Abstract
According to the small circulating blood volume, acute hemorrhage in children, especially in preterms and newborns, leads rapidly into a life-threatening event. The successful use of activated recombinant factor VII (rFVIIa) in life-threatening hemorrhage has been reported in adult critical care patients. Except for one case report, the application of rFVIIa in children has not yet been described. We report on our experience with five preterms and neonates and two children (mean age 4 weeks, range 2 days-7 years) with acute hemorrhage, who were treated with rFVIIa (Novo Seven®; Novo Nordisk, Denmark). Prior to the acute blood loss they had no hereditary coagulation disorder nor disseminated intravascular coagulopathy. One preterm showed bleeding from an intecostal artery, whereas the manifestation in the other cases was of pulmonal (diffuse pulmonary bleeding) or abdominal origin (isolated liver bleeding, traumatic mucosal bleeding of the distal esophagus, gastrointestinal bleeding according to viscerocutaneous hemangiomatosis). All patients received rFVIIa after other attempts (treatment with fresh frozen plasma, platelet concentrate and packed red cells; surgical interventions) failed and hemorrhagic shock persisted. Except in one 7-year-old girl, within 15 min after the application or rFVIIa bleeding stopped and all patients recovered. No acute adverse event nor thromboembolic complications over a long observation period could be observed.
Highlights
Activation of the HPA axis occurs in order to control potentially deleterious effects of systemic inflammation during sepsis
Arterial blood gases (ABGs) are the immediate, easiest, most reliable and cost effective bedside method of assessing an unstable patient. It portrays an array of functional reserves from the lungs to the kidneys and the blood cells in between
It hints at the causes of hypoxia and hypercarbia
Summary
Activation of the HPA axis occurs in order to control potentially deleterious effects of systemic inflammation during sepsis. The aim of the study was to evaluate the effects of PEEP on intrathoracic blood volumes and cardiac function measured by the COLD system in ARDS patients. The objective was to identify risk factors and outcome of pregnant women who required intensive care This pilot study aims to find stress (S) and other personality traits (physical symptoms [PS], anger [A]) among the ICU staff, and any existing correlation between them and length of working time (LWT) in the ICU and with educational level (EDL). The role of Drotrecogin alfa (activated) (recombinant human activated protein C [rhAPC]) in modulating microvascular coagulation through the inhibition of thrombin generation has been well studied in experimental and clinical settings of severe sepsis, little is known about its direct anti-inflammatory effects on vascular endothelial cells. The aim is to determine whether an effective lifestyle adaptation program post CABG could enhance the quality of life of the CABG patient
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