Intensive care medicine
-
Intensive care medicine · Oct 2002
ReviewUpdates in the management of severe coagulopathy in trauma patients.
Coagulopathy is the major cause of bleeding-related mortality in patients who survive the operating room. Its association with hypothermia and metabolic acidosis is common and constitutes a vicious cycle. Usually, post-traumatic coagulopathy is an early event and may be present during surgery. ⋯ Recently, a new adjunct to the treatment of coagulopathy in trauma patients has been reported and is undergoing controlled animal trials. Recombinant activated factor VII (rFVIIa) was originally developed as a pro-hemostatic agent for the treatment of bleeding episodes in hemophilia patients. rFVIIa has been successfully used in moribund trauma patients in whom standard procedures had failed to correct bleeding. Preliminary preclinical and clinical studies are under way.
-
Intensive care medicine · Oct 2002
Comparative StudyAssessment of former ICU patients' quality of life: comparison of different quality-of-life measures.
To compare three different measures to assess quality of life (QOL) after an Intensive Care Unit (ICU) stay: a standardized telephone interview, a satisfaction scale, and the Sickness Impact Profile (SIP). ⋯ For the global assessment of overall or health-related QOL after ICU stay, long questionnaires such as SIP may be replaced by a short, structured telephone interview or, better, by a satisfaction scale. Quantitative measures such as SIP may be needed for comparison of therapeutic interventions or specific functional or psychosocial aspects.
-
Intensive care medicine · Oct 2002
Clinical TrialCitrate anticoagulation in continuous venovenous hemodiafiltration: a metabolic challenge.
Feasibility and safety evaluation of regional citrate anticoagulation (RCA) versus systemic heparinization for continuous venovenous hemodiafiltration. ⋯ RCA may be a safe and useful form of anticoagulation which is more expensive than heparinization but helps to minimize bleeding risk. The risk of metabolic complications is higher at the beginning of a new RCA program. For centers lacking experienced staff we suggest reserving this technique for patients with rapid clotting of the extracorporeal circuit if treated without anticoagulation.
-
Intensive care medicine · Oct 2002
A multidisciplinary quality management system for the early treatment of severely injured patients: implementation and results in two trauma centers.
The impact of a multidisciplinary quality management system (MQMS) on the early treatment of severely injured patients was tested. ⋯ MQMS improved early clinical treatment in severe injury with respect to therapeutic effectiveness and outcome. The effectiveness of the MQMS was shown at two different hospitals