Articles: function.
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Total hip arthroplasty results in substantial blood loss in the peri-operative period. We evaluated the effects of acute normovolaemic haemodilution on blood coagulation and platelet function in 11 patients undergoing total hip arthroplasty. We performed acute normovolaemic haemodilution and haematological tests, rotational thromboelastometry (ROTEM(®) ) and whole-blood impedance aggregometry. ⋯ There were no significant changes in platelet aggregation during the study. At 20 min after the end of acute normovolaemic haemodilution, the international normalised ratio of prothrombin time was increased compared with the baseline value (p = 0.003). We conclude that acute normovolaemic haemodilution resulted in a hypocoagulable state compared with baseline values and that coagulation parameters returned to normal after retransfusion.
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Osteoarthr. Cartil. · Mar 2015
Multicenter Study Comparative StudyKnee osteoarthritis radiographic progression and associations with pain and function prior to knee arthroplasty: a multicenter comparative cohort study.
We determined the radiographic osteoarthritic worsening rate prior to knee arthroplasty (TKA) and whether this worsening was associated with worsening pain and function as compared to a non-surgical matched sample. ⋯ Persons undergoing TKA 2 years later had substantial worsening pain and function over the 2-year pre-operative period as compared to a non-surgical sample matched based on KL grades. Almost 30% of persons who elect to undergo TKA undergo rapid disease progression and symptom worsening during the 2 years prior to TKA.
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Minerva anestesiologica · Mar 2015
ReviewManagement of pediatric delirium in critical illness: a practical update.
Pediatric delirium (PD) is an acute state of brain dysfunction and is often seen in the pediatric intensive care unit (PICU). There is a growing awareness of its clinical interdisciplinary importance. The aim of this article was to describe the three clinical presentations, to evaluate the differential diagnosis and to give a concise and practical update for the pharmacological and non-pharmacological treatment of PD at the PICU, based on recent literature and expert opinions. We discuss an interdisciplinary flow chart which helps the reader dealing with the diagnosis and management of any acute emotional and or behavioral disturbance, of which PD is a special case.
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In critically ill patients, the right ventricle is susceptible to dysfunction due to increased afterload, decreased contractility, or alterations in preload. With the increased use of point-of-care ultrasonography and a decline in the use of pulmonary artery catheters, echocardiography can be the ideal tool for evaluation and to guide hemodynamic and respiratory therapy. We review the epidemiology of right ventricular failure in critically ill patients; echocardiographic parameters for evaluating the right ventricle; and the impact of mechanical ventilation, fluid therapy, and vasoactive infusions on the right ventricle. Finally, we summarize the principles of management in the context of right ventricular dysfunction and provide recommendations for echocardiography-guided management.
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Comparative Study
Poor symptom control is associated with reduced CT segmental airway lumen area in asthmatic smokers.
Cigarette smoking is associated with worse symptoms in asthma and abnormal segmental airways in healthy subjects. We tested the hypothesis that current symptom control in smokers with asthma is associated with altered segmental airway dimensions measured by CT scan. ⋯ The CT scan segmental airway lumen area is reduced in smokers with asthma compared with never smokers with asthma, particularly in severe disease, and is associated with worse current symptom control and small airway dysfunction.