Articles: critical-care.
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Review Retracted Publication
[Volume replacement in critically ill intensive-care patients. No classic review].
Effective fluid therapy is a mainstay of managing the critically ill. The ideal kind of volume replacement in this situation still remains a challenge. In spite of an immense number of contributions to this problem there is still no solution yet. ⋯ However, there seems to be no convincing clinical advantage on patients' outcome for either solution. The lack of acceptance of synthetic colloids such as hydroxyethyl starch (HES) solution for volume replacement is most likely due to reports on abnormal coagulation function. This cannot be used as an argument when new modern HES preparations with low molecular weight (70,000 or 200,000 dalton) and low degree of substitution (0.5) are used.
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Intensive care medicine · May 1997
Retracted PublicationDoes continuous heparinization influence platelet function in the intensive care patient?
To study the influence of continuous administration of heparin on platelet function in intensive care patients. ⋯ Continuous administration of heparin with an average dose of approximately 500 U/h did not negatively influence platelet function in the trauma patients. Recovery from reduced platelet function in the sepsis group was not affected by continuous heparinization. Thus, continuous heparinization with this dose appears to be safe with regard to platelet function in the intensive care patient.
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Randomized Controlled Trial Comparative Study Clinical Trial Retracted Publication
Influence of different volume therapy regimens on regulators of the circulation in the critically ill.
Various vasoactive substances are involved in the regulation of the macro- and microcirculation. We have investigated if these regulators change during long-term volume therapy with human albumin (HA) or hydroxyethylstarch solution (HES) in trauma and sepsis patients. To maintain pulmonary capillary wedge pressure (PCWP) at 10-15 mm Hg, either 20% HA (HA-trauma, n = 14; HA-sepsis, n = 14) or 10% low-molecular weight HES solution (HES-trauma, n = 14; HES-sepsis, n = 14) were infused for 5 days, otherwise patient management did not differ between the two groups (trauma/sepsis). ⋯ In both sepsis groups, vasopressors (vasopressin, endothelin-1, noradrenaline and adrenaline) were significantly increased above normal at baseline and decreased more markedly in HES than in HA patients. Concentrations of atrial natriuretic peptide increased only in the HA patients (from 159 (SD 31) to 215 (38) pg ml-1 on day 2). Plasma concentrations of 6-keto-prostaglandin F1 alpha decreased significantly only in the HES sepsis patients (from 112 (25) to 47 (15) pg ml-1).