Browsing by Subject "SURGICAL-PATIENTS"

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  • Vahtera, Annukka; Valkonen, Miia; Huhtala, Heini; Pettila, Ville; Kuitunen, Anne (2017)
    Introduction: In intensive care unit (ICU) patients, subcutaneous low-molecular weight heparin thromboprophylaxis results in lower plasma anti-factor Xa (anti-FXa) levels compared to general ward patients. The aim of this study was to examine whether enoxaparin thromboprophylaxis given as a continuous intravenous infusion (CII) results in more constant and predictable anti-FXa concentration than standard subcutaneous bolus (SCB) administration. Materials and methods: This was a prospective, single-blind, multicenter, randomized controlled trial where ICU patients requiring thromboprophylaxis received enoxaparin either 40 mg as a SCB once daily or 40 mg as a CII over 24 h for three consecutive days. The primary outcome was maximum serum anti-FXa concentration (C-max24 (h)) within the first 24 h; the secondary outcome was anti-FXa area under the curve (AUC)((0-24 h)). Trough level was measured at 72 h. Results: Thirty-nine patients were included in the intention to treat analysis. The median anti-FXa C-max24 (h) was 0.05 (interquartile range, IQR, 0.05-0.18) IU/ml in the CII group and 0.18 (IQR, 0.12-0.33) IU/ml in the SCB group (p= 0.05). Median anti-FXa AUC((0-24 h)) was 1.20 (IQR, 0.98-2.88) in the CII and 1.54 (IQR, 1.22-4.12) in the SCB group (p = 0.095). After 72 h, 66.7% of patients in the CII group had a detectable anti-FXa concentration of > 0.1 IU/ml, compared with 16.7% in the SCB group (p = 0.019). Conclusions: Continuous infusion of enoxaparin led to lower anti-FXa C-max24 h than standard SCB administration. No difference in anti-FXa AUC(0-24) (h) was detected.
  • Vahtera, Annukka; Vaara, Suvi; Pettila, Ville; Kuitunen, Anne (2016)
    Background: Critical care patients are prone to venous thromboembolism (VTE) and, thus, pharmacological thromboprophylaxis is generally advised. Low-molecular weight heparins (LMWHs) have become the drug of choice in ICU patients, since their predictable and reproducible dose response. Monitoring their pharmacological effect is not usually necessary except in special occasions (i.e. with obese or renal failure patients), where anti-FXa level measuring is recommended. However, there is neither recommendation of adequate anti-FXa levels in critically ill patients nor is it known whether peak or trough level should be measured. The aim of this systematic review was to evaluate the recommended LMWH doses, and the reasons to monitor anti-FXa levels. Methods: We searched MEDLINE, Scopus, Cochrane Central Register of Controlled Trials and to identify all potentially relevant studies. Prospective studies done in critically ill patients were included if at least one anti-FXa level (i.e. peak or trough) after any specified LMWH thromboprophylaxis dose was measured. Results: Total 18 eligible studies including 1644 patients were included. There was a wide variation in the median peak anti-FXa levels ( Conclusion: Based on the current literature, no definite conclusions can be drawn on targeted anti-FXa level in critically ill patients when using LMWH thromboprophylaxis. (C) 2016 Elsevier Ltd. All rights reserved.
  • Kesanen, Jukka; Leino-Kilpi, Helena; Lund, Teija; Montin, Liisa; Puukka, Pauli; Valkeapaa, Kirsi (2016)
    Objective: To assess the impact of a preoperative educational intervention on the knowledge level of patients with spinal stenosis. Methods: One hundred spinal stenosis patients were randomized into a preoperative educational intervention group (IG, n = 50) or a control group (CG, n = 50). All the patients received routine preoperative education. In addition, the IG went through an empowering telephone discourse based on a knowledge test performed before admission to hospital. Data on patients' knowledge level were collected at baseline (after the treatment decision), admission to hospital, discharge from hospital and at 3 and 6 months follow-up. Results: At baseline, there was no difference in the knowledge level of the study groups. At admission, the knowledge level was significantly higher in five of six dimension of empowering knowledge in the IG compared to the CG. During follow-up, the knowledge level within the study groups remained stable. Conclusion: A preoperative KTFI significantly increased the patients' knowledge level in most dimensions of empowering knowledge. Practice implication: KTFI is an effective method of preoperative education in patients with spinal stenosis. (C) 2016 Elsevier Ireland Ltd. All rights reserved.
  • Coccolini, Federico; Biffl, Walter; Catena, Fausto; Ceresoli, Marco; Chiara, Osvaldo; Cimbanassi, Stefania; Fattori, Luca; Leppaniemi, Ari; Manfredi, Roberto; Montori, Giulia; Pesenti, Giovanni; Sugrue, Michael; Ansaloni, Luca (2015)
    The indications for Open Abdomen (OA) are generally all those situations in which is ongoing the development an intra-abdominal hypertension condition (IAH), in order to prevent the development of abdominal compartmental syndrome (ACS). In fact all those involved in care of a critically ill patient should in the first instance think how to prevent IAH and ACS. In case of ACS goal directed therapy to achieve early opening and early closure is the key: paradigm of closure shifts to combination of therapies including negative pressure wound therapy and dynamic closure, in order to reduce complications and avoid incisional hernia. There have been huge studies and progress in survival of critically ill trauma and septic surgical patients: this in part has been through the great work of pioneers, scientific societies and their guidelines; however future studies and continued innovation are needed to better understand optimal treatment strategies and to define more clearly the indications, because OA by itself is still a morbid procedure.