Critical care clinics
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In this article, the authors review the current recommendations from the American Society for Apheresis regarding the use of plasmapheresis in many of the diseases that intensivists commonly encounter in critically ill patients. Recent experience indicates that therapeutic plasma exchange may be useful in a wide spectrum of illnesses characterized by microvascular thrombosis, the presence of autoantibodies, immune activation with dysregulation of immune response, and some infections.
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Critically ill patients are at increased risk for development of thrombosis. In addition, thrombosis is often unrecognized in this population. ⋯ Herein the authors review the pharmacology, data from clinical trials, management of bleeding complications, and perioperative use of these agents in the intensive care unit population. Well-designed clinical trials are needed to improve our understanding of the safety and efficacy of these newer agents in critically ill patients.
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Critical care clinics · Jul 2012
ReviewTransfusion reactions: newer concepts on the pathophysiology, incidence, treatment, and prevention of transfusion-related acute lung injury.
Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-related mortality. TRALI presents as acute lung injury (ALI) within 6 hours after blood product transfusion. ⋯ Recent studies have identified both recipient and transfusion risk factors for the development of TRALI. This article describes these TRALI risk factors, as well as diagnosis, treatment and prevention strategies.
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Critical care clinics · Jul 2012
ReviewA reappraisal of plasma, prothrombin complex concentrates, and recombinant factor VIIa in patient blood management.
Plasma therapy and plasma products such as prothrombin complex concentrates (PCCs), and recombinant activated factor VII (rFVIIa) are used in the setting of massive or refractory hemorrhage. Their roles have evolved because of newly emerging options, variable availability, and heterogeneity in guidelines. These factors can be attributable to lack of evidence-based support for a defined role for plasma therapy, variability in coagulation factor content among PCCs, and uncertainty regarding safety and efficacy of rFVIIa in these settings. This review summarizes these issues and provides insight regarding use of these options in management of refractory or massive bleeding.
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Critical care clinics · Jul 2012
Review Comparative StudyAnemia in the ICU: anemia of chronic disease versus anemia of acute illness.
Anemia is common in the ICU, increasing morbidity and mortality. Its etiology is multifactorial but anemia of inflammation is the most common cause, followed closely by iron deficiency. ⋯ Randomized controlled trials have not supported the use of either therapy except in well defined clinical situations. Better understanding of the pathophysiology of anemia of inflammation may lead to development of novel therapies.