Study population. This study was approved by the Johns Hopkins Medicine Institutional Review Board. All patients admitted to the Johns Hopkins Bayview Medical Center SICU or BICU were evaluated for study inclusion. The IIT protocol had 3 entry criteria: (1) an adult patient with morbidity significant enough to warrant designation as a critically ill patient; (2) blood glucose level greater than 119 mg/dL; and (3) an anticipated duration of ICU stay greater than 24 hours. The IIT protocol was approved by the Pharmacy and Therapeutics Committee before its 2006 implementation in the mixed-service SICU and BICU.

The protocol was implemented after a period of training for staff in both units, and was accompanied by ongoing supervision and assessment by an oversight committee with representatives of the nursing and physician staff of both units. To evaluate the effect of tight glycemic control, we divided subjects into those whose mean blood glucose measurement on day 3 of the IIT was <150 mg/dL (tight control) and $150 mg/dL (poor control)..
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Introduction Since the launch of drotrecogin alfa activated (DrotAA), institutions and individual countries have published data on its use in clinical practice, based on audit or registry data. These studies were limited in size and geographic locale and included patients with greater disease severity and higher mortality than those in clinical trials.

The purpose of this study was to compare baseline characteristics and clinical outcomes (using appropriate statistical adjustments) of patients treated or not treated with DrotAA from the international PROGRESS (Promoting Global Research Excellence in Severe Sepsis) cohort study of severe sepsis. Methods PROGRESS was a global, non-interventional, multicenter, prospective, observational study of patients having a diagnosis of severe sepsis treated in intensive care units at a participating institution.
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The aim of this case series is to review the effect of recombinant activated factor VIIa (rFVIIa) on refractory haemorrhage, despite aggressive treatment with conventional blood products and medications at our institution. All patients undergoing cardiac surgery who received rFVIIa as rescue therapy for persistent uncontrollable haemorrhage were studied. We examined coagulation immediately before and after rFVIIa was given; international normalized ratio (INR), activated partial thromboplastin (APTT) fibrinogen and platelet levels, in addition to the use of red cell and non-red cell blood products, morbidity and mortality.

Thirty patients (0.6%) received 31 doses of rFVIIa for bleeding refractory to conventional treatment. Twenty received rFVIIa in theatre after primary surgery, three after re-exploration and eight in the intensive care unit (ICU). Hospital mortality was 6.5% (2y30) and there were no documented thromboembolic phenomena. There was significant reduction in red blood cell and product transfusion before and after rFVIIa administration (P-0.001). There was significant correction in coagulation parameters after rFVIIa.
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To assess the robustness of our results, we conducted several sensitivity analyses. First, we refitted the propensity score models including only treatment and the associated propensity score quintiles in the logistic models for mortality. Second, we fitted ‘‘classical’’ multivariable logistic regression models for each treatment including as covariates the ones used to estimate the propensity scores. Third, to assess the presence of immortal bias for treatments showing a statistically significant reduction in mortality, we refitted the propensity score models excluding patients who died within the time recommended for administering the treatment in the SSC (6 hours for antibiotics and fluids and 24 hours for steroids and drotrecogin alfa).

In addition, we fitted timevarying Cox proportional hazards models where the treatment was included as a time-dependent covariate, and the covariates used to estimate the propensity scores were included as nontime-varying covariates (22). Two-tailed P values less than 0.05 were considered statistically significant. All analyses were conducted using SPSS version 17.0 (SPSS, Chicago, IL)..
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The end of the 20th century brought significant improvements in the outcome of extremely low-birth-weight infants related to the increased use of antenatal corticosteroids and the introduction of postnatal surfactant to prevent or treat respiratory distress syndrome. As we complete the first decade of the 21st century, less progress in improving clinical outcome in this population has been accomplished. Newer modes of ventilation and the use of inhaled nitric oxide have made few demonstrable improvements in outcome.

Surprisingly, the greatest hope for improvement may come from the refinement of currently available care including less invasive respiratory support and the combining of various known therapies (such as continuous positive airway pressure and surfactant).
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The development of antibodies that inhibit or neutralize replacement therapy with factor VIII or factor IX is today the most serious complication of haemophilia and its treatment. Inhibitor patients have more severe joint morbidity than patients without inhibitors, and older adults experience significant orthopaedic disabilities. Because of the serious and disabling consequences of persistent inhibitors, there is considerable clinical and research interest in establishing effective bypassing agent regimens to prevent bleeding in inhibitor patients in much the same way as prophylaxis procedure works in noninhibitor patients.

In the majority of these patients, the bypass agent was used as a secondary prophylactic. In this report, the use of recombinant factor VIIa prior to any clinically evident joint bleed in a patient with haemophilia A and high-titre inhibitor is described. Blood Coagul Fibrinolysis 19:719–720
2008 Wolters Kluwer Health | Lippincott Williams & Wilkins.
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