scholarly journals Special aspects of intensive care of patients with complicated diverticulosis of the colon

2021 ◽  
Vol 23 (3) ◽  
pp. 149-156
Author(s):  
Boris N. Shah ◽  
Magomed A. Abdulaev ◽  
Aleksey M. Avdeev ◽  
Egor Yu. Strukov ◽  
Aleksey V. Shchegolev ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Gastrointestinal Tract ◽  
Fresh Frozen Plasma ◽  
Recurrent Bleeding ◽  
Lower Gastrointestinal Tract ◽  
Antifibrinolytic Drugs ◽  
Fresh Frozen ◽  
Colonic Diverticula ◽  
Frozen Plasma

This study presented examination and treatment results of 129 patients with bleeding from the lower gastrointestinal tract who were treated at the Alexandrovskaya Hospital of St. Petersburg in the period from 2012 to 2017. Examination and treatment were performed in the intensive care unit following current clinical guidelines, taking into account the identified concomitant diseases. Endoscopic examination of the colon is the main diagnostic method for the pathological processes that caused bleeding from the lower gastrointestinal tract. Conservative therapy has been demonstrated effectiveness, and urgent surgical treatment was not needed. The main drug therapy included antifibrinolytic drugs and fresh-frozen plasma preparations. Continuous parenteral administration of proteolysis inhibitors was mandatory. Intensive therapy included correction of hemodynamic disturbances and respiratory failure and restoration of the volume of the circulating blood and plasma. Such an approach was found to be 90% effective. In patients with diverticular disease, bleeding from the colonic diverticula develops in one-third of cases. However, if additional risk factors are present, their frequency reaches 50%, often causing death. Continuous or recurrent bleeding is an indication of surgery. In our study, the conservative method of stopping bleeding from the colonic diverticula was possible in all cases. In general, the disease correlated with the age of the patients. In 68 (53%) patients, bleeding occurred despite anticoagulant or antiplatelet therapy. Patients with bleeding from colonic diverticula do not require urgent surgical intervention, and these patients may require admission to the intensive care unit. Intensive care should include the provision of antifibrinolytic drugs, proteolysis inhibitors, and fresh-frozen plasma.

A Multifaceted Strategy to Reduce Inappropriate Use of Fresh Frozen Plasma Transfusions in the Intensive Care Unit.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1412-1412
Author(s):  
Donald M. Arnold ◽  
Heather Whittingham ◽  
Francois Lauzier ◽  
France Clarke ◽  
Ellen McDonald ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Phase I ◽  
Phase Ii ◽  
Fresh Frozen Plasma ◽  
Phase Iii ◽  
Request Form ◽  
Assessment Period ◽  
Fresh Frozen ◽  
Frozen Plasma

Abstract Abstract 1412 Poster Board I-435 Introduction: The overuse of fresh frozen plasma (FFP) transfusions has been well documented, especially among critically ill patients. In a mixed medical surgical intensive care unit (ICU), we documented that 43% of FFP transfusions were given for indications other than those proposed in published guidelines (Lauzier 2007). Methods: We developed a 3-Phase multifaceted behavior-change strategy to curtail inappropriate FFP transfusions, documenting all patients who had FFP, excluding plasmapheresis. Phase I was a 3-month baseline assessment period with no intervention, in which the FFP transfusion orders prescribed at the discretion of the ICU team were recorded. Phase II was a 3-month intervention targeted to all ICU clinicians, comprised of education on the appropriate use of FFP transfusions, audit and feedback of performance indicators, and a pre-order FFP Request Form to specify the indication and the pre-transfusion INR. Phase III was a 9-month assessment period incorporating only the FFP Request Form. At the end of the study, the indications for all transfusions were adjudicated independently in triplicate by 2 ICU clinicians and 1 hematologist, to determine whether each FFP transfusion was a) consistent with published guidelines, b) inconsistent with guidelines but appropriate for the ICU context, or c) inconsistent and inappropriate. Discrepancies were resolved in all cases. FFP orders were not withheld if FFP Request Forms were not completed. Results: Chance-corrected agreement (which considers clustered transfusions within patients) between ICU reviewers on whether transfusions were consistent or appropriate versus inconsistent and inappropriate was high (phi = 0.80). During Phase I (3 months), 66 FFP transfusions were administered (n= 26 patients), of which 30 were for bleeding. During Phase II (3 months), 24 transfusions were administered (n = 11 patients), of which 11 were for bleeding. During Phase III (7 months of data), 96 transfusions were given (n= 41 patients), of which 57 were for bleeding. Rates of FFP transfusions per month for all indications and for bleeding indications were 22 and 10, respectfully in Phase I; 8 and 4 in Phase II; and 14 and 8 in Phase III. A FFP Request form accompanied 39 (40.6%) of 96 FFP transfusions in Phase III. Conclusions: A multifaceted behavior-change strategy appears to be an effective method of changing inappropriate FFP transfusion practices; however satisfactory uptake of a pre-transfusion FFP Request Form requires consistent reminders. We recommend that transfusion guidelines are improved to explicitly incorporate FFP transfusion criteria appropriate for the ICU setting. Disclosures: No relevant conflicts of interest to declare.

Clinical use of fresh-frozen plasma in neonatal intensive care unit

2012 ◽  
Vol 47 (1) ◽  
pp. 91-94 ◽  
Author(s):  
Nilgün Altuntas ◽  
İdil Yenicesu ◽  
Serdar Beken ◽  
Ferit Kulali ◽  
Fatma Burcu Belen ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Fresh Frozen Plasma ◽  
Clinical Use ◽  
Fresh Frozen ◽  
Frozen Plasma

scholarly journals Hypoalbuminemia in critically sick children

2019 ◽  
Vol 6 (3) ◽  
pp. 922
Author(s):  
Sandeep T. Golhar ◽  
Hina Agrawal ◽  
Urmila M. Chauhan ◽  
Abhishek Madhura
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Serum Albumin ◽  
Paediatric Intensive Care Unit ◽  
Human Albumin ◽  
Fresh Frozen Plasma ◽  
Paediatric Intensive Care ◽  
Common Finding ◽  
Fresh Frozen ◽  
Frozen Plasma

Background: Hypoalbuminemia at admission is a common finding in patients admitted to the Paediatric Intensive Care Unit (PICU) and may predict morbidity and mortality.Methods: Patients of age more than 1 year and less than 12 years diagnosed with hypoalbuminemia on the grounds of the inclusion criteria who were admitted in the Paediatric Intensive Care Unit (PICU) were enrolled in the study as ‘cases’ and patients with normal levels of serum albumin and otherwise similar characteristics to cases were included in the study as ‘controls’. Detailed clinical examination and required investigations were done. Above collected information was utilized to select two groups for the study i.e., those with hypoalbuminemia and others with no hypoalbuminemia. Both these groups were further followed up till discharge or death and the outcome in terms of morbidity and mortality was noted.Results: Incidences of MODS and degree of severity of illness as judged by PRISM III score in cases and control showed that, a lower serum albumin concentration correlated well with higher rates of complications such as ventilator dependence and development of new infections leading longer stay in the critical care unit. The mean length of PICU stay in cases group was statistically longer than in the control group. Although we did not observe a difference in fatal outcome in patients managed with either Human Albumin or Fresh Frozen Plasma compared to those managed conservatively in this study, we did observe a decreased mean length of PICU stay and rate of complications in the patients treated with either Human Albumin or Fresh Frozen Plasma, thus achieving a faster rate of recovery with lesser rate of complications and thus alleviating the morbidity, though still not being able to affect the overall mortality.Conclusions: Hypoalbuminemia at admission was a predictive factor of poor outcome in critically ill children. It is associated with a higher mortality, a longer length of stay in the PICU, as well as longer ventilator use.

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