Browsing by Subject "Shock"

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  • Kupari, Reino (Helsingin yliopisto, 2017)
    Kuolleisuus kardiogeenisessa sokissa on noin 40 % huolimatta lisääntyneestä revaskularisaatioasteesta ja mekaanisten tukihoitojen kehittymisestä sydäninfarktin hoidossa. Aortan vastapulsaattori on ollut yleisimmin käytetty mekaaninen tukihoito kardiogeenisessa sokissa, mutta näyttö sen hyödyistä on perustunut ei-satunnaistettuihin kohorttitutkimuksiin. Tässä tutkimuksessa tutkittiin oliko vastapulsaattorin asennusajankohdalla vaikutusta päätetapahtumiin, joita olivat hemodynaamiset muuttujat (CI, PCWP), sairaalakuolleisuus ja kuolleisuus puoli vuotta hoitojakson alusta. Sairaalakuolleisuudessa ja kuolleisuudessa puoli vuotta hoitojakson alusta ei havaittu eroa varhaisella hoidolla ja yli 2 päivää sairaalaan tulosta aloitetulla hoidolla. Myöskään hemodynaamisissa parametreissa ei havaittu eroa potilasryhmien välillä.
  • Perner, Anders; Cecconi, Maurizio; Cronhjort, Maria; Darmon, Michael; Jakob, Stephan M.; Pettilä, Ville; van der Horst, Iwan C. C. (2018)
    Hypovolemia is frequent in patients with sepsis and may contribute to worse outcome. The management of these patients is impeded by the low quality of the evidence for many of the specific components of the care. In this paper, we discuss recent advances and controversies in this field and give expert statements for the management of hypovolemia in patients with sepsis including triggers and targets for fluid therapy and volumes and types of fluid to be given. Finally, we point to unanswered questions and suggest a roadmap for future research.
  • Perner, Anders; Prowle, John; Joannidis, Michael; Young, Paul; Hjortrup, Peter B.; Pettilä, Ville (2017)
    Acute kidney injury (AKI) and fluids are closely linked through oliguria, which is a marker of the former and a trigger for administration of the latter. Recent progress in this field has challenged the physiological and clinical rational of using oliguria as a trigger for the administration of fluid and brought attention to the delicate balance between benefits and harms of different aspects of fluid management in critically ill patients, in particular those with AKI. This narrative review addresses various aspects of fluid management in AKI outlining physiological aspects, the effects of crystalloids and colloids on kidney function and the effect of various resuscitation and de-resuscitation strategies on the course and outcome of AKI.
  • Meinander, Tuula; Lassila, Riitta (2017)
    •Keuhkoemboliapotilaan diagnostiikka etenee eri tavoin siitä riippuen, onko potilas sokissa vai ei. •Sokissa olevan potilaan kuolemanriski on suuri, joten on toimittava nopeasti ja suunnitelmallisesti. •Kuolemanriski on pienempi, jos potilas ei ole sokissa. Diagnostiikka perustuu todennäköisyyteen ja muiden diagnoosien sulkemiseen pois. •Keuhkoembolian sulkeminen pois todennäköisyysarvion ja D-dimeeritutkimuksen avulla vähentää säde¬rasitusta, varjoainekuormitusta ja kustannuksia.
  • Hjortrup, Peter B.; Haase, Nicolai; Bundgaard, Helle; Thomsen, Simon L.; Winding, Robert; Pettilä, Ville; Aaen, Anne; Lodahl, David; Berthelsen, Rasmus E.; Christensen, Henrik; Madsen, Martin B.; Winkel, Per; Wetterslev, Jorn; Perner, Anders; CLASSIC Trial Grp; Scandinavian Critical Care Trials (2016)
    Purpose: We assessed the effects of a protocol restricting resuscitation fluid vs. a standard care protocol after initial resuscitation in intensive care unit (ICU) patients with septic shock. Methods: We randomised 151 adult patients with septic shock who had received initial fluid resuscitation in nine Scandinavian ICUs. In the fluid restriction group fluid boluses were permitted only if signs of severe hypoperfusion occurred, while in the standard care group fluid boluses were permitted as long as circulation continued to improve. Results: The co-primary outcome measures, resuscitation fluid volumes at day 5 and during ICU stay, were lower in the fluid restriction group than in the standard care group [ mean differences -1.2 L (95 % confidence interval -2.0 to -0.4); p <0.001 and -1.4 L (-2.4 to -0.4) respectively; p <0.001]. Neither total fluid inputs and balances nor serious adverse reactions differed statistically significantly between the groups. Major protocol violations occurred in 27/75 patients in the fluid restriction group. Ischaemic events occurred in 3/75 in the fluid restriction group vs. 9/76 in the standard care group (odds ratio 0.32; 0.08-1.27; p = 0.11), worsening of acute kidney injury in 27/73 vs. 39/72 (0.46; 0.23-0.92; p = 0.03), and death by 90 days in 25/75 vs. 31/76 (0.71; 0.36-1.40; p = 0.32). Conclusions: A protocol restricting resuscitation fluid successfully reduced volumes of resuscitation fluid compared with a standard care protocol in adult ICU patients with septic shock. The patient-centred outcomes all pointed towards benefit with fluid restriction, but our trial was not powered to show differences in these exploratory outcomes.
  • Mansur, A. (2019)
    Sharia banking industry in Indonesia has been established since early 1990s and growing remarkably after 1998. How the industry contributed to the Indonesian economy and what shocks drove the sharia banks' credit in Indonesia were investigated in this paper using a Structural Vector Auto-regression (SVAR) model with recursive short run restrictions as its identification strategy. The results showed that GDP growth, core inflation, and business activity responded to increase in sharia banks' financing positively, but with lags. Expanding sharia financing by 1 per cent boosted up GDP growth by 0.06 per cent. In the short-run, the contribution of sharia banks' financing to the macroeconomic variables was limited, but it then escalated in the long run with the main channel of transmission through its ability to drive people's purchasing power. Another result showed that sharia banks' financing had a negative relationship with the Government's monetary policy. In order to improve the performance of sharia banking in Indonesia, the demands of domestic sharia financing have to be strengthened with regards to the large number of Moslems in Indonesia. At the same time, Islamic banks have to improve their business processes. Rather than capping their profit margins or murabahah-based financing, they should promote more profit sharing mudharabah-based financing with prioritizing principle of mutual help among Moslems. © 2019 Penerbit Universiti Kebangsaan Malaysia. All rights reserved.
  • Wilkman, Erika; Kuitunen, Anne (2018)