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  • 1
    Electronic Resource
    Electronic Resource
    Coagulation effects of in vitro serial haemodilution with a balanced electrolyte hetastarch solution compared with a saline-based hetastarch solution and lactated Ringer's solution (2002)
    Oxford, UK : Blackwell Science Ltd
    Anaesthesia 57 (2002), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The hydroxyethyl starches are a group of compounds that has been associated with impairment of coagulation when large volumes are administered. The thrombelastograph® is commonly used to assess point-of-care whole blood coagulation. Little is known about the dose–response relationships of haemodilution, and it is reasonable to assume that a linear association exists. This may not be the case with altered electrolyte compositions of the fluids used for haemodilution. We have therefore conducted an in vitro study of haemodilution of human whole blood using lactated Ringer's solution and two high molecular weight hetastarches, one in a balanced salt solution, the other in a 0.9% saline solution. The thrombelastograph®, commonly used for the assessment of the coagulation effects of synthetic colloids, was used as the coagulation assessment device. Serial haemodilution with hetastarch in a balanced salt solution demonstrated a biphasic response (of r-times and k-times, as well as alpha angles), with haemodilution in the 20–40% range causing enhanced coagulation, and higher degrees of dilution causing a decrease in overall coagulation performance. A similar picture was observed with lactated Ringer's solution, but only significantly so in alpha angles. Hetastarch in saline did not display this initial increased coagulability at mild to moderate dilutions. This biphasic response of lactated Ringer's solution and hetastarch in a balanced salt solution reflects the complex interaction of fluids and the coagulation system, and that these effects cannot be attributed to simple haemodilution. On the other hand, there was a linear decrease in maximum amplitude with haemodilution. Maximum amplitude was particularly affected by both starches, which is an expected finding in view of the known interaction between the hydroxyethyl starches and von Willebrand's factor.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2044.2002.02707.x
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  • 2
    Electronic Resource
    Electronic Resource
    Use of the platelet function analyser (PFA-100®) to quantify the effect of low dose aspirin in patients with ischaemic heart disease (2005)
    Oxford, UK : Blackwell Science Ltd
    Anaesthesia 60 (2005), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Continuing aspirin up until surgery in cardiac surgical patients may increase peri-operative blood loss. It is possible that there is a subset of patients particularly sensitive to aspirin. The platelet function analyser (PFA-100®) can demonstrate the antiplatelet effect of aspirin. This study was designed to assess the effect of daily 75 mg aspirin on platelet function, as measured by the PFA-100®, in 92 patients with ischaemic heart disease. Patients were classified into three groups according to their PFA-100® results; aspirin hyper-responders (16%), aspirin normal responders (33%) and aspirin non-responders (51%). The PFA-100® has potential as a screening tool to identify patients who are either hyper-responsive or resistant to aspirin. Pre-operative PFA-100® screening to isolate aspirin hyper-responders could enable the vast majority of patients to continue with aspirin therapy pre-operatively, avoiding the risks of stopping treatment.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.2005.04291.x
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  • 3
    Electronic Resource
    Electronic Resource
    Intra-operative gut mucosal hypoperfusion is associated with increased post-operative complications and cost (1994)
    Springer
    Intensive care medicine 20 (1994), S. 99-104 
    Details
    ISSN: 1432-1238
    Keywords: Tonometry ; Oesophageal Doppler ; Postoperative morbidity ; MOF ; Cost analysis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives To determine CO and gastric mucosal perfusion in patients during elective major surgery; to seek a relationship with subsequent outcome. Design Prospective descriptive study. Setting University hospital. Patients 51 patients undergoing elective major surgery of an anticipated duration of greater than 2 h who were at risk of developing gut mucosal hypoperfusion and postoperative organ failure. Measurements and results CO was determined by oesophageal Doppler measurement of aortic blood flow. Gastric mucosal perfusion was determined by tonometric assessmment of gastric mucosal pH (pHi). Blood pressure and urine flow were measured. At the end of surgery no patients were oliguric or hypotensive. Post-operatively morbidity, mortality, duration and cost of stay in the ITU and hospital were assessed. There were 32 patients with evidence of gastric mucosal ischaemia at the end of surgery (pHi〈7.32) despite maintenance of CO. This group of patients spent a mean of 4.7 (range 0–33) days in the ITU, 14 developed major complications (7 with multiple organ failure [MOF] and 6 died. In 19 patients gut mucosal perfusion was maintained during surgery (pHi≥7.32); these patients demonstrated an increase in CO of 48.4% (95% confidence interval 21.3–75.6) and spent a mean of 1.0 (range 0–4) days in the ITU. Only one developed a major complication and none died. The total cost of post-operative care for the 51 patients was estimated at £ 356650. Mean cost per patient in the low pHi group was significantly greater at £ 8 845 (range £600–£42 700) compared to £ 3 874 (range £2 600–£9 600) in the normal pHi group. The total·cost of post-operative care for the 7 patients who developed MOF was £ 171 450 i.e. 48% of the total cost. Conclusion A low gastric pHi measured during the intraoperative period in a group of patients undergoing major (mainly cardiovascular) surgery is associated with increased post-operative complications and cost.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01707662
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  • 4
    Electronic Resource
    Electronic Resource
    Low intramucosal pH is associated with failure to acidify the gastric lumen in response to pentagastrin (1994)
    Springer
    Intensive care medicine 20 (1994), S. 105-108 
    Details
    ISSN: 1432-1238
    Keywords: Tonometry ; pH ; Gastric acid ; Gastric mucosa ; Critical care
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To determine if low gastric intramucosal pH is associated with impaired secretion of gastric acid after pentagastrin stimulation. Design Prospective study. Setting Intensive care unit of a university teaching hospital. Patients 20 patients requiring mechanical ventilation. Interventions All patients with a gastric luminal pH〉4 were given pentagastrin 6 μg/kg s.c. to stimulate gastric acid secretion and the response assessed by further measurements of gastric luminal pH. Measurements and results Gastric intramucosal pH (pHi) and luminal pH (pHL) were measured. Patients were divided into two groups on the basis of a low or normal pHi (A value of 7.35 was taken as the lower limit of normal). Patients (n=6) with normal pHi (7.40±0.05 [mean±SD]) and a luminal pH〉4 (5.65±1.25) all had a decrease in pHL in response to pentagastrin (decrease in pHL 4.02±1.52). Of the patients (n=7) with low pHi (7.2±0.13) and a pHL〉4 (6.51±0.48) only one responded to pentagastrin (decrase in pHL for this group 0.93±1.86). Patients with a pHL〈4 (2.4±0.71) were not given pentagastrin (n=7). Conclusion Some critically ill patients with low gastric intramucosal pH appear to have an impaired ability to acidify the gastric lumen in response to pentagastrin.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01707663
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  • 5
    Electronic Resource
    Electronic Resource
    Maintaining blood flow in the extracorporeal circuit: haemostasis and anticoagulation (1995)
    Springer
    Intensive care medicine 21 (1995), S. 84-93 
    Details
    ISSN: 1432-1238
    Keywords: Extracorporeal circuits ; Anticoagulation ; Haemostasis ; Heparin ; Prostacyclin ; Citrate ; Aprotinin
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives To review the methods and developments in maintaining extracorporeal circuits in critically ill patients. Design The review includes details of the pathophysiological processes of haemostasis and coagulation in critically ill patients, methods of maintaining blood flow in the extracorporeal circuit and methods of monitoring anticoagulation agents used. Setting Information is relevant to the management of critically ill patients requiring extracorporeal renal and respiratory support and cardiopulmonary bypass. Conclusions Heparin is the mainstay of anticoagulation for the extracorporeal circuit although the complex abnormalities of the coagulation system in critically ill patients are associated with a considerable risk of bleeding. Alternative therapeutic agents and physical strategies (prostacyclin, low molecular weight heparin, sodium citrate, regional anticoagulation, heparin bonding and attention to circuit design) may reduce the risk of bleeding but expense and difficulty in monitoring are disadvantages.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02425162
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    Paper (German National Licenses)
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  • 6
    Electronic Resource
    Electronic Resource
    Studies on glomerular basement membrane in experimental diabetes using lectin histochemistry in Wistar rats (1986)
    Springer
    Diabetologia 29 (1986), S. 495-499 
    Details
    ISSN: 1432-0428
    Keywords: Diabetic rats ; wheat germ agglutinin ; N-acetyl glucosamine ; glomerular basement membrane ; lectin histochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary This study was designed to establish whether specific early changes in carbohydrate content of proteins in the glomerulus of the diabetic rat could be detected. Lectin staining of kidney sections from streptozotocin-induced diabetic rats were compared with similar sections from healthy and diabetic rats that were treated with insulin. Animal groups were killed 1 month, 3 months and 6 months after induction of diabetes. There were no differences in the staining of the glomerular basement membrane between control, insulin-treated and diabetic rats for the lectins concanavalin A, lotus tetragonolobus, soybean and kidney bean, with and without trypsinisation. Staining of the glomerulur basement membrane with wheat germ agglutinin after trypsinisation was significantly increased in the diabetic group when compared to both healthy and insulin-treated groups (p 〈 0.01). It was concluded that, in experimental diabetes mellitus in the rat, there is an accumulation of substances in the glomerular basement membrane and mesangium with an affinity for wheat germ agglutinin, most probably N-acetyl glucosamine, and this is partially prevented by insulin treatment.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00453500
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    Paper (German National Licenses)
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  • 7
    Electronic Resource
    Electronic Resource
    Tonometry to assess the adequacy of splanchnic oxygenation in the critically ill patient (1995)
    Springer
    Intensive care medicine 21 (1995), S. 777-777 
    Details
    ISSN: 1432-1238
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01704748
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    Paper (German National Licenses)
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  • 8
    Electronic Resource
    Electronic Resource
    The role of gut mucosal hypoperfusion in the pathogenesis of post-operative organ dysfunction (1994)
    Springer
    Intensive care medicine 20 (1994), S. 203-209 
    Details
    ISSN: 1432-1238
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Conclusion In the quest for an absolute monitor of tissue oxygen utilisation the tonometer is, unfortunately, not the Holy Grail. However, the tonometer is commercially available and a practical monitor of gut mucosal perfusion for use in the peri-operative period. As the tonometer is not yet in general use we are faced with an ideal opportunity to audit its introduction, something we have failed to do for other clinical monitors.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01704701
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    Paper (German National Licenses)
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  • 9
    Electronic Resource
    Electronic Resource
    Gut mucosal hypoperfusion measured with an automated on-line tonometer (the tonocap) in a canine model of hemorrhage (1996)
    Springer
    Intensive care medicine 22 (1996), S. S65 
    Details
    ISSN: 1432-1238
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Conclusion The Tonocap was used successfully to detect gut mucosal hypoperfusion in a canine model of hemorrhage. With re-injection of sampled air there was no suggestion of CO2 depletion during hypoperfusion.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01921239
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  • 10
    Electronic Resource
    Electronic Resource
    Comparison of commonly used clinical indicators of hypovolaemia with gastrointestinal tonometry (1997)
    Springer
    Intensive care medicine 23 (1997), S. 276-281 
    Details
    ISSN: 1432-1238
    Keywords: Key words Tonometer ; Haemorrhage ; Hypovolaemia ; Splanchnic
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: The gastrointestinal tonometer, which allows measurement of gastrointestinal mucosal CO2 and subsequent derivation of gut intramucosal pH (pHi), has been demonstrated to be a sensitive predictor of outcome following major surgery. Current theory suggests that the origin of the low pH may be hypovolaemia. This study was designed to compare the temporal sequence of changes in tonometric readings with invasive blood pressure, stroke volume, heart rate, lactate and arterial blood gas measurements during progressive haemorrhage. Design: Observational healthy volunteer study. Setting: Intensive care unit at University College London Hospitals. Subjects: Six healthy, medically qualified volunteers. Interventions: After obtaining baseline measurements, the subjects were progressively bled 25 % (range = 21–31 %) of their blood volume over a period of 1 h in two approximately equal aliquots. Equilibration was allowed for 30 min following the bleed, after which further measurements were made and the blood was then retransfused over 30 min. Measurements and main results: There was no consistent change in any of the haemodynamic variables other than gastric intramucosal CO2 : arterial CO2 gap (PiCO2− PaCO2) after removal of the first aliquot of blood, although five of the six subjects also demonstrated a fall in pHi. After removal of the second aliquot of blood, PiCO2− PaCO2 gap and pHi continued to indicate a worsening gastric intramucosal acidosis; stroke volume, as measured by suprasternal Doppler, demonstrated a marked fall, while all other variables measured had not altered consistently or to such a degree as to elicit a clinical response or cause suspicion of a hypovolaemic state. On retransfusion, all variables returned towards baseline. Conclusions: This study demonstrates the value of tonometry as an early monitor of hypovolaemia and highlights the shortcomings of other more commonly measured clinical variables.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050328
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