuscitator 76,7 %; Laerdal Silicone 97,3 %; Laerdal The Bag II 94,5 % and the O-Two Smart Bag 39,0 %. All differences in FDO2 were significant apart from the two Ambu models. CONCLUSIONS: In simulated spontaneous breathing, four out of six (by Ambu and Laerdal) Self-Inflating Resuscitation Bags delivered a high fraction of oxygen while two (Intersurgical and O-two) underperformed in oxygen delivery. These large variations confirm results reported in other studies. It is our opinion that underperforming Self-Inflating Resuscitation Bags might pose a serious threat to patients' health if used in resuscitation and anaesthesia. Manufacturers of Self-Inflating Resuscitation Bags rarely provide information on performance for spontaneous breathing. This poses a challenge to all organizations that need their devices to deliver adequate oxygen during spontaneous breathing.


Assuntos
Simulação por Computador , Oxigênio/administração & dosagem , Ressuscitação/instrumentação , Desenho de Equipamento , Humanos , Oxigênio/análise , Volume de Ventilação Pulmonar
16.
Zhongguo Dang Dai Er Ke Za Zhi ; 23(7): 702-706, 2021 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-34266527

RESUMO

OBJECTIVE: To study whether there are differences in the resuscitation process and early outcomes between the extremely preterm infants delivered on off-hours (6 pm to 8 am of working days, weekends, and national holidays) and those delivered on working hours. METHODS: A retrospective analysis was performed on the medical data of extremely preterm infants who were born in the Peking University Third Hospital from January 1, 2010 to December 31, 2020 and transferred to the neonatal intensive care unit (NICU). According to the time of birth, they were divided into two groups:working hours (n=77) and off-hours (n=98). The resuscitation process and early outcomes were compared between the two groups. RESULTS: Compared with the working hours group, the off-hours group had a significantly lower proportion of infants with the use of full-dose dexamethasone before delivery (P < 0.05) and a significantly higher proportion of infants with a 1-minute Apgar score of < 7, positive pressure ventilation, or tracheal intubation (P < 0.05). The incidence rates of neonatal respiratory distress syndrome and intrauterine pneumonia in the off-hours group were significantly higher than those in the working hours group (P < 0.05). CONCLUSIONS: Extremely preterm infants delivered on off-hours tend to have a low Apgar score at 1 minute after birth, with a higher proportion of infants requiring positive pressure ventilation or tracheal intubation during resuscitation than those delivered on working hours, and they tend to develop neonatal respiratory distress syndrome and intrauterine pneumonia. This suggests that it is important to make adequate preparations in terms of personnel and supplies for resuscitation of extremely preterm infants after birth and that NICUs should develop a detailed management plan for extremely preterm infants at each period of time before, during, and after birth.


Assuntos
Lactente Extremamente Prematuro , Síndrome do Desconforto Respiratório do Recém-Nascido , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Ressuscitação , Estudos Retrospectivos
17.
Transfusion ; 61 Suppl 1: S159-S166, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34269430

RESUMO

BACKGROUND: The use of blood products early in the resuscitation of bleeding trauma patients is widely accepted, but made difficult by limited supplies of D- red blood cell (RBC)-containing products. Use of D+ RBC-containing products would alleviate this issue, but could lead to alloimmunization. Risk associated with transfusing D+ RBC in emergency bleeding situations is being reconsidered. The level of concern surrounding emergency transfusion as it relates to future fetal harm was surveyed among surgeons and nurses. METHODS: Faculty and staff in the Departments of Surgery and Nursing were surveyed on the risks of receiving an emergency RBC transfusion and the subsequent potential for fetal harm. Answers were grouped as likely to accept (likely/very likely) or refuse transfusion (unlikely/very unlikely). Participants were compared by sex, and women by child-bearing age, ([15-50 years] vs. [>50 years]). RESULTS: Ninety surveys were initiated with 76 fully completed. Male (n = 39) and female (n = 37) respondents were comparable. Most female respondents (30/37, 81%) were of childbearing age. Overall, both males (38/39, 95%) and females (33/37, 89%; p = .19) were likely to accept a transfusion in an emergency. There was no difference in transfusion acceptance if the risk of fetal harm was presented as 1% (p = .73) or 0.1% (p = .51). Most females (34/37, 92%) were not opposed to transfusion even if there was an unspecified risk of future fetal harm. CONCLUSION: Most of the surgeons and nurses who responded would accept a transfusion in an emergency situation even if it might lead to harming a future fetus.


Assuntos
Transfusão de Eritrócitos/efeitos adversos , Hemorragia/terapia , Reação Transfusional/etiologia , Ferimentos e Lesões/terapia , Adolescente , Adulto , Transfusão de Sangue/métodos , Transfusão de Eritrócitos/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros , Cooperação do Paciente , Gravidez , Ressuscitação/efeitos adversos , Ressuscitação/métodos , Medição de Risco , Cirurgiões , Inquéritos e Questionários , Centros de Traumatologia , Recusa do Paciente ao Tratamento , Adulto Jovem
18.
Transfusion ; 61 Suppl 1: S22-S31, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34269432

RESUMO

BACKGROUND: Civilian and military guidelines recommend early balanced transfusion to patients with life-threatening bleeding. Low titer group O whole blood was introduced as the primary blood product for resuscitation of massive hemorrhage at Haukeland University Hospital, Bergen, Norway, in December 2017. In this report, we describe the whole blood program and present results from the first years of routine use. STUDY DESIGN AND METHODS: Patients who received whole blood from December 2017 to April 2020 were included in our quality registry for massive transfusions. Post-transfusion blood samples were collected to analyze isohemagglutinin (anti-A/-B) and hemolysis markers. Administration of other blood products, transfusion reactions, and patient survival (days 1 and 30) were recorded. User experiences were surveyed for both clinical and laboratory staff. RESULTS: Two hundred and five patients (64% male and 36% female) received 836 units in 226 transfusion episodes. Patients received a mean of 3.7 units (range 1-35) in each transfusion episode. The main indications for transfusion were trauma (26%), gastrointestinal (22%), cardiothoracic/vascular (18%), surgical (18%), obstetric (11%), and medical (5%) bleeding. There was no difference in survival between patients with blood type O when compared with non-group O. Haptoglobin level was lower in the transfusion episodes for non-O group patients, however no clinical hemolysis was reported. No patients had conclusive transfusion-associated adverse events. Both clinical and laboratory staff preferred whole blood to component therapy for massive transfusion. DISCUSSION: The experience from Haukeland University Hospital indicates that whole blood is feasible, safe, and effective for in-hospital treatment of bleeding.


Assuntos
Transfusão de Sangue , Ressuscitação , Reação Transfusional/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transfusão de Sangue/métodos , Criança , Pré-Escolar , Feminino , Hemólise , Hospitais , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Ressuscitação/métodos , Reação Transfusional/sangue , Reação Transfusional/patologia , Adulto Jovem
19.
Transfusion ; 61 Suppl 1: S252-S263, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34269434

RESUMO

BACKGROUND: Multiple thresholds are defined to identify patients at risk of death from hemorrhage, including massive transfusion (MT), critical administration threshold (CAT), and resuscitation intensity (RI). All fail to account for the use of whole blood (WB). We hypothesized that a definition including WB transfusion would better predict early mortality following trauma. METHODS: This is a retrospective review of all trauma patients with activation of the MT protocol from December 2018 to February 2020. Combinations of WB, RBCs, and fresh frozen plasma (FFP) units transfused during the initial hour of resuscitation were compared using receiver operating characteristic and area under the receiver curve (AUC) for 3- and 6-h mortality. WB massive transfusion (WB MT) score was defined as the sum of each unit RBC plus three times each unit of WB transfused within the first hour of resuscitation. RESULTS: There were 235 patients eligible for analysis with 60 resuscitated using ≥1 unit of WB. Overall, 27 and 29 patients died in the first 3 and 6 h, respectively. WB MT ≥7 had the greatest 3-h and 6-h mortality AUC values (0.78 and 0.79, respectively) when compared to MT, CAT, RI4+, and other attempted definitions using units of WB, RBC, and FFP. Compared to WB MT-, WB MT+ patients died at significantly higher rates at 3 h (28.9% vs. 3.1%, p < .001), 24 h (35.5% vs. 5.7%, p < .001), and 28 days (42.1% vs. 11.9%, p < .001). CONCLUSION: WB MT is the first measure of massive resuscitation to incorporate WB and better identifies early mortality than other definitions.


Assuntos
Transfusão de Sangue/métodos , Hemorragia/terapia , Ressuscitação/métodos , Ferimentos e Lesões/terapia , Adulto , Feminino , Hemorragia/sangue , Hemorragia/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Ferimentos e Lesões/sangue , Ferimentos e Lesões/mortalidade
20.
Transfusion ; 61 Suppl 1: S333-S335, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34269445

RESUMO

Hemorrhage is the most common mechanism of death in battlefield casualties with potentially survivable injuries. There is evidence that early blood product transfusion saves lives among combat casualties. When compared to component therapy, fresh whole blood transfusion improves outcomes in military settings. Cold-stored whole blood also improves outcomes in trauma patients. Whole blood has the advantage of providing red cells, plasma, and platelets together in a single unit, which simplifies and speeds the process of resuscitation, particularly in austere environments. The Joint Trauma System, the Defense Committee on Trauma, and the Armed Services Blood Program endorse the following: (1) whole blood should be used to treat hemorrhagic shock; (2) low-titer group O whole blood is the resuscitation product of choice for the treatment of hemorrhagic shock for all casualties at all roles of care; (3) whole blood should be available within 30 min of casualty wounding, on all medical evacuation platforms, and at all resuscitation and surgical team locations; (4) when whole blood is not available, component therapy should be available within 30 min of casualty wounding; (5) all prehospital medical providers should be trained and logistically supported to screen donors, collect fresh whole blood from designated donors, transfuse blood products, recognize and treat transfusion reactions, and complete the minimum documentation requirements; (6) all deploying military personnel should undergo walking blood bank prescreen laboratory testing for transfusion transmitted disease immediately prior to deployment. Those who are blood group O should undergo anti-A/anti-B antibody titer testing.


Assuntos
Transfusão de Sangue/métodos , Ressuscitação/métodos , Choque Hemorrágico/terapia , Ferimentos e Lesões/terapia , Bancos de Sangue/métodos , Serviços Médicos de Emergência/métodos , Humanos , Medicina Militar , Militares
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