2009 Red cell transfusion for the management of upper gastrointestinal haemorrhage

Hearnshaw S, Brunskill S, Doree C, Hyde C, Travis S, Murphy MF.; Cochrane Database Syst Rev. 2009;(2):CD006613

BACKGROUND: Upper gastrointestinal haemorrhage affects 50 to 150 per 100,000 adults per year and has a high mortality. Red blood cell transfusions are frequently given, but their impact on rebleeding rates and mortality is not known.

OBJECTIVES: To assess the effects of red blood cell transfusion in adults with upper gastrointestinal haemorrhage.

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2009 Randomized trial of emergency endoscopic sclerotherapy versus emergency portacaval shunt for acutely bleeding esophageal varices in cirrhosis

Orloff MJ, Isenberg JI, Wheeler HO, Haynes KS, Jinich-Brook H, Rapier R, et al. ; J Am Coll Surg. 2009 Jul;209(1):25-40

BACKGROUND: The mortality rate of bleeding esophageal varices in cirrhosis is highest during the period of acute bleeding. This is a report of a randomized trial that compared endoscopic sclerotherapy (EST) with emergency portacaval shunt (EPCS) in cirrhotic patients with acute variceal hemorrhage.

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2009 Clinical Sequelae of Thrombus in an Inferior Vena Cava Filter

Ahmad I, Yeddula K, Wicky S, Kalva SP.; Cardiovasc Intervent Radiol. 2009 Aug 18.

The purpose of this study was to assess the long-term clinical sequelae of inferior vena cava (IVC) filter thrombus and the effect of anticoagulation on filter thrombus. Of 1,718 patients who had IVC filters placed during 2001-2008, 598 (34.8%) had follow-up abdominal CT. Filter thrombus was seen in 111 of the 598 (18.6%).

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2009 Modern rapidly degradable hydroxyethyl starches: current concepts [Review]

Boldt J. Anesth Analg. 2009 May;108(5):1574-82.

Hydroxyethyl starch (HES) is a widely used plasma substitute for correcting perioperative hypovolemia. HES preparations are defined by concentration, molar substitution (MS), mean molecular weight (M(w)), the C(2)/C(6) ratio of substitution, the solvent, and the origin. The possible unwanted side effects of HES are anaphylactic reactions, alterations of hemostasis resulting in increased bleeding, kidney dysfunction, accumulation, and pruritus. In view of the potential side effects, it is crucial to distinguish among the different HES preparations; all HES preparations are not the same.

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2009 Transfusion management of trauma patients [Review]

Shaz BH, Dente CJ, Harris RS, MacLeod JB, Hillyer CD. ; Anesth Analg. 2009 Jun;108(6):1760-8.

The management of massively transfused trauma patients has improved with a better understanding of trauma-induced coagulopathy, the limitations of crystalloid infusion, and the implementation of massive transfusion protocols (MTPs), which encompass transfusion management and other patient care needs to mitigate the "lethal triad" of acidosis, hypothermia, and coagulopathy. MTPs are currently changing in the United States and worldwide because of recent data showing that earlier and more aggressive transfusion intervention and resuscitation with blood components that approximate whole blood significantly decrease mortality.

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2009 The role of nesiritide in heart failure

Tong AT, Rozner MA.; Expert Opin Drug Metab Toxicol. 2009 Jul;5(7):823-34.

BACKGROUND: Heart failure afflicts > 5 million patients in the US, with about 550,000 new diagnoses a year. Side effects and increased mortality limit heart failure treatment. Nesiritide is the newest addition to therapeutic options for treatment of acute decompensated heart failure (ADHF). It has been used as single in-patient infusions, multiple out-patient infusions, and perioperatively to improve hemodynamics and promote diuresis. Initially well-received, meta-analyses suggesting increased mortality and renal dysfunction after nesiritide use were published 4 - 5 years after its introduction in the US. These reports prompted new recommendations on nesiritide use by an expert panel.

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2009 Natriuretic peptides in the diagnosis and management of acute heart failure [Review]

Mohammed AA, Januzzi JL Jr.; Heart Fail Clin. 2009 Oct;5(4):489-500.

The emergence of BNP or NT-proBNP testing has improved the management of acutely decompensated heart failure patients significantly by aiding in early recognition, prognostication, and treatment.

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2009 Continuous-infusion beta-lactam antibiotics during continuous venovenous hemofiltration for the treatment of resistant gram-negative bacteria

Moriyama B, Henning SA, Neuhauser MM, Danner RL, Walsh TJ.; Ann Pharmacother. 2009 Jul;43(7):1324-37. Epub 2009 Jul 7.
OBJECTIVE: To describe the rationale, principles, and dosage calculations for continuous-infusion beta-lactam antibiotics to treat multidrug-resistant bacteria in patients undergoing continuous venovenous hemofiltration (CVVH).

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2009 Continuous Hemofiltration in 2009: What Is New for Clinicians Regarding Pathophysiology, Preferred Technique and Recommended Dose?

Honoré PM, Joannes-Boyau O, Collin V, Boer W, Jennes S.

Blood Purif. 2009 Jul 4;28(2):135-143. [Epub ahead of print]

In the last years, publications have questioned the classical dose of 35 ml/kg, but are those studies strong enough in terms of scientific power in order to change our practice? We will try to settle some recommendations for clinicians. Manipulation of dose, porosity, and combinations have yielded promising findings. However, conclusive evidence based on randomized trials remains scarce, limiting the practical implementation in daily practice.

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2009 Extracorporeal elimination in acute valproic acid poisoning [Review]

Thanacoody RH.; Clin Toxicol (Phila). 2009 Aug;47(7):609-16.

INTRODUCTION: Valproic acid (VPA) is an antiepileptic drug that is now used for a variety of neurological and psychiatric indications. Clinical manifestations of severe VPA poisoning include central nervous system depression, hypotension, electrolyte and acid-base disturbances, and hyperammonemia. Although extracorporeal methods have been used to enhance VPA elimination, the indications for and effectiveness of these methods have not been fully characterized.

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2009 Monitoring fluid therapy [Review]

Renner J, Scholz J, Bein B.; Best Pract Res Clin Anaesthesiol. 2009 Jun;23(2):159-71.

Hypovolaemia is a common cause of circulatory failure in the perioperative period. However, only 50% of critically ill patients respond to volume expansion with an adequate increase in cardiac output. Therefore, in daily clinical practice it is still a challenge to assess each subject's individual position on the Starling curve in order to optimize cardiac preload and avoid deleterious fluid overload.

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2009 Influence of fluid therapy on the haemostatic system of intensive care patients

Kozek-Langenecker SA.; Best Pract Res Clin Anaesthesiol. 2009 Jun;23(2):225-36.

Haemostatic alterations associated with the use of fluids are related to non-specific dilutional effects and colloid-specific effects, such as acquired von Willebrand syndrome, inhibition of platelet function and fibrin polymerization. Judging by currently available evidence, dextran, hetastarch and pentastarch have a more pronounced impact than tetrastarch, gelatin and albumin.

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2009 Relevance of non-albumin colloids in intensive care medicine

Ertmer C, Rehberg S, Van Aken H, Westphal M.; Best Pract Res Clin Anaesthesiol. 2009 Jun;23(2):193-212.

Current guidelines on initial haemodynamic stabilization in shock states suggest infusion of either natural or artificial colloids or crystalloids. However, as the volume of distribution is much larger for crystalloids than for colloids, resuscitation with crystalloids alone requires more fluid and results in more oedema, and may thus be inferior to combination therapy with colloids.

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2009 Safety and efficacy of corticosteroids for the treatment of septic shock: A systematic review and meta-analysis [Review]

Sligl WI, Milner DA Jr, Sundar S, Mphatswe W, Majumdar SR.;Clin Infect Dis. 2009 Jul 1;49(1):93-101.

BACKGROUND: Septic shock is common and results in significant morbidity and mortality. Adjunctive treatment with corticosteroids is common, but definitive data are lacking. We aimed to determine the efficacy and safety of corticosteroid therapy among patients with septic shock.

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2009 Hydroxyethyl starches: different products--different effects [Review]

Westphal M, James MF, Kozek-Langenecker S, Stocker R, Guidet B, Van Aken H.; Anesthesiology. 2009 Jul;111(1):187-202.

With the development of a new generation of hydroxyethyl starches (HES), there has been renewed interest in their clinical potential. High doses of first- and second-generation HES were associated with adverse effects on renal function, coagulation, and tissue storage, thereby limiting their clinical applicability. Newer HES products have lower molar substitution and in vivo molecular weight, resulting in more rapid metabolism and clearance. In this review article, the differences between HES generations are highlighted, with particular emphasis on the improved safety profile of the third generation products.

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2009 Early endoscopic retrograde cholangiopancreatography in predicted severe acute biliary pancreatitis: a prospective multicenter study

van Santvoort HC, Besselink MG, Dutch Acute Pancreatitis Study Group, et al; Ann Surg. 2009 Jul;250(1):68-75

INDRODUCTION: The role of early endoscopic retrograde cholangiopancreatography (ERCP) in acute biliary pancreatitis (ABP) remains controversial. Previous studies have included only a relatively small number of patients with predicted severe ABP. We investigated the clinical effects of early ERCP in these patients.

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2009 High levels of PEEP may improve survival in acute respiratory distress syndrome: A meta-analysis

Oba Y, Thameem DM, Zaza T. ; Respir Med. 2009 Aug;103(8):1174-81. Epub 2009 Mar 9.


OBJECTIVE: Positive end-expiratory pressure (PEEP) has been viewed as an essential component of mechanical ventilation in acute respiratory distress syndrome (ARDS) and acute lung injury (ALI). However, clinical trials have not yet convincingly demonstrated that high PEEP levels improve survival. The object of this study was to test a priori hypotheses that a small but clinically important mortality benefit of high PEEP did exist, especially in patients with greater overall severity of illness and differences in PEEP protocols might have affected the study results.

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2009 Incentive spirometry for prevention of postoperative pulmonary complications in upper abdominal surgery

 

GuimarĂ£es MM, El Dib R, Smith AF, Matos D.

Cochrane Database Syst Rev. 2009 Jul 8;(3):CD006058.


BACKGROUND: Upper abdominal surgical procedures are associated with a high risk of postoperative pulmonary complications. The risk and severity of postoperative pulmonary complications can be reduced by the judicious use of therapeutic manoeuvres that increase lung volume. Our objective was to assess the effect of incentive spirometry (IS) compared to no therapy, or physiotherapy including coughing and deep breathing, on all-cause postoperative pulmonary complications and mortality in adult patients admitted for upper abdominal surgery.

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2009 Isolation precautions for antibiotic-resistant bacteria in healthcare settings [Review]

Gasink LB, Brennan PJ.

Curr Opin Infect Dis. 2009 Aug;22(4):339-44.

PURPOSE OF REVIEW: Emergence of drug-resistant bacteria and new or changing infectious pathogens is an important public health problem. Transmission of these pathogens in an acute care setting may occur frequently if proper precautions are not taken. Despite several guidelines and an abundance of literature on the prevention of transmission of epidemiologically important organisms in the healthcare setting, substantial controversy exists. This review focuses on recent data regarding the use of infection control and isolation precautions.

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2009 The concept of ischemic penumbra in acute stroke and therapeutic opportunities [Review]

Paciaroni M, Caso V, Agnelli G. Eur Neurol. 2009;61(6):321-30. Epub 2009 Apr 9.

Ischemic penumbra was first defined by Astrup in 1981 as perfused brain tissue at a level within the thresholds of functional impairment and morphological integrity, which has the capacity to recover if perfusion is improved.

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