Abstract
We assessed the efficacy and tolerance of solvent-detergent (SD) plasma in neonates, in obstetric and gynaecological patients, and in patients with liver disease in three large hospitals in Dublin over an 18-month period. Forty-one neonates received 67 transfusions of SD plasma at a mean dose ± standard deviation of 18.4 ± 3.2 ml/kg. Thirty-eight obstetric and gynaecological patients received 57 SD plasma transfusions at a mean dose of 15.3 ± 7.7 ml/kg. Thirty-six women (94.7%) had haemorrhage with mean blood loss per patient of 3345.8 ± 2738.1 ml. Fifteen children with liver disease received 33 SD plasma transfusions at a mean volume of 38.0 ± 41.5 ml/kg body weight. Seventeen adult patients with severe endstage liver disease were transfused with SD plasma either following liver transplantation or prior to other invasive procedures, at a mean dose of 10.2 ± 3.4 ml/kg. There were statistically significant decreases in APTT and PT in neonates, in obstetric and gynaecological patients, and in patients with liver disease. Pre-transfusion and post-transfusion APTT was measured in 40/67 neonatal transfusion episodes, PT in 43/67, fibrinogen in 39/67, and platelets in 49/67. After plasma infusion the mean APTT improved from 68.9 ± 37.4 s to 44.0 ± 15.6 s (t = 4.79; P 0.05). In the group of adult patients with severe end-stage liver disease, precoagulation and postcoagulation test results were available for 14 of 17 transfusion episodes. There was a statistically significant improvement in the PT from 23.2 ± 4.9 s to 18.6 ± 2.9 s (t = 4.46, P < 0.001) and in the APTT from 45.1 ± 8.9 s to 36.4 ± 7.1 s (t = 3.95, P < 0.002). No adverse reactions were observed for SD plasma infusion. Use of SD plasma in critically ill neonates, in women with obstetric and gynaecological emergencies, and in patients with liver disease appears safe, and improves laboratory indices of coagulopathy.
Highlights
Tight blood glucose (BG) control has been shown to videos of the alveolar dynamics
Computer-advised insulin infusion in postoperative cardiac surgery patients: a randomized prospective controlled multicenter trial quality the alveoli are observed at an open chest wall under a glass plate representing an artificial situation. To circumvent this restriction we developed a method of intravital endoscopy and tested it on an animal rat model
1Royal Brompton Hospital, London, UK; 2Medical University Graz, observation from mechanical deformation due to the tip of the Austria; 3Charles University Hospital, Prague, Czech Republic; endoscope we developed a flushing catheter that continuously
Summary
Tight blood glucose (BG) control has been shown to videos of the alveolar dynamics. The thorax remains intact.decrease morbidity and mortality in critically ill patients [1] but is Results Figure 1 shows a tissue area after lavage of 0.8 mm difficult to achieve using standard insulin infusion protocols. Results Patient characteristics (mean ± SD): age 57.4 ± 15.4 years, 28 female, 52 male, APACHE II score 28.2 ± 6.6; number of organ failures 4.0 ± 1.12; preceding ICU period 8.5 ± 9.3 days; continuous sedation with midazolam 31.2 ± 34.2 mg/hour, fentanyl 0.12 ± 0.08 mg/hour, propofol 45.6 ± 105.2 mg/hour; sedation assessment according to RS 5.65 ± 0.63, CPS 5.15 ± 1.67, CKS 0.65 ± 0.69, CS 9.34 ± 2.13 und LSS 1.78 ± 1.69, RASS –4.50 ± 1.27, FiO2 0.52 ± 0.17, PEEP 8.2 ± 2.4 cmH2O, ventilatory frequency 20.5 ± 4.8/min, pressure control 16.8 ± 4.4 cmH2O, tidal volume 540 ± 115 ml, TVV 2525.6 ± 11,366 ml (minimum 1.52; maximum 91,586). We hypothesized that S100β levels correlate with this tumor’s preoperative characteristics and with perioperative neurological injury despite its supratentorial location and non-neural origin
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