Abstract
Haemostatic failure, secondary to large volume fluid replacement, is a major component to the mortality and morbidity associated with blunt trauma. Progressive bleeding in multiply injured patients is due to both dilution effects and specific inhibitory effects on platelet function of the colloids used. Recombinant factor VIIa (rVIIa) is seen increasingly as a possible universal haemostatic agent that could act to reverse or prevent haemostatic failure associated with dilution and the direct effects of the colloids within the 'Golden' hour of haemorrhagic shock. We have conducted a pilot preclincal study to evaluate the potential role of rVIIa as a universal haemostatic agent in a model of large volume fluid replacement using thrombelastography (TEG). TEG is a method of global haemostasis assessment, providing information on the rate of clot formation, clot strength and durability. Whole blood samples from normal donors were tested undiluted (100%) or diluted (50% and 80%) with standard colloid replacement solutions (Haemacel, Albumin, Gelofusine, Hydroxyethyl starch) and N/Saline. Global haemostasis was assessed in the TEG, ± 90 μg/kg rVIIa added. In undiluted blood (100%) there were no statistically significant changes in any TEG parameter when rVIIa was added. At dilutions of > 50% addition of rVIIa significantly improved the kinetics of clot formation and rate of platelet reactivity, P < 0.05, although time to the start of coagulation and final clot strength were not significantly different. The beneficial effects of addition of rVIIa did not differ between different fluid replacement solutions. Addition of rVIIa therefore appears to improve markers of global haemostasis in this model of large volume fluid replacement. Further work is required to assess its potential value as a universal haemostatic agent in the setting of blunt trauma and large volume fluid replacement.
Highlights
In our experience, very often, even with a nonrebreathing mask (NRM), high oxygen delivery to patient with the existent materials is insufficient
TMSORG for R, C, N and Re were significantly associated with HM
P109 How we reduce allogenic blood transfusions in the patients undergoing surgery of ascending aorta D Radojevic, Z Jankovic, B Calija, M Jovic, B Djukanovic
Summary
Very often, even with a nonrebreathing mask (NRM), high oxygen delivery to patient with the existent materials is insufficient. There is evidence that increasing the dose of continuous renal replacement therapy (CRRT) is associated with improved survival in critically ill patients with acute renal failure (ARF) [1]. The aim of this study is to investigate if there is any difference in patients’ characteristics in ICU between COPD and nonCOPD diseases caused chronic respiratory failure and require mechanical ventilation during acute exacerbations. Noninvasive positive pressure ventilation (NPPV) has been reported to be beneficial in the treatment of acute exacerbation of chronic obstructive pulmonary disease (COPD), and to facilitate weaning In this trial we assessed the possible benefit of early NPPV in patients with blunt chest trauma and acute respiratory failure. The aim of this study was to compare the pharmacokinetic and pharmacodynamic parameters and the clinical efficacy of a continuous infusion of cefepime versus an intermittent regimen in critically ill adults patients with gram negative bacilli infection. The purpose of the study is to identify the factors associated with DNR status in our institution
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