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  • 1
    Electronic Resource
    Electronic Resource
    Does long-term continuous administration of pentoxifylline affect platelet function in the critically ill patient? (1996)
    Springer
    Intensive care medicine 22 (1996), S. 644-650 
    Details
    ISSN: 1432-1238
    Keywords: Key words Pentoxifylline ; Critically ill ; Sepsis ; Trauma ; Inflammation ; Coagulation ; Platelet function ; Aggregometry ; Collagen ; Epinephrine ; Adenosine diphosphate
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: The methylxanthine derivative pentoxifylline (PTX) is one of those promising substances which are under current investigation to modify or limit inflammatory response. Antiaggregation activity has also been described that may contribute to the beneficial effects of this substance. Long-term effects on platelet function have not been elucidated yet. Design: Prospective, randomized study. Setting: Clinical investigation on a surgical intensive care unit of a university hospital. Patients: 26 trauma patients and 26 patients suffering from sepsis secondary to major operations were consecutively studied. Interventions: The patients prospectively received either 1.5 mg/kg per h pentoxifylline continuously for 5 days (after a loading dose of 600 mg) (trauma-PTX, n=13; sepsis-PTX, n=13) or saline solution as placebo (trauma-control; n=13; sepsis-control, n=13). Measurements: On the day of admission (trauma patients) or day of the diagnosis of sepsis and at 12:00 p.m. during the next 5 days, platelet aggregation induced by adenosine diphosphate (ADP 2.0 μmol/l), collagen (4 μl/ml), and epinephrine (25 μmol/l) was determined by a turbidimetric method from arterial blood samples. Standard coagulation screen was also monitored. Main results: In untreated trauma and sepsis patients, maximum platelet aggregation induced by all three agonists decreased during the first few days after inclusion in the study [trauma: ADP–17.1±8.0 rel% (% change from baseline); sepsis: ADP –26.1±5.6 rel%]. In due course, maximum platelet aggregation recovered, reaching the baseline value or even exceeding it (trauma patients). In the PTX-treated patients, platelet aggregation was significantly less impaired (sepsis group: ADP –4.4±3.3 rel%) or even increased beyond baseline values in the first few days of the study (trauma group: ADP 16.1±8.0 rel%). Fibrinogen plasma levels were lower in the non-treated control groups (p〈0.05) than in the PTX groups. Conclusions: Continuous infusion of PTX for 5 days did not impair platelet function in critically ill patients. In both trauma and sepsis patients, the usual deterioration in platelet function was even attenuated, which may be due to the effects of PTX on cytokine release (e.g., reduction in tumor necrosis factor and interleukin-1), improvement in microcirculation, or additional fibrinolytic effects.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01709740
    Library Location Call Number Volume/Issue/Year Availability
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    Does long-term continous administration of pentoxifylline affect platelet function in the critically ill patient? (1996)
    Springer
    Intensive care medicine 22 (1996), S. 644-650 
    Details
    ISSN: 1432-1238
    Keywords: Pentoxifylline ; Critically ill ; Sepsis ; Trauma ; Inflammation ; Coagulation ; Platelet function ; Aggregometry ; Collagen ; Epinephrine ; Adenosine diphosphate
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective The methylxanthine derivative pentoxifylline (PTX) is one of those promising substances which are under current investigation to modify or limit inflammatory response. Antiaggregation activity has also been described that may contribute to the beneficial effects of this substance. Long-term effects on platelet function have not been elucidated yet. Design Prospective, randomized study. Setting Clinical investigation on a surgical intensive care unit of a university hospital. Patients 26 trauma patients and 26 patients suffering from sepsis secondary to major operations were consecutively studied. Interventions The patients prospectively received either 1.5 mg/kg per h pentoxifylline continuously for 5 days (after a loading dose of 600 mg) (trauma-PTX,n=13; sepsis-PTX,n=13) or saline solution as placebo (trauma-control;n=13; sepsis-control,n=13). Measurements On the day of admission (trauma patients) or day of the diagnosis of sepsis and at 12:00 p.m. during the next 5 days, platelet aggregation induced by adenosine diphosphate (ADP 2.0 μmol/l), collagen (4 μl/ml), and epinephrine (25 μmol/l) was determined by a turbidimetric method from arterial blood samples. Standard coagulation screen was also monitored. Main results In untreated trauma and sepsis patients, maximum platelet aggregation induced by all three agonists decreased during the first few days after inclusion in the study [trauma: ADP −17.1±8.0 rel% (% change from baseline); sepsis: ADP −26.1±5.6 rel%]. In due course, maximum platelet aggregation recovered, reaching the baseline value or even exceeding it (trauma patients). In the PTX-treated patients, platelet aggregation was significantly less impaired (sepsis group: ADP −4.4±3.3 rel%) or even increased beyond baseline values in the first few days of the study (trauma group: ADP 16.1±8.0 rel%). Fibrinogen plasma levels were lower in the non-treated control groups (p〈0.05) than in the PTX groups. Conclusions Continuous infusion of PTX for 5 days did not impair platelet function in critically ill patients. In both trauma and sepsis patients, the usual deterioration in platelet function was even attenuated, which may be due to the effects of PTX on cytokine release (e.g., reduction in tumor necrosis factor and interleukin-1), improvement in microcirculation, or additional fibrinolytic effects.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01709740
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Paper (German National Licenses)
    Fulltext
  • 3
    Electronic Resource
    Electronic Resource
    Volume therapy in the critically ill: is there a difference? (1998)
    Springer
    Intensive care medicine 24 (1998), S. 28-36 
    Details
    ISSN: 1432-1238
    Keywords: Key words Critically ill ; Sepsis ; Trauma ; Volume therapy ; Albumin ; Hydroxyethylstarch solution ; Macrocirculation ; Microcirculation ; Pulmonary function ; Renal ; function ; Coagulation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: There are still several concerns about the extensive and prolonged use of hydroxyethylstarch solution (HES) in critically ill patients. The effects of volume replacement with HES over 5 days on hemodynamics, laboratory data, and organ function were compared with volume therapy using human albumin (HA). Design: Prospective, randomized study. Setting: Clinical investigations on a surgical intensive care unit (ICU) of a university hospital. Patients: 150 traumatized patients (injury severity score 〉 15) and 150 postoperative patients with sepsis were analyzed. Interventions: Either 10 % low-molecular weight HES (HES-trauma, n = 75; HES-sepsis, n = 75) or 20 % HA (HA-trauma, n = 75; HA-sepsis, n = 75) was given for 5 days to maintain the pulmonary capillary wedge pressure (PCWP) between 12 and 15 torr. The entire management of therapy of the patients was performed by physicians who were not involved in the study and blinded to the infusion regimen. Measurements and results: In addition to extensive cardiorespiratory monitoring, several routine laboratory parameters for assessing pulmonary, renal, hepatic, and coagulation function were analyzed from arterial blood samples on the day of admission to the ICU and on the day of sepsis diagnosis, respectively (“baseline” value) and daily over the following 5 days. Mortality during and after the study did not differ significantly between the infusion groups. There were also no differences between the incidence of pulmonary, renal, or hepatic failure in the two subgroups. Mean arterial pressure, heart rate, and PCWP were similar in both subgroups, whereas cardiac index, oxygen delivery index, oxygen consumption index, and the ratio between the partial pressure of oxygen in arterial blood and fractional inspired oxygen were higher in the HES- than in the HA-treated groups. Standard coagulation parameters did not differ, albumin concentration increased significantly in both HA groups, and lactate concentrations decreased only in the HES-sepsis patients (from 2.8 ± 0.5 to 1.5 ± 0.4 mg/dl). Volume replacement using albumin was significantly (p 〈 0.001) more costly than therapy with HES. Conclusions: Volume therapy with 10 % HES for 5 days in the ICU patient showed no disadvantages compared with an infusion regimen using 20 % albumin. Volume replacement using HES may even be associated with improved hemodynamics. HES appears to be a valuable and significantly cheaper alternative to albumin – even for prolonged volume therapy in the critically ill patient.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050511
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Paper (German National Licenses)
    Fulltext
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