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[D-dimer screening in surgical long-term intensive care patients Erkennung klinisch stummer Thrombosen.]
[Article in German]
Hilbert P, Zur Nieden K, Stuttmann R.
Klinik fur Anasthesiologie, Intensiv- und Notfallmedizin, BG Kliniken Bergmannstrost, Halle.
BACKGROUND: Clinically unrecognized thrombosis with the danger of a pulmonary embolism represents an underestimated problem in surgical ICU patients. In patients undergoing total hip replacement for instance, over 30% develop a clinically inapparent form of thrombosis, despite initial thrombosis prophylaxis. We tried to recognize clinically inapparent thrombosis in long-term intensive care patients using D-dimer screening and ultrasound imaging.METHODS: All surgical long-term ICU patients received intravenous heparin 5-10 IU/kg body weight and a D-dimer was assay was carried out every 2 days. If the D-dimer level surpassed 2 mg/l, ultrasound imaging of the veins in the legs, pelvis, arms and neck was performed.RESULTS: Included in the study were 50 patients and D-dimer levels above 2 mg/l were detected in 38%. A thrombosis was proven in 63% of the patients with D-dimer values above 2 mg/l and 50% of the thrombosis were detected in the arm and neck veins very often associated with intravenous catheters.CONCLUSION: Routine D-dimer screening and specific use of ultrasound imaging appears to be a valuable method to verify clinically inapparent thromboses in surgical ICU patients.
PMID: 15654612 [PubMed - as supplied by publisher]
Clinical evaluation of USCOM ultrasonic cardiac output monitor in cardiac surgical patients in intensive care unit.
Tan HL, Pinder M, Parsons R, Roberts B, van Heerden PV.
Department of Intensive Care, Sir Charles Gairdner Hospital and Pharmacology Unit, School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.
BACKGROUND: The USCOM ultrasonic cardiac output monitor (USCOM Pty Ltd, Coffs Harbour, NSW, Australia) is a non-invasive device that determines cardiac output by continuous-wave Doppler ultrasound. The aim of this study was to evaluate the accuracy of the USCOM device compared with the thermodilution technique in intensive care patients who had just undergone cardiac surgery. METHODS: We conducted a prospective study in the 18-bed intensive care unit of a 600-bed tertiary referral hospital. Twenty-four mechanically ventilated patients were studied immediately following cardiac surgery. We evaluated the USCOM monitor by comparing its output with paired measurements obtained by the standard thermodilution technique using a pulmonary artery catheter. RESULTS: Forty paired measurements were obtained in 22 patients. We were unable to obtain an acceptable signal in the remaining two patients. Comparison of the two techniques showed a bias of 0.18 and limits of agreement of -1.43 to 1.78. The agreement may not be as good between techniques at higher cardiac output values. CONCLUSIONS: The USCOM monitor has a place in intensive care monitoring. It is accurate, rapid, safe, well-tolerated, non-invasive and cost-effective. The learning curve for skill acquisition is very short. However, during the learning phase the USCOM monitor measurements are rather 'operator dependent'. Its suitability for use in high and low cardiac output states requires further validation.
PMID: 15653709 [PubMed - as supplied by publisher]
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Thrombocytosis after trauma: incidence, aetiology, and clinical significance.
Valade N, Decailliot F, Rebufat Y, Heurtematte Y, Duvaldestin P, Stephan F.
Unite de Reanimation chirurgicale et traumatologique, Service d'Anesthesie-Reanimation, AP-HP Hopital Henri Mondor, and Universite Paris XII 94000, Creteil, France.
BACKGROUND: Our aim was to assess the occurrence, aetiology, and clinical significance of a platelet count greater than 600 x 10(3)/mm(3) in trauma patients. METHODS: All trauma patients admitted to the intensive care unit (ICU) during a 13-month period were prospectively studied. Platelet counts were performed daily. We recorded the patient's age, sex, nature of trauma, severity of illness scores, episodes of infections in the ICU, acute lung injury, bleeding, and thromboembolic events. Patients with thrombocytosis were also followed during their hospital stay and 1 month after hospital discharge. RESULTS: A total of 176 patients were included. Thrombocytosis developed in 36 patients (20.4%) at a mean (sd) time of 14.0 (4.0) days and the platelet count normalized 35.0 (13.0) days after admission to the ICU. All patients with thrombocytosis had one or more possible predisposing conditions before the occurrence of thrombocytosis: nosocomial infection occurred in 30 patients (83%), acute lung injury in 17 (47%), bleeding in 27 (75%), and administration of cathecholamines in 24 (67%). Three venous thromboembolic complications occurred in the ICU (1.7%) and one during follow-up. Only one patient presented thrombocytosis at the time of diagnosis. Despite the fact that patients with thrombocytosis had a greater severity of illness, the ICU mortality was comparable among patients with and without thrombocytosis (8 vs 14%, P=0.34). CONCLUSIONS: Reactive thrombocytosis is a common finding after severe trauma and was found to be associated with a better survival than predicted by severity of illness score. Unless additional risk factors are present, reactive thrombocytosis is not associated with an increased risk of thromboembolic events.
PMID: 15486007 [PubMed - indexed for MEDLINE]
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