Wiener klinische Wochenschrift
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Wien. Klin. Wochenschr. · May 2002
Severe accidental hypothermia with or without hemodynamic instability: rewarming without the use of extracorporeal circulation.
The optimal rewarming technique for patients in deep accidental hypothermia with core temperatures below 28 degrees C is not established. Several authors believe that extracorporeal rewarming is essential, especially for patients with hemodynamic instability. Others believe that invasive rewarming ought to be reserved for patients in cardiac arrest. We describe our experience with a strictly conservative technique without the use of invasive rewarming devices in patients with severe accidental hypothermia and a sustained perfusion rhythm. ⋯ A conservative approach is highly successful in achieving normothermia in patients with deep hypothermia with or without stable hemodynamics. In-hospital mortality of severe accidental hypothermia in urban conditions is high; comorbidity might play a major role. The influence of the rewarming strategy on late in-hospital mortality remains unclear.
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Wien. Klin. Wochenschr. · May 2002
Editorial Comment Comparative StudyAccidental deep hypothermia: a rewarming challenge.
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Acute myocardial infarction induces an inflammatory reaction. We related conventional inflammatory parameters including C-reactive protein, erythrocyte sedimentation rate, white blood cell count and axillary temperature to plasma concentrations of procalcitonin in patients with acute myocardial infarction. In a prospective-descriptive study, we evaluated 54 patients with acute myocardial infarction. ⋯ Conventional inflammatory parameters were all significantly increased even in the absence of cardiac and non-cardiac complications of acute myocardial infarction. In conclusion, procalcitonin increases in patients with acute myocardial infarction only if associated with severe left heart failure, resuscitation after cardiac arrest or in the presence of bacterial infections. Thus, procalcitonin may help to elucidate the etiology of systemic inflammatory response during the early course of acute myocardial infarction.
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Wien. Klin. Wochenschr. · Feb 2002
Comparative StudyRegional citrate anticoagulation using a citrate-based substitution solution for continuous venovenous hemofiltration in cardiac surgery patients.
To evaluate the feasibility, efficacy, safety and side effects of routinely performed continuous venovenous hemofiltration (CVVH) with regional citrate anticoagulation using a citrate-containing substitution solution as compared with conventional systemic low-dose unfractionated heparin-anticoagulation in postoperative cardiac surgery patients. ⋯ We conclude that citrate-based regional anticoagulation is effective, safe and easy to use in CVVH following cardiac surgery and might become the first choice for anticoagulation in patients in whom the application of systemic heparin is contraindicated.