Wiener klinische Wochenschrift
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Wien. Klin. Wochenschr. · Feb 2002
Randomized Controlled Trial Comparative Study Clinical TrialAnticoagulation with prostaglandins and unfractionated heparin during continuous venovenous haemofiltration: a randomized controlled trial.
The objective of this prospective, randomized, controlled clinical study was to compare efficacy, safety, and costs of fixed-dose prostaglandins with adjusted-dose unfractionated heparin as anticoagulants for continuous venovenous haemofiltration. ⋯ Fixed-dose prostaglandins I2 and E1 reduced the incidence of haemofilter failure and bleeding when compared with adjusted-dose unfractionated heparin. There was no significant difference between the two prostaglandin groups. The increase in daily costs for haemofiltration treatment under prostaglandins is not clinically relevant.
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Wien. Klin. Wochenschr. · Feb 2002
Comparative StudySafety of hypertonic hyperoncotic solutions--a survey from Austria.
Hypertonic hyperoncotic solutions (HHS), composed of 7.2 to 7.5% sodium chloride and 6 to 10% dextran or hydroxyethyl starch, are able to restore the disturbed macro- and microcirculation in hypovolemic states within a short period of time. Even small amounts of HHS induce a relevant fluid shift from the extravasal into the intravasal space, and the use of HHS has thus been recommended in acute hypovolemia and hypovolemic shock (principle of "small-volume resuscitation"). Recently, attention has also focused on the treatment of elevated intracranial pressure using HHS. Austria is the only European country where market authorization of HHS was already obtained several years ago and where HHS have been widely used in clinical routine for a comparatively long time. This offers the unique possibility of evaluating, for the first time, the safety profile of HHS solutions. In this study, we analyzed the reported adverse drug reactions of HHS in a large number of applications. ⋯ Austrian experience with the use of a large number of HHS in clinical routine during nearly a decade indicates that the prescribed application of a combination of hydroxyethyl starch and hypertonic sodium chloride has a low potential for complications.
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Wien. Klin. Wochenschr. · Jan 2002
Review[Acute phase reaction and immunocompetence in sepsis and SIRS].
The incidence of sepsis and SIRS, respectively is still rising. Mortality is 40 to 70% and, thus, remains very high in spite of major advances in intensive care medicine. Numerous experimental data have helped to explain isolated aspects of the pathophysiology of these disease states but the complex patho-mechanism remains to be elucidated. ⋯ Additionally, several gene polymorphisms have been detected for example within the toll-like receptor genes and TNF genes. These polymorphisms document the existence of pre-disposing factors, which influence acute phase reaction as well as immuno-competence in sepsis. Both genes and gender will play an important role in the future to identify patients at risk and potentially, to design a specific and individualized immuno-therapies.
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Wien. Klin. Wochenschr. · Jan 2002
Review[Cortisol in critically ill patients with sepsis--physiological functions and therapeutic implications].
Modern immunology reveals that cortisol interacts with the immune response at virtually all levels exerting suppressive and permissive effects. A prerequisite for the defense of severe infections is the functional integrity of the hypothalamic-pituitary-adrenal axis (HPAA) resulting in adequate cortisol production. There is increasing evidence that cortisol physiology and regulation substantially change in the course of septic shock. ⋯ The earlier weaning from vasopressor therapy was associated with a trend towards improvements in organ dysfunction and mortality, respectively. Large-scale trials are on the way to investigate the benefit of stress doses of hydrocortisone on mortality of septic shock. This paper will focus on changes in glucocorticoid physiology and regulation during septic shock and will discuss the effects of stress doses of hydrocortisone on immune response and vascular tone in the course of septic shock.