Journal of intensive care
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Journal of intensive care · Jan 2014
ReviewRole of prothrombin complex concentrate in perioperative coagulation therapy.
Prothrombin complex concentrate (PCC) is a term to describe pharmacological products that contain lyophilized, human plasma-derived vitamin K-dependent factors (F), FII, FVII, FIX, FX, and various amounts of proteins C and S. PCCs can be rapidly reconstituted in a small volume (20 ml for about 500 international units (IU)) at bedside and administered regardless of the patient's blood type. PCCs are categorized as 4-factor PCC if they contain therapeutic amounts of FVII, and 3-factor PCC when FVII content is low. ⋯ There is also an ongoing controversy about plasma transfusion and its potential hazards including transfusion-related lung injury (TRALI). Early fixed ratio plasma transfusion has been implemented in many trauma centers in the USA, whereas fibrinogen concentrate and PCC are preferred over plasma transfusion in some European centers. In this review, the rationales for including PCCs in the perioperative hemostatic management will be discussed in conjunction with plasma transfusion.
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Journal of intensive care · Jan 2014
Procalcitonin for the differential diagnosis of infectious and non-infectious systemic inflammatory response syndrome after cardiac surgery.
This study was performed to assess the value of procalcitonin (PCT) for the differential diagnosis between infectious and non-infectious systemic inflammatory response syndrome (SIRS) after cardiac surgery. ⋯ PCT was a useful marker for the diagnosis of infectious SIRS after cardiac surgery. The optimal PCT cut-off value for diagnosing infectious SIRS was 0.47 ng/mL.
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Journal of intensive care · Jan 2014
Effect of a selective neutrophil elastase inhibitor on mortality and ventilator-free days in patients with increased extravascular lung water: a post hoc analysis of the PiCCO Pulmonary Edema Study.
Neutrophil elastase plays an important role in the development and progression of acute respiratory distress syndrome (ARDS). Although the selective elastase inhibitor, sivelestat, is widely used in Japan for treating ARDS patients, its effectiveness remains controversial. The aim of the current study was to investigate the effects of sivelestat in ARDS patients with evidence of increased extravascular lung water by re-analyzing a large multicenter study database. ⋯ Although sivelestat did not significantly affect 28-day mortality, this treatment may have the potential to increase VFDs in ARDS patients with increased extravascular lung water. Prospective randomized controlled studies are required to confirm the results of the current study.
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Journal of intensive care · Jan 2014
Colloids to improve diuresis in critically ill patients: a systematic review.
The background of this study is to determine whether the addition of intravenous colloid to diuretic therapy, in comparison to diuretic therapy alone, improves diuresis and oxygenation and prevents intravascular volume depletion in intensive care unit (ICU) patients without shock. ⋯ Our review is limited by the small number of high-quality RCTs available to study this clinical question, both of which only studied albumin. High-quality RCTs are required to evaluate the effect of albumin as well as other colloids as an adjunct to diuresis in a general ICU population.
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Journal of intensive care · Jan 2014
Early prediction of acute kidney injury biomarkers after endovascular stent graft repair of aortic aneurysm: a prospective observational study.
Acute kidney injury (AKI) is a common and serious condition usually detected some time after onset by changes in serum creatinine (sCr). Although stent grafting to repair aortic aneurysms is associated with AKI caused by surgical procedures or the use of contrast agents, early biomarkers for AKI have not been adequately examined in stent graft recipients. We studied biomarkers including urinary neutrophil gelatinase-associated lipocalin (NGAL), blood NGAL, N-acetyl-β-d-glucosaminidase (NAG), microalbumin (Alb), and liver fatty acid-binding protein (L-FABP) as prospective early biomarkers for AKI in patients who had received stent graft repairs of aortic aneurysms. ⋯ After stent graft repair of aortic aneurysm, NGAL/Cr is a potentially useful early biomarker for AKI.