Abstract
Bleeding complications still remain a real problem in patients undergoing long-time surgery with extracorporeal circulation. In these cases a large hemotransfusion is needed and the usual sequence with postoperative multiorganic failure affecting patient outcome. Recombinant activated factor VII (rFVIIa; NovoSeven®, Novo Nordisk A/S, Bagsvaerd, Denmark) was used in 15 patients undergoing open heart surgery or surgery for aorta and aortic arch aneurysms. All patients had normal coagulation parameters before surgery. In these patients massive bleeding (10–20 ml/min) have developed during intraoperative or early postoperative periods, but bloodloss rate have minimal reduction, despite infusions of fresh frozen plasma, cryoprecipitate plasma, platelet concentrate, Trasilol and e-aminocapronic acid. After one-time recombinant FVIIa NovoSeven administration (the dose of rFVIIa ranged between 60 and 90 mg/kg body weight), bleeding disappeared in 14 patients. In one patient the bloodloss rate had been decreased from 20 to 5.5 ml/min and then repeated NovoSeven administration (90 mg/kg body weight) stopped the bleeding and simultaneously stabilized some hemocoagulating parameters. rFVIIa (NovoSeven®) may be used to effective treatment massive bleeding and to reduce the amount of transfused blood components in patients undergoing long-time surgery with extracorporeal circulation.
Highlights
In contrast to conventional surgical tracheostomy, percutaneous dilational tracheostomy (PDT) in different variants is spreading rapidly in intensive care units today
Summary Our study demonstrated that LS is a good alternative to restore cardiac contractile function when combined with NE
The use of AVP may lead to further deteriorate sepsis-related myocardial dysfunction even when combined with a positive inotropic agent
Summary
In contrast to conventional surgical tracheostomy, percutaneous dilational tracheostomy (PDT) in different variants is spreading rapidly in intensive care units today. The objectives of the current study were (1) to assess the prognostic significance of plasma concentrations of NSE for early prediction of outcome in patients at risk for anoxic encephalopathy after cardiopulmonary resuscitation (CPR), and (2) to compare the prognostic information provided by NSE measurements with that provided by conventional risk indicators (clinical neurological examination and computerised tomography [CT] scan of the brain). Independent pulmonary ventilation was introduced in the 1930s and allows the utilization of different ventilatory strategies for each lung to improve gas exchange, respiratory mechanics or both in patients with heterogeneous lung diseases It is not clear whether the lower inflection point (LIP) on the inspiratory limb or the point of maximum curvature (PMC) on the deflation limb of the pressure–volume (PV) curve should be used for the positive end-expiratory pressure (PEEP) setting in acute lung injury (ALI). The long-term outcome, health-related quality of life (HRQL), and ICU and hospital costs of medical ICU patients were assessed
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