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[PMID]:29254304
[Au] Autor:Li JK; Wang C; Gong HD; Li HZ
[Ad] Endereço:Department of Neurosurgery, Affiliated HongQi Hospital of Mu Dan Jiang Medical University, Mudanjiang City, China.
[Ti] Título:Coagulation in hindbrain membrane meningioma patients treated with different injections using acute hypervolemic hemodilution.
[So] Source:J Biol Regul Homeost Agents;31(4):991-996, 2017 Oct-Dec.
[Is] ISSN:0393-974X
[Cp] País de publicação:Italy
[La] Idioma:eng
[Ab] Resumo:The aim of this study was to analyze the changes in coagulation in meningioma patients treated with different injections using the method of acute hypervolemic hemodilution (AHH). One hundred fifty hindbrain membrane meningioma patients were randomly divided into 5 groups, 30 per group. The first group were injected 40ml/time with Danhong after anesthesia induction; the second group were injected with 40ml~60ml/time Kangai and combined with interventional chemotherapy and embolization procedure; the third group of AHH were injected with polygeline 15ml/kg; the fourth group were injected with hydroxyethyl starch (130/0.4) sodium chloride in doses of 15ml/kg; the control group underwent basic treatment for lowering blood pressure and lowering blood fat. The changes of coagulation index were recorded before and after surgery and before and after the injection of different medications. Compared to the control group, for the first group of AHH, after being treated for 10 days and 30 days, the concentrations of bone specific alkaline phosphatase (BALP), bone Gla protein (BGP) and pro-collagen carboxy-terminal propeptide (PICP) were higher than that of the control group, the levels of endotoxin (ET) and C-reactive protein (CRP) were decreased compared to the control group (p less than 0.05); for the second group of AHH, after being treated for 10 days, the index of prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (Fg) were not significantly changed, but the related level of vascular endothelial growth factor (VEGF) significantly decreased (p less than 0.05). Comparing the coagulation function index after surgery in the third and fourth groups, there were no significant changes in mean arterial pressure (MAP) level, heart rate (HR) value presented a low decrease, central venous pressure (CVP) level increased and the level of interleukin IL-6 showed a steady state after increasing. Analyzing the levels of interleukin IL-8 and tumor necrosis factor-α (TNF-α) after surgery, it was seen that in the third group they increased and in the fourth group they decreased (p less than 0.05). Danhong injection improved the coagulation function and microcirculation of patients, Kangai injection and interventional chemotherapy and embolization restrained the appearance of tumor angiogenesis, AHH operation with polygeline injection and hydroxyethyl starch (130/0.4) sodium chloride kept blood flow in normal parameters.
[Mh] Termos MeSH primário: Coagulação Sanguínea/efeitos dos fármacos
Cardiotônicos/uso terapêutico
Medicamentos de Ervas Chinesas/uso terapêutico
Hemodiluição/métodos
Neoplasias Meníngeas/tratamento farmacológico
Meningioma/tratamento farmacológico
[Mh] Termos MeSH secundário: Adulto
Fosfatase Alcalina/genética
Fosfatase Alcalina/metabolismo
Pressão Arterial/efeitos dos fármacos
Pressão Arterial/fisiologia
Biomarcadores/metabolismo
Viscosidade Sanguínea/efeitos dos fármacos
Proteína C-Reativa/genética
Proteína C-Reativa/metabolismo
Embolização Terapêutica/métodos
Endotoxinas/metabolismo
Feminino
Fibrinogênio/genética
Fibrinogênio/metabolismo
Expressão Gênica
Frequência Cardíaca/efeitos dos fármacos
Frequência Cardíaca/fisiologia
Seres Humanos
Derivados de Hidroxietil Amido/administração & dosagem
Masculino
Neoplasias Meníngeas/sangue
Neoplasias Meníngeas/patologia
Neoplasias Meníngeas/cirurgia
Meningioma/sangue
Meningioma/patologia
Meningioma/cirurgia
Meia-Idade
Osteocalcina/genética
Osteocalcina/metabolismo
Fragmentos de Peptídeos/genética
Fragmentos de Peptídeos/metabolismo
Substitutos do Plasma/administração & dosagem
Poligelina/administração & dosagem
Pró-Colágeno/genética
Pró-Colágeno/metabolismo
Rombencéfalo/efeitos dos fármacos
Rombencéfalo/metabolismo
Rombencéfalo/patologia
Rombencéfalo/cirurgia
Fator A de Crescimento do Endotélio Vascular/genética
Fator A de Crescimento do Endotélio Vascular/metabolismo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Biomarkers); 0 (Cardiotonic Agents); 0 (Drugs, Chinese Herbal); 0 (Endotoxins); 0 (Hydroxyethyl Starch Derivatives); 0 (Peptide Fragments); 0 (Plasma Substitutes); 0 (Procollagen); 0 (VEGFA protein, human); 0 (Vascular Endothelial Growth Factor A); 0 (danhong); 0 (procollagen type I carboxy terminal peptide); 104982-03-8 (Osteocalcin); 9001-32-5 (Fibrinogen); 9007-41-4 (C-Reactive Protein); 9015-56-9 (Polygeline); EC 3.1.3.1 (Alkaline Phosphatase)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171220
[St] Status:MEDLINE


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[PMID]:29181841
[Au] Autor:Ray A; Ray S
[Ad] Endereço:Department of Obstetrics and Gynaecology, DM Wayanad Institute of Medical Sciences, Naseera Nagar ,Meppadi (PO), Wayanad, Wayanad, Kerala, India, 673577.
[Ti] Título:Epidural therapy for the treatment of severe pre-eclampsia in non labouring women.
[So] Source:Cochrane Database Syst Rev;11:CD009540, 2017 11 28.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Pre-eclampsia is a pregnancy-specific multi-organ disorder, which is characterised by hypertension and multisystem organ involvement and which has significant maternal and fetal morbidity and mortality. Failure of the placental vascular remodelling and reduced uteroplacental flow form the etiopathological basis of pre-eclampsia. There are several established therapies for pre-eclampsia including antihypertensives and anticonvulsants. Most of these therapies aim at controlling the blood pressure or preventing complications of elevated blood pressure, or both. Epidural therapy aims at blocking the vasomotor tone of the arteries, thereby increasing uteroplacental blood flow. This review was aimed at evaluating the available evidence about the possible benefits and risks of epidural therapy in the management of severe pre-eclampsia, to define the current evidence level of this therapy, and to determine what (if any) further evidence is required. OBJECTIVES: To assess the effectiveness, safety and cost of the extended use of epidural therapy for treating severe pre-eclampsia in non-labouring women. This review aims to compare the use of extended epidural therapy with other methods, which include intravenous magnesium sulphate, anticonvulsants other than magnesium sulphate, with or without use of the antihypertensive drugs and adjuncts in the treatment of severe pre-eclampsia.This review only considered the use of epidural anaesthesia in the management of severe pre-eclampsia in the antepartum period and not as pain relief in labour. SEARCH METHODS: We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) (13 July 2017) and reference lists of retrieved studies. SELECTION CRITERIA: Randomised controlled trials (RCTs) or quasi-RCTs comparing epidural therapy versus traditional therapy for pre-eclampsia in the form of antihypertensives, anticonvulsants, magnesium sulphate, low-dose dopamine, corticosteroids or a combination of these, were eligible for inclusion. Trials using a cluster design, and studies published in abstract form only are also eligible for inclusion in this review. Cross-over trials were not eligible for inclusion in this review. DATA COLLECTION AND ANALYSIS: The two review authors independently assessed trials for inclusion and trial quality. There were no relevant data available for extraction. MAIN RESULTS: We included one small study (involving 24 women). The study was a single-centre randomised trial conducted in Mexico. This study compared a control group who received antihypertensive therapy, anticonvulsant therapy, plasma expanders, corticosteroids and dypyridamole with an intervention group that received epidural block instead of the antihypertensives, as well as all the other four drugs. Lumbar epidural block was given using 0.25% bupivacaine, 10 mg bolus and 5 mg each hour on continuous epidural infusion for six hours. This study was at low risk of bias in three domains but was assessed to be high risk of bias in two domains due to lack of allocation concealment and blinding of women and staff, and unclear for random sequence generation and outcome assessor blinding.The included study did not report on any of this review's important outcomes. Meta-analysis was not possible.For the mother, these were: maternal death (death during pregnancy or up to 42 days after the end of the pregnancy, or death more than 42 days after the end of the pregnancy); development of eclampsia or recurrence of seizures; stroke; any serious morbidity: defined as at least one of stroke, kidney failure, liver failure, HELLP syndrome (haemolysis, elevated liver enzymes and low platelets), disseminated intravascular coagulation, pulmonary oedema.For the baby, these were: death: stillbirths (death in utero at or after 20 weeks' gestation), perinatal deaths (stillbirths plus deaths in the first week of life), death before discharge from the hospital, neonatal deaths (death within the first 28 days after birth), deaths after the first 28 days; preterm birth (defined as the birth before 37 completed weeks' gestation); and side effects of the intervention. Reported outcomesThe included study only reported on a single secondary outcome of interest to this review: the Apgar score of the baby at birth and after five minutes and there was no clear difference between the intervention and control groups.The included study also reported a reduction in maternal diastolic arterial pressure. However, the change in maternal mean arterial pressure and systolic arterial pressure, which were the other reported outcomes of this trial, were not significantly different between the two groups. AUTHORS' CONCLUSIONS: Currently, there is insufficient evidence from randomised controlled trials to evaluate the effectiveness, safety or cost of using epidural therapy for treating severe pre-eclampsia in non-labouring women.High-quality randomised controlled trials are needed to evaluate the use of epidural agents as therapy for treatment of severe pre-eclampsia. The rationale for the use of epidural is well-founded. However there is insufficient evidence from randomised controlled trials to show that the effect of epidural translates into improved maternal and fetal outcomes. Thus, there is a need for larger, well-designed studies to come to an evidence-based conclusion as to whether the lowering of vasomotor tone by epidural therapy results in better maternal and fetal outcomes and for how long that could be maintained. Another important question that needs to be answered is how long should extended epidural be used to ensure any potential clinical benefits and what could be the associated side effects and costs. Interactions with other modalities of treatment and women's satisfaction could represent other avenues of research.
[Mh] Termos MeSH primário: Anestesia Epidural/métodos
Anestesia Obstétrica/métodos
Anestésicos Locais/administração & dosagem
Bupivacaína/administração & dosagem
Pré-Eclâmpsia/terapia
[Mh] Termos MeSH secundário: Corticosteroides/uso terapêutico
Anticonvulsivantes/uso terapêutico
Anti-Hipertensivos/uso terapêutico
Dipiridamol/uso terapêutico
Feminino
Seres Humanos
Substitutos do Plasma/uso terapêutico
Gravidez
Vasodilatadores/uso terapêutico
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Nm] Nome de substância:
0 (Adrenal Cortex Hormones); 0 (Anesthetics, Local); 0 (Anticonvulsants); 0 (Antihypertensive Agents); 0 (Plasma Substitutes); 0 (Vasodilator Agents); 64ALC7F90C (Dipyridamole); Y8335394RO (Bupivacaine)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180116
[Lr] Data última revisão:
180116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171129
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD009540.pub2


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[PMID]:28449710
[Au] Autor:Peng Y; Du J; Zhao X; Shi X; Wang Y
[Ad] Endereço:Department of Anesthesiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong, Shanghai, 200092, China.
[Ti] Título:Effects of colloid pre-loading on thromboelastography during elective intracranial tumor surgery in pediatric patients: hydroxyethyl starch 130/0.4 versus 5% human albumin.
[So] Source:BMC Anesthesiol;17(1):62, 2017 04 27.
[Is] ISSN:1471-2253
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Volume replacement therapy with colloid is still worth studying in major pediatric surgery with potential risk of bleeding. This study assessed the effects of 6% hydroxyethyl starch (HES) 130/0.4 and 5% Human Albumin (HA) on coagulation tested by thromboelastography (TEG) during elective intracranial tumor surgery in pediatric patients. METHODS: In this randomized controlled trial, 60 patients undergoing intracranial tumor resection under general anesthesia were assigned to HES and HA groups (n = 30), and administered preloads of 20 mL · kg HES 130/0.4 and 5% HA, respectively, prior to dura opening. Primary outcomes were perioperative thromboelastography findings, and hemodynamic and hematological parameters. Blood transfusion, perioperative fluid balance, intracranial pressure, mortality, intensive care unit stay, and hospital stay were also assessed. RESULTS: TEG parameters did not differ after preloading compared to baseline values in either group, except for a decrease in maximum amplitude immediately after infusion (HES group, 57.6 ± 6.0 mm vs. 50.9 ± 9.2 mm; HA group, 60.1 ± 7.9 mm vs. 56.6 ± 7.1 mm; p < 0.01), which was restored to preoperative levels 1 h after fluid infusion. Total perioperative fluid balance, blood loss or transfusion, intracranial pressure, and hematological and hemodynamic variables were similar between both groups (p > 0.05). Mortality, length of hospital stay, and clinical complications were similar between both groups. CONCLUSION: These findings suggest that HES and HA might have no significant differences regarding coagulation as assessed by TEG during pediatric intracranial tumor surgery with 20 ml/kg volume pre-loading, which can maintain stable hemodynamics and may represent a new avenue for volume therapy during brain tumor resection in pediatrics. TRIAL REGISTRATION: ChiCTR-IPR- 16009333 , retrospectively registered October 8, 2016.
[Mh] Termos MeSH primário: Albuminas/farmacologia
Coagulação Sanguínea/efeitos dos fármacos
Derivados de Hidroxietil Amido/farmacologia
Substitutos do Plasma/farmacologia
Tromboelastografia
[Mh] Termos MeSH secundário: Anestesia Geral
Neoplasias Encefálicas/cirurgia
Pré-Escolar
Método Duplo-Cego
Procedimentos Cirúrgicos Eletivos
Feminino
Hemodinâmica/efeitos dos fármacos
Seres Humanos
Masculino
Estudos Prospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Albumins); 0 (Hydroxyethyl Starch Derivatives); 0 (Plasma Substitutes)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171204
[Lr] Data última revisão:
171204
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1186/s12871-017-0353-z


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[PMID]:28857856
[Au] Autor:Schöchl H; Grottke O; Sutor K; Dony K; Schreiber M; Ranucci M; Collins PW
[Ad] Endereço:From the *Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Centre, Vienna, Austria; †Department of Anaesthesiology and Intensive Care, AUVA Trauma Centre, Salzburg, Austria; ‡Department of Anesthesiology, RWTH Aachen University Hospital, Aachen, Germany; §Meridian HealthComms Ltd, Plumley, Cheshire, United Kingdom; ‖Parker Design Consultants Ltd, Lostock Gralam, Cheshire, United Kingdom; ¶Trauma, Critical Care and Acute Care Surgery Division, Oregon Health and Science University, Portland, Oregon; #Department of Cardiothoracic and Vascular Anaesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy; and **School of Medicine, Cardiff University and University Hospital of Wales, Cardiff, United Kingdom.
[Ti] Título:Theoretical Modeling of Coagulation Management With Therapeutic Plasma or Prothrombin Complex Concentrate.
[So] Source:Anesth Analg;125(5):1471-1474, 2017 Nov.
[Is] ISSN:1526-7598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Prothrombin complex concentrates (PCCs) have been associated with a possible risk of thromboembolic complications, potentially attributable to an increased ratio of the plasma concentration of factor II (FII) to antithrombin (AT). We developed a mathematical model to examine the relationship between amounts of PCC or therapeutic plasma administered, and plasma levels of FII and AT. The model showed that PCC produces substantial increases in plasma levels of FII but only small changes in AT, increasing the FII:AT ratio. Therapeutic plasma was shown to have only modest effects on levels of FII or AT, unless high doses are used.
[Mh] Termos MeSH primário: Fatores de Coagulação Sanguínea/uso terapêutico
Coagulação Sanguínea/efeitos dos fármacos
Hemorragia/prevenção & controle
Hemostáticos/uso terapêutico
Modelos Biológicos
[Mh] Termos MeSH secundário: Antitrombinas/metabolismo
Fatores de Coagulação Sanguínea/efeitos adversos
Hemorragia/sangue
Hemostáticos/efeitos adversos
Seres Humanos
Soluções Isotônicas/uso terapêutico
Substitutos do Plasma/uso terapêutico
Volume Plasmático
Protrombina/metabolismo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antithrombins); 0 (Blood Coagulation Factors); 0 (Hemostatics); 0 (Isotonic Solutions); 0 (Plasma Substitutes); 0 (crystalloid solutions); 37224-63-8 (prothrombin complex concentrates); 9001-26-7 (Prothrombin)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171030
[Lr] Data última revisão:
171030
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170901
[St] Status:MEDLINE
[do] DOI:10.1213/ANE.0000000000002410


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[PMID]:28774488
[Au] Autor:Ghodraty MR; Rokhtabnak F; Dehghan HR; Pournajafian A; Baghaee Vaji M; Koleini ZS; Porhomayon J; Nader ND
[Ad] Endereço:Iran University of Medical Sciences, Tehran, Iran.
[Ti] Título:Crystalloid versus colloid fluids for reduction of postoperative ileus after abdominal operation under combined general and epidural anesthesia.
[So] Source:Surgery;162(5):1055-1062, 2017 Nov.
[Is] ISSN:1532-7361
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The main objective of this study was to compare the effect of perioperative administration of crystalloid versus colloid solutions and its impact on reversal of ileus after resection with primary anastomosis of intestine. We hypothesized that inclusion of colloids will improve the return of intestinal motility. METHODS: In a double-blinded clinical trial, 91 the American Society of Anesthesiologists I to III patients undergoing abdominal operation for resection with anastomosis of small or large intestine were randomized to receive either lactated Ringer solution crystalloid group or 6% hydroxyethyl starch colloid group to replace intraoperative fluid loss (blood loss + third space). The time to resume normal intestinal motility was the primary end point and the prevalence of composite postoperative complications was the secondary end point. RESULTS: Average duration of ileus was 86.7 ± 23.6 hours in crystalloid group and it lasted 73.4 ± 20.8 hours in colloid group (P = .006). While there was no difference in the frequency of postoperative nausea and vomiting between the 2 groups (P = .3), the actual vomiting occurred less frequently in colloid group (P = .02). Serum concentrations of potassium ion decreased significantly in both groups, whereas the degree of potassium changes was more remarkable in colloid group compared with crystalloid group (P = .03). Postoperative ileus did not correlate with sex, age, and the duration of operation. Duration of hospital stay was similar between the 2 groups. CONCLUSION: We concluded that administration of colloids as a part of perioperative fluid management improves intestinal motility and shortens the duration of ileus after gastrointestinal operations. This may improve the tolerance for enteral feeding and reduce ileus-related symptoms.
[Mh] Termos MeSH primário: Anastomose Cirúrgica/efeitos adversos
Motilidade Gastrointestinal/efeitos dos fármacos
Trato Gastrointestinal/cirurgia
Íleus/prevenção & controle
Soluções Isotônicas/administração & dosagem
Soluções para Reidratação/administração & dosagem
[Mh] Termos MeSH secundário: Abdome/cirurgia
Adulto
Idoso
Anestesia Epidural
Anestesia Geral
Coloides/administração & dosagem
Coloides/farmacologia
Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos
Método Duplo-Cego
Feminino
Hidratação/métodos
Trato Gastrointestinal/efeitos dos fármacos
Seres Humanos
Derivados de Hidroxietil Amido/administração & dosagem
Derivados de Hidroxietil Amido/farmacologia
Íleus/etiologia
Intestinos/efeitos dos fármacos
Intestinos/cirurgia
Soluções Isotônicas/farmacologia
Laparotomia/efeitos adversos
Masculino
Meia-Idade
Substitutos do Plasma/administração & dosagem
Substitutos do Plasma/farmacologia
Soluções para Reidratação/farmacologia
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Colloids); 0 (Hydroxyethyl Starch Derivatives); 0 (Isotonic Solutions); 0 (Plasma Substitutes); 0 (Rehydration Solutions); 0 (crystalloid solutions); 8022-63-7 (Ringer's lactate)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171109
[Lr] Data última revisão:
171109
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170805
[St] Status:MEDLINE


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[PMID]:28683810
[Au] Autor:Bentzer P; Broman M; Kander T
[Ad] Endereço:Department of Anesthesia and Intensive Care Helsingborg Hospital, Helsingborgs lasarett, Charlotte Yhlens gata 10, 251 87, Helsingborg, Sweden.
[Ti] Título:Effect of dextran-70 on outcome in severe sepsis; a propensity-score matching study.
[So] Source:Scand J Trauma Resusc Emerg Med;25(1):65, 2017 Jul 06.
[Is] ISSN:1757-7241
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Albumin may be beneficial in patients with septic shock but availability is limited and cost is high. The objective of the present study was to investigate if the use of dextran-70 in addition to albumin and crystalloids influences organ failure or mortality in patients with severe sepsis or septic shock. METHODS: Patients with severe sepsis or septic shock (n = 778) admitted to a university hospital intensive care unit (ICU) between 2007 and 2015 that received dextran-70 during resuscitation were propensity score matched to controls at a 1 to 1 ratio. Outcomes were highest acute kidney injury network (AKIN) score the first 10 days in the ICU, use of renal replacement therapy, days alive and free of organ support the first 28 days after admission to ICU, mortality and events of severe bleeding. Outcomes were assessed using paired hypothesis testing. RESULTS: Propensity score matching resulted in two groups of patients with 245 patients in each group. The dextran group received a median volume of 1483 ml (interquartile range, 1000-2000 ml) of dextran-70 during the ICU stay. Highest AKIN score did not differ between the control- and dextran groups (1 (0-3) versus 2 (0-3), p = 0.06). Incidence of renal replacement therapy in the control- and dextran groups was similar (19% versus 22%, p = 0.42, absolute risk reduction -2.9% [95% CI: -9.9 to 4.2]). Days alive and free of renal replacement, vasopressors and mechanical ventilation did not differ between the control- and dextran groups. The 180-day mortality was 50.2% in the control group and 41.6% in the dextran group (p = 0.046, absolute risk reduction 8.6% [-0.2 to 17.4]). Fraction of patients experiencing a severe bleeding in the first 10 days in the ICU did not differ between the control and dextran groups (14% versus 18%, p = 0.21). DISCUSSION: There is a paucity of high quality data regarding effects of dextran solutions on outcome in sepsis. In the present study, propensity score matching was used in attempt to reduce bias. CONCLUSION: No evidence to support a detrimental effect of dextran-70 on mortality or on organ failures in patients with severe sepsis or septic shock could be detected.
[Mh] Termos MeSH primário: Dextranos/uso terapêutico
Insuficiência de Múltiplos Órgãos/etiologia
Substitutos do Plasma/uso terapêutico
Choque Séptico/mortalidade
Choque Séptico/terapia
[Mh] Termos MeSH secundário: Lesão Renal Aguda/etiologia
Lesão Renal Aguda/mortalidade
Lesão Renal Aguda/terapia
Adulto
Idoso
Idoso de 80 Anos ou mais
Hemorragia/etiologia
Hemorragia/mortalidade
Hemorragia/terapia
Seres Humanos
Unidades de Terapia Intensiva
Meia-Idade
Insuficiência de Múltiplos Órgãos/mortalidade
Insuficiência de Múltiplos Órgãos/terapia
Pontuação de Propensão
Terapia de Substituição Renal
Sepse/complicações
Sepse/mortalidade
Sepse/terapia
Choque Séptico/complicações
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Dextrans); 0 (Plasma Substitutes)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170921
[Lr] Data última revisão:
170921
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170708
[St] Status:MEDLINE
[do] DOI:10.1186/s13049-017-0413-x


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[PMID]:28514324
[Au] Autor:Messina A; Longhini F; Coppo C; Pagni A; Lungu R; Ronco C; Cattaneo MA; Dore S; Sotgiu G; Navalesi P
[Ad] Endereço:From the *Anesthesia and Intensive Care Medicine, Maggiore della Carità University Hospital, Novara, Italy; †Anesthesia and Intensive Care Medicine, Sant'Andrea Hospital (ASL VC), Vercelli, Italy; ‡Department of Translational Medicine, Università del Piemonte Orientale "Amedeo Avogadro," Alessandria-Novara-Vercelli, Italy; §Clinical Epidemiology and Medical Statistics Unit, Department of Biomedical Sciences, University of Sassari, Research, Medical Education and Professional Development Unit, AOU Sassari, Sassari, Italy; and ‖Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.
[Ti] Título:Use of the Fluid Challenge in Critically Ill Adult Patients: A Systematic Review.
[So] Source:Anesth Analg;125(5):1532-1543, 2017 Nov.
[Is] ISSN:1526-7598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The fluid challenge (FC) aims at identifying patients in whom fluid administration improves hemodynamics. Although the FC has been extensively studied, the implementation and definition of improvement are not standardized. This systematic review of studies published between January 1, 1994 and December 31, 2014 characterizes these key components of the FC for critically ill adult patients, as described in the medical literature in the last 20 years. A literature search was performed using MEDLINE, Embase, and Cochrane. For each study, data were collected on study design, study size, study setting, patient population, and how the FC was administered. Eligibility criteria for FC were (1) the infusion of a definite quantity of fluid, (2) of a specific type, (3) in a fixed time period (expressed as either span or infusion rate), (4) with a defined hemodynamic variable as the target, and (5) for a predetermined threshold. One hundred fifty-seven full-text manuscripts were extracted from 870 potentially relevant studies. The inclusion criteria were met by 71 studies including 3617 patients. Sixty-six studies were from a single center and 45 were prospective observational in format. The most common amount infused was 500 cc, used by 55 (77.5%) studies. The most commonly infused fluids were colloids (62.0%). In 43 (60.5%) studies, the FC was administered between 20 and 30 minutes. A positive response to fluid administration was defined as an increase ≥15% of cardiac index or cardiac output in 44 (62.6%) studies. Static or dynamic physiologic indices were utilized in a minority of studies (16.9%) and safety limits for interrupting the FC are adopted in 4 (5.6%) studies only. This systematic review indicates that the FC most commonly consists in infusing 500 mL of crystalloids or colloids in 20-30 minutes, and considered an increase in cardiac index ≥15% as a positive response. However, definite standards for FC administration and evaluation remain undefined.
[Mh] Termos MeSH primário: Hidratação
Hemodinâmica
Soluções Isotônicas/administração & dosagem
Substitutos do Plasma/administração & dosagem
Soluções para Reidratação/administração & dosagem
Choque/terapia
[Mh] Termos MeSH secundário: Adulto
Pressão Sanguínea
Débito Cardíaco
Coloides
Estado Terminal
Feminino
Seres Humanos
Infusões Intravenosas
Soluções Isotônicas/efeitos adversos
Masculino
Meia-Idade
Seleção de Pacientes
Substitutos do Plasma/efeitos adversos
Valor Preditivo dos Testes
Soluções para Reidratação/efeitos adversos
Choque/diagnóstico
Choque/fisiopatologia
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Colloids); 0 (Isotonic Solutions); 0 (Plasma Substitutes); 0 (Rehydration Solutions); 0 (crystalloid solutions)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171030
[Lr] Data última revisão:
171030
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170518
[St] Status:MEDLINE
[do] DOI:10.1213/ANE.0000000000002103


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[PMID]:28471979
[Au] Autor:Min JJ; Cho HS; Jeon S; Lee JH; Lee JJ; Lee YT
[Ad] Endereço:aDepartment of Anesthesiology and Pain Medicine bDepartment of Thoracic and Cardiovascular Surgery, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
[Ti] Título:Effects of 6% hydroxyethyl starch 130/0.4 on postoperative blood loss and kidney injury in off-pump coronary arterial bypass grafting: A retrospective study.
[So] Source:Medicine (Baltimore);96(18):e6801, 2017 May.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:We retrospectively evaluated the effects of 6% hydroxyethyl starch (HES) 130/0.4 on postoperative blood loss and acute kidney injury (AKI) in patients undergoing off-pump coronary artery bypass grafting (OPCAB).Electronic medical records of 771 patients who underwent OPCAB in our hospital between July 2012 and July 2014 were reviewed, and 249 patients without intraoperative HES-exposure (group NoHES) were matched 1:N with intraoperative HES-exposed 413 patients (group HES) based on propensity score. The effects of intraoperative HES on postoperative cumulative blood loss within the first 24 hours, need for bleeding-related reoperation, and occurrence of postoperative AKI (determined by KDIGO and RIFLE criteria) were analyzed.In our propensity score matched cohort, there were no significant differences between groups for median postoperative 24 hours blood loss (525 mL in group HES vs. 540 mL in group NoHES, P = .203) or need for bleeding-related reoperation (OR, 2.44; 95% confidence interval [CI], 0.64-9.34, P = .19). However, postoperative AKI (assessed by 2 criteria) occurred more frequently in group HES than in group NoHES (by KDIGO criteria: 10.7% vs. 3.6%; OR 3.43 [95% CI, 1.67-7.04]; P < .001 and by RIFLE criteria: 9.6% vs. 2%; OR 3.32 [95% CI, 1.34-8.24]; P = .01). The median volume of infused HES per patient weight was 16 mL/kg in group HES.In the patients undergoing OPCAB, intraoperative 6% HES 130/0.4 did not increase postoperative bleeding. However, renal safety remains a concern. Intraoperative use of HES should be determined cautiously during OPCAB.
[Mh] Termos MeSH primário: Lesão Renal Aguda/etiologia
Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos
Derivados de Hidroxietil Amido/administração & dosagem
Substitutos do Plasma/administração & dosagem
Hemorragia Pós-Operatória/etiologia
[Mh] Termos MeSH secundário: Idoso
Feminino
Seres Humanos
Derivados de Hidroxietil Amido/efeitos adversos
Incidência
Masculino
Meia-Idade
Substitutos do Plasma/efeitos adversos
Pontuação de Propensão
Reoperação
Estudos Retrospectivos
Risco
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Hydroxyethyl Starch Derivatives); 0 (Plasma Substitutes)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170613
[Lr] Data última revisão:
170613
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000006801


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[PMID]:28387886
[Au] Autor:Zhang JZ; Liu JS; Zhang SH; Huang SY; Zhang JJ; Zhou J; Zhou JH
[Ad] Endereço:Department of Anesthesia, Yantaishan Hospital, Yantai, Shandong, China. m18153529929@163.com.
[Ti] Título:Distinctive effect of 6% hydroxyethyl starch 130/0.4 (Voluven) infusion on pediatric patients with congenital heart disease.
[So] Source:Eur Rev Med Pharmacol Sci;21(6):1384-1396, 2017 Mar.
[Is] ISSN:2284-0729
[Cp] País de publicação:Italy
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: It has not been clear that Voluven (6% hydroxyethyl starch 130/0.4) may be administered in pediatric patients safely. The purpose of this study was to determine if Voluven could be used for blood volume expansion and hypovolemia prevention in pediatric patients with congenital heart disease. PATIENTS AND METHODS: 50 pediatric patients with congenital heart disease were recruited in the study. Circulatory and respiratory parameters were determined to monitor the responses to intravenous infusion of Voluven in the patients. RESULTS: Intravenous infusion of Voluven significantly increased levels of colloid osmotic pressure and central venous pressure, but decreased levels of hemoglobin in the patients. Voluven infusion did not significantly affect colloid osmotic pressure, central venous pressure, hemoglobin and heart rate in the preschool children (<6 years old), and similarly, low infusion (100-240 mL per patient) of Voluven did not significantly affect colloid osmotic pressure, central venous pressure, hemoglobin and heart rate in the young child patients. Also, there was the similar response, i.e. increased colloid osmotic pressure, to Voluven infusion in both female child patients and patients with atrial septal defect. CONCLUSIONS: Voluven may be used in pediatric patients with congenital heart disease, but not in the preschool child patients. Furthermore, special attention should be paid to the intravenous administration of Voluven for blood volume expansion and hypovolemia prevention in female pediatric patients and child patients with atrial septal defect.
[Mh] Termos MeSH primário: Volume Sanguíneo
Cardiopatias Congênitas/tratamento farmacológico
Derivados de Hidroxietil Amido/administração & dosagem
Substitutos do Plasma/administração & dosagem
[Mh] Termos MeSH secundário: Adolescente
Fatores Etários
Criança
Pré-Escolar
Feminino
Seres Humanos
Masculino
Pressão Osmótica
Fatores Sexuais
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (HES 130-0.4); 0 (Hydroxyethyl Starch Derivatives); 0 (Plasma Substitutes)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170804
[Lr] Data última revisão:
170804
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170408
[St] Status:MEDLINE


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[PMID]:28319549
[Au] Autor:Levy JH; Grottke O; Fries D; Kozek-Langenecker S
[Ad] Endereço:From the *Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina; †Department of Anaesthesiology, RWTH Aachen University Hospital, Aachen, Germany; ‡Department of Surgical and General Critical Care Medicine, Medical University Innsbruck, Innsbruck, Austria; and §Department of Anesthesia and Intensive Care, Evangelical Hospital Vienna, Hans-Sachs-Gasse, Vienna, Austria.
[Ti] Título:Therapeutic Plasma Transfusion in Bleeding Patients: A Systematic Review.
[So] Source:Anesth Analg;124(4):1268-1276, 2017 Apr.
[Is] ISSN:1526-7598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Plasma products, including fresh frozen plasma, are administered extensively in a variety of settings from massive transfusion to vitamin K antagonist reversal. Despite the widespread use of plasma as a hemostatic agent in bleeding patients, its effect in comparison with other available choices of hemostatic therapies is unclear. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PubMed Central, and databases of ongoing trials for randomized controlled trials that assessed the efficacy and/or safety of therapeutic plasma as an intervention to treat bleeding patients compared with other interventions or placebo. Of 1243 unique publications retrieved in our initial search, no randomized controlled trials were identified. Four nonrandomized studies described the effect of therapeutic plasma in bleeding patients; however, data gathered from these studies did not allow for comparison with other therapeutic interventions primarily as a result of the low number of patients and the use of different (or lack of) comparators. We identified two ongoing trials investigating the efficacy and safety of therapeutic plasma, respectively; however, no data have been released as yet. Although plasma is used extensively in the treatment of bleeding patients, evidence from randomized controlled trials comparing its effect with those of other therapeutic interventions is currently lacking.
[Mh] Termos MeSH primário: Transfusão de Componentes Sanguíneos/métodos
Hemorragia/terapia
Plasma
[Mh] Termos MeSH secundário: Ensaios Clínicos como Assunto/métodos
Hemorragia/diagnóstico
Seres Humanos
Substitutos do Plasma/administração & dosagem
Transfusão de Plaquetas/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Plasma Substitutes)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170713
[Lr] Data última revisão:
170713
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170321
[St] Status:MEDLINE
[do] DOI:10.1213/ANE.0000000000001897



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