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  • 1
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    Prognosis of coma after therapeutic hypothermia: A prospective cohort study
    Wiley ; 2012
    In:  Annals of Neurology Vol. 71, No. 2 ( 2012-02), p. 206-212
    Details
    In: Annals of Neurology, Wiley, Vol. 71, No. 2 ( 2012-02), p. 206-212
    Abstract: This study was designed to establish the reliability of neurologic examination, neuron‐specific enolase (NSE), and median nerve somatosensory‐evoked potentials (SEPs) to predict poor outcome in patients treated with mild hypothermia after cardiopulmonary resuscitation (CPR). Methods: This multicenter prospective cohort study included adult comatose patients admitted to the intensive care unit (ICU) after CPR and treated with hypothermia (32–34°C). False‐positive rates (FPRs 1 − specificity) with their 95% confidence intervals (CIs) were calculated for pupillary light responses, corneal reflexes, and motor scores 72 hours after CPR; NSE levels at admission, 12 hours after reaching target temperature, and 36 hours and 48 hours after collapse; and SEPs during hypothermia and after rewarming. The primary outcome was poor outcome, defined as death, vegetative state, or severe disability (Glasgow Outcome Scale 1–3) after 6 months. Results: Of 391 patients included, 53% had a poor outcome. Absent pupillary light responses (FPR 1; 95% CI, 0–7) or absent corneal reflexes (FPR 4; 95% CI, 1–13) 72 hours after CPR, and absent SEPs during hypothermia (FPR 3; 95% CI, 1–7) and after rewarming (FPR 0; 95% CI, 0–18) were reliable predictors. Motor scores 72 hours after CPR (FPR 10; 95% CI, 6–16) and NSE levels were not. Interpretation: In patients with persisting coma after CPR and therapeutic hypothermia, use of motor score or NSE, as recommended in current guidelines, could possibly lead to inappropriate withdrawal of treatment. Poor outcomes can reliably be predicted by testing brainstem reflexes 72 hours after CPR and performing SEP. ANN NEUROL 2012;71:206–212
    Type of Medium: Online Resource
    ISSN: 0364-5134 , 1531-8249
    URL: Issue
    URL: Article
    DOI: 10.1002/ana.v71.2
    DOI: 10.1002/ana.22632
    Language: English
    Publisher: Wiley
    Publication Date: 2012
    detail.hit.zdb_id: 80362-5
    detail.hit.zdb_id: 2037912-2
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  • 2
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    Transfusion of fresh‐frozen plasma in critically ill patients with a coagulopathy before invasive procedures: a randomized clinical trial (CME)
    Wiley ; 2015
    In:  Transfusion Vol. 55, No. 1 ( 2015-01), p. 26-35
    Details
    In: Transfusion, Wiley, Vol. 55, No. 1 ( 2015-01), p. 26-35
    Abstract: Prophylactic use of fresh‐frozen plasma ( FFP ) is common practice in patients with a coagulopathy undergoing an invasive procedure. Evidence that FFP prevents bleeding is lacking, while risks of transfusion‐related morbidity after FFP have been well demonstrated. We aimed to assess whether omitting prophylactic FFP transfusion in nonbleeding critically ill patients with a coagulopathy who undergo an intervention is noninferior to a prophylactic transfusion of FFP . Study Design and Methods A multicenter randomized open‐label trial with blinded endpoint evaluation was performed in critically ill patients with a prolonged international normalized ratio ( INR ; 1.5‐3.0). Patients undergoing placement of a central venous catheter, percutaneous tracheostomy, chest tube, or abscess drainage were eligible. Patients with clinically overt bleeding, thrombocytopenia, or therapeutic use of anticoagulants were excluded. Patients were randomly assigned to omitting or administering a prophylactic transfusion of FFP (12  mL /kg). Outcomes were occurrence of postprocedural bleeding complications, INR correction, and occurrence of lung injury. Results Due to slow inclusion, the trial was stopped before the predefined target enrollment was reached. Eighty‐one patients were randomly assigned, 40 to FFP and 41 to no FFP transfusion. Incidence of bleeding did not differ between groups, with a total of one major and 13 minor bleedings (p = 0.08 for noninferiority). FFP transfusion resulted in a reduction of INR to less than 1.5 in 54% of transfused patients. No differences in lung injury scores were observed. Conclusion In critically ill patients undergoing an invasive procedure, no difference in bleeding complications was found regardless whether FFP was prophylactically administered or not.
    Type of Medium: Online Resource
    ISSN: 0041-1132 , 1537-2995
    URL: Issue
    URL: Article
    DOI: 10.1111/trf.2015.55.issue-1
    DOI: 10.1111/trf.12750
    Language: English
    Publisher: Wiley
    Publication Date: 2015
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  • 3
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    Systemic and Urinary Neutrophil Gelatinase-Associated Lipocalins Are Poor Predictors of Acute Kidney Injury in Unselected Critically Ill Patients
    Wiley ; 2012
    In:  Critical Care Research and Practice Vol. 2012 ( 2012), p. 1-8
    Details
    In: Critical Care Research and Practice, Wiley, Vol. 2012 ( 2012), p. 1-8
    Abstract: Background . Neutrophil gelatinase-associated lipocalin (NGAL) in serum and urine have been suggested as potential early predictive biological markers of acute kidney injury (AKI) in selected critically ill patients. Methods . We performed a secondary analysis of a multicenter prospective observational cohort study of unselected critically ill patients. Results . The analysis included 140 patients, including 57 patients who did not develop AKI, 31 patients who developed AKI, and 52 patients with AKI on admission to the ICU. Levels of sNGAL and uNGAL on non-AKI days were significantly lower compared to levels of sNGAL on RIFLE RISK days, RIFLE INJURY days, and RIFLE FAILURE days. The AUC of sNGAL for predicting AKI was low: 0.45 (95% confidence interval (CI) 0.27–0.63) and 0.53 (CI 0.38–0.67), 2 days and 1 day before development of AKI, respectively. The AUC of uNGAL for predicting AKI was also low: 0.48 (CI 0.33–0.62) and 0.48 (CI 0.33–0.62), 2 days and 1 day before development of AKI, respectively. AUC of sNGAL and uNGAL for the prediction of renal replacement therapy requirement was 0.47 (CI 0.37–0.58) and 0.26 (CI 0.03–0.50). Conclusions . In unselected critically ill patients, sNGAL and uNGAL are poor predictors of AKI or RRT.
    Type of Medium: Online Resource
    ISSN: 2090-1305 , 2090-1313
    URL: Article
    DOI: 10.1155/2012/712695
    Language: English
    Publisher: Wiley
    Publication Date: 2012
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  • 4
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    Analysis of Sites of Bacterial Contamination in an Enteral Feeding System
    Wiley ; 2006
    In:  Journal of Parenteral and Enteral Nutrition Vol. 30, No. 6 ( 2006-11), p. 519-525
    Details
    In: Journal of Parenteral and Enteral Nutrition, Wiley, Vol. 30, No. 6 ( 2006-11), p. 519-525
    Abstract: The safety of prolonged use of enteral feedings has previously been assessed by risk analysis of contamination of the feeding container. A new 1‐L enteral feeding system with minimal chances of touching critical areas was compared with routinely used 0.5‐L glass bottle systems by culturing the contents of feeding containers and delivery sets.
    Type of Medium: Online Resource
    ISSN: 0148-6071 , 1941-2444
    URL: Article
    DOI: 10.1177/0148607106030006519
    Language: English
    Publisher: Wiley
    Publication Date: 2006
    detail.hit.zdb_id: 800861-9
    detail.hit.zdb_id: 2170060-6
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  • 5
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    Clinically Relevant Differences in Accuracy of Enteral Nutrition Feeding Pump Systems
    Wiley ; 2006
    In:  Journal of Parenteral and Enteral Nutrition Vol. 30, No. 4 ( 2006-07), p. 339-343
    Details
    In: Journal of Parenteral and Enteral Nutrition, Wiley, Vol. 30, No. 4 ( 2006-07), p. 339-343
    Abstract: Important differences exist between prescribed and delivered volumes of enteral nutrition in intensive care. This laboratory study suggests that this might be caused, at least partially, by function and construction of frequently used feeding pump systems. This finding is independent of viscosity of nutrition formulas and feeding‐tube resistances.
    Type of Medium: Online Resource
    ISSN: 0148-6071 , 1941-2444
    URL: Article
    DOI: 10.1177/0148607106030004339
    Language: English
    Publisher: Wiley
    Publication Date: 2006
    detail.hit.zdb_id: 800861-9
    detail.hit.zdb_id: 2170060-6
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  • 6
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    The practice of reporting transfusion‐related acute lung injury: a national survey among clinical and preclinical disciplines
    Wiley ; 2010
    In:  Transfusion Vol. 50, No. 2 ( 2010-02), p. 443-451
    Details
    In: Transfusion, Wiley, Vol. 50, No. 2 ( 2010-02), p. 443-451
    Abstract: BACKGROUND: Transfusion‐related acute lung injury (TRALI) is hypothesized to be a “two‐hit” entity, in which an inflammatory condition (e.g., sepsis) predisposes to TRALI. TRALI is a clinical diagnosis. Disciplines involved in managing TRALI may differ in decision‐making on the reporting of TRALI. STUDY DESIGN AND METHODS: A survey was conducted among critical care physicians, hematologists, hemovigilance workers, and transfusion medicine physicians, using case vignettes and a questionnaire. The vignettes varied in patient‐ and blood product–related factors that may influence the decision to report a TRALI case. Multiple linear regression analysis was performed. A positive β‐coefficient is in favor of reporting. RESULTS: Ninety‐two questionnaires were returned (response rate, 68%). For all disciplines, preferences in favor of reporting TRALI were onset of symptoms within 1 hour (β = 0.4), after transfusion of a single unit of FFP (β = 0.5), and in the absence of acute lung injury before transfusion (β = 1.3). An admission diagnosis of sepsis was a negative preference (β = −0.3). Massive transfusion (6 RBC plus 4 FFP units) was a negative preference for transfusion medicine physicians (β = −0.3), but a positive preference for the other disciplines. The questionnaire revealed that massive transfusion and the age of blood products were considered relatively more important reasons to report TRALI by critical care physicians compared to the other disciplines (p  〈  0.05). CONCLUSION: A pretransfusion inflammatory condition is a reason to withhold from reporting of a suspected TRALI case. Disciplines involved in managing TRALI differ in decision‐making of reporting TRALI, which may contribute to variance in incidence.
    Type of Medium: Online Resource
    ISSN: 0041-1132 , 1537-2995
    URL: Issue
    URL: Article
    DOI: 10.1111/trf.2010.50.issue-2
    DOI: 10.1111/j.1537-2995.2009.02415.x
    Language: English
    Publisher: Wiley
    Publication Date: 2010
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  • 7
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    Incidence, risk factors, and outcome of transfusion‐associated circulatory overload in a mixed intensive care unit population: a nested case‐control study
    Wiley ; 2018
    In:  Transfusion Vol. 58, No. 2 ( 2018-02), p. 498-506
    Details
    In: Transfusion, Wiley, Vol. 58, No. 2 ( 2018-02), p. 498-506
    Abstract: The objective of this study was to determine the incidence, risk factors, and outcome of transfusion‐associated circulatory overload (TACO) in a cohort of mixed intensive care unit patients and to compare risk factors with those for cardiac overload in the absence of transfusion. STUDY DESIGN AND METHODS In a retrospective cohort study, patients who developed TACO were compared using multivariate analysis of two control groups: patients without pulmonary deterioration who received transfusion and patients who developed circulatory overload in the absence of transfusion. RESULTS TACO was diagnosed in 66 of 1140 patients who received transfusions (5.8%). A total of 585 control transfusion recipients and 76 control patients who developed circulatory overload also were identified. Risk factors were the referring specialties cardiology (odds ratio [OR], 13.6; 95% confidence interval [CI] , 5.1‐35.7; p ≤ 0.001) and cardiothoracic surgery (OR, 8.8; 95% CI, 3.7‐20.7; p ≤ 0.001), history of cardiac failure (OR, 2.4; 95% CI, 1.2‐4.6; p = 0.01), continuous veno‐venous hemofiltration (OR, 3.2; 95% CI, 1.2‐8.9; p = 0.03), and degree of positive fluid balance (OR, 1.15; 95% CI, 1.07‐1.24; p ≤ 0.001), which was associated less with the onset of TACO compared with circulatory overload (OR, 0.89; 95% CI, 0.82‐0.97; p = 0.005). Patients in the TACO group had a longer length of stay in the intensive care unit compared with the transfusion and circulatory overload controls groups (median, 7.2 vs. 4.3 vs. 4.4 days; p = 0.001 vs. p = 0.008). CONCLUSIONS The incidence of TACO is high in a mixed intensive care unit population. The risk factors identified for TACO are cardiac failure, renal failure, and degree of positive fluid balance. A positive fluid balance may be less essential in the onset of TACO than in the onset of circulatory overload in the absence of transfusion.
    Type of Medium: Online Resource
    ISSN: 0041-1132 , 1537-2995
    URL: Issue
    URL: Article
    DOI: 10.1111/trf.2018.58.issue-2
    DOI: 10.1111/trf.14432
    Language: English
    Publisher: Wiley
    Publication Date: 2018
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  • 8
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    Low‐risk transfusion‐related acute lung injury donor strategies and the impact on the onset of transfusion‐related acute lung injury: a meta‐analysis
    Wiley ; 2015
    In:  Transfusion Vol. 55, No. 1 ( 2015-01), p. 164-175
    Details
    In: Transfusion, Wiley, Vol. 55, No. 1 ( 2015-01), p. 164-175
    Abstract: Transfusion‐related acute lung injury ( TRALI ) is the leading cause of transfusion‐related mortality. In the past decade blood banks have implemented low‐risk TRALI donor strategies, including a male‐only donor policy for plasma‐containing blood products to prevent onset of TRALI . We performed a meta‐analysis to determine whether use of low‐risk TRALI donor strategies for plasma indeed reduces onset of TRALI . Study Design and Methods We searched MEDLINE and C ochrane C entral R egister of C ontrolled T rials from J anuary 1995 up to J anuary 2013. Two reviewers independently extracted data on study characteristics, methods, and outcomes. Primary endpoint was onset of TRALI . Subgroup analyses were performed for patient populations prone to develop TRALI and general patient populations. Results Ten articles were included. Meta‐analysis using a random‐effects model taking into account all transfused products showed a significant reduction for the risk of TRALI after implementation of low‐risk TRALI donor strategies (odds ratio [ OR ], 0.61; 95% confidence interval [ CI ], 0.42‐0.88). Data from patient populations prone to develop TRALI showed a significant reduction of TRALI risk ( OR , 0.51; 95% CI , 0.29‐0.90), while data from general patient populations showed a similar nonsignificant trend ( OR , 0.66; 95% CI , 0.40‐1.09). Results were similar when taking only plasma products into account ( OR , 0.62; 95% CI , 0.42‐0.92). Conclusion The introduction of low‐risk TRALI donor strategies for plasma‐containing products results in a reduction of TRALI .
    Type of Medium: Online Resource
    ISSN: 0041-1132 , 1537-2995
    URL: Issue
    URL: Article
    DOI: 10.1111/trf.2015.55.issue-1
    DOI: 10.1111/trf.12816
    Language: English
    Publisher: Wiley
    Publication Date: 2015
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  • 9
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    Central venous catheter placement in coagulopathic patients: risk factors and incidence of bleeding complications
    Wiley ; 2017
    In:  Transfusion Vol. 57, No. 10 ( 2017-10), p. 2512-2525
    Details
    In: Transfusion, Wiley, Vol. 57, No. 10 ( 2017-10), p. 2512-2525
    Abstract: Central venous catheters are frequently inserted into patients with coagulation disorders. It is unclear whether preprocedural correction of hemostasis is beneficial. We determined the incidence of bleeding complications after central venous catheter placement in patients who had severe coagulopathy and identified potential risk factors for bleeding. STUDY DESIGN AND METHODS The MEDLINE and Cochrane Library databases were systematically searched through November 2015. To be included, articles must have reported on hemorrhagic complications with specification of abnormal coagulation testing results. Severe coagulopathy was defined as a reduced platelet count of 50 × 10 9 /L or less, and/or an elevated international normalized ratio of 1.5 or greater, and/or a partial thromboplastin time of 45 seconds or greater. RESULTS We included one randomized controlled trial and 21 observational studies. In total, there were 13,256 catheter insertions, including 4213 in patients with severe coagulopathy. Before 3150 central venous catheter placements, coagulopathy was not corrected. The bleeding incidence varied from 0 to 32%. The severity of coagulopathy did not predict the risk of bleeding. No study demonstrated a beneficial effect from the prophylactic administration of platelets or fresh‐frozen plasma to prevent bleeding complications. Retrospective observational studies suggested that no preprocedural correction is required up to a platelet count of 20 × 10 9 /L and an international normalized ratio of 3.0. CONCLUSION The incidence of major bleeding complications after central venous catheter placement is low, even in coagulopathic patients. Based on a systematic research of the literature, strong evidence supporting the correction of hemostatic defects before central venous catheter insertion is lacking. However, well‐powered randomized controlled trials will be necessary to determine the minimal platelet count, the maximal international normalized ratio, and an activated partial thromboplastin time that is safe before central venous catheter insertion.
    Type of Medium: Online Resource
    ISSN: 0041-1132 , 1537-2995
    URL: Issue
    URL: Article
    DOI: 10.1111/trf.2017.57.issue-10
    DOI: 10.1111/trf.14248
    Language: English
    Publisher: Wiley
    Publication Date: 2017
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  • 10
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    Estimation of Body Composition Depends on Applied Device in Patients Undergoing Major Abdominal Surgery
    Wiley ; 2015
    In:  Nutrition in Clinical Practice Vol. 30, No. 2 ( 2015-04), p. 249-256
    Details
    In: Nutrition in Clinical Practice, Wiley, Vol. 30, No. 2 ( 2015-04), p. 249-256
    Abstract: Background: Bioelectrical impedance analysis (BIA) is a method used to estimate body compartments such as fat‐free mass (FFM) and fat mass (FM). Two BIA devices, a single‐frequency BIA (SF‐BIA) device and a bioimpedance spectroscopy (BIS) approach, were compared to evaluate their reliability and to study whether their estimations resulted in similar classifications of body composition. Materials and Methods: In a prospective observational study, body composition was estimated by SF‐BIA and BIS in 123 adult patients scheduled for major abdominal surgery. Measurement agreement for the continuous variables FFM and FM were analyzed by using the intraclass correlation coefficient (ICC), the mean differences, and their limits of agreement. Measurement differences were also visualized by Bland‐Altman plots. For the dichotomized FFM index (FFMI) and FM index (FMI), interobserver agreement was calculated using Cohen κ statistics; the McNemar test was performed to compare the paired proportions. Results: Agreement for the continuous variables was almost perfect for FM (.86; 95% confidence interval [CI], .80–.90) and substantial for FFM (.78; 95% CI, .70–.84). For the dichotomous va riables, the agreement was substantial for FMI (.67; 95% CI, .51–.83) and slight for FFMI (.19; 95% CI, .01–.37). BIS classified a larger proportion having a low FFMI and a high FMI. Conclusion: There were good ICCs between SF‐BIA and BIS for FFM and FM. However, the mean differences were substantial, whereas the classification of body composition based on FFMI and FMI was influenced by the device. Therefore, BIA devices are not interchangeable.
    Type of Medium: Online Resource
    ISSN: 0884-5336 , 1941-2452
    URL: Article
    DOI: 10.1177/0884533614542614
    Language: English
    Publisher: Wiley
    Publication Date: 2015
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    detail.hit.zdb_id: 2170063-1
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