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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)
    Fulltext
  • 2
    Electronic Resource
    Electronic Resource
    Influence of different volume therapies on platelet function in the critically ill (1996)
    Springer
    Intensive care medicine 22 (1996), S. 1075-1081 
    Details
    ISSN: 1432-1238
    Keywords: Key words Critically ill ; Sepsis ; Trauma ; Volume therapy ; Platelet function ; Aggregometry ; Hydroxyethyl starch solution ; Albumin
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: Both albumin and synthetic colloids such as hydroxyethyl starch (HES) solution are used to optimize hemodynamics in the critically ill. The influence of different long-term infusion regimes on platelet function was studied. Design: Prospective, randomized study. Setting: Clinical investigation on a university hospital surgical intensive care unit. Patients: Twenty-eight consecutive trauma patients (injury severity score〉15 points) and 28 consecutive nontraumatized surgical patients with sepsis. Interventions: The patients received either 20% human albumin (HA trauma, n=14; HA sepsis, n=14) or 10% low-molecular-weight HES solution HES 200/0.5 (HES trauma, n=14; HES sepsis; n=14) for 5 days to maintain central venous pressure and/or pulmonary capillary wedge pressure between 12 and 16 mmHg. Measurements and results: Platelet function was assessed by aggregometry (=turbidimetric technique) using adenosine diphosphate 2.0 μmol/l, collagen 4 μl/ml, and epinephrine 25 μmol/l as inductors. Arterial blood was sampled on the day of admission or the day of diagnosis of sepsis (=baseline value) and over the next 5 days. Standard coagulation parameters (antithrombin III, fibrinogen, partial thromboplastin time) were also measured. Total use of HES by the 5th day totalled 4870±990 ml in the trauma and 3260±790 ml in the sepsis patients (HA trauma: 1850±380 ml; HA sepsis: 1790±400 ml). Maximum platelet aggregation decreased significantly during the first 2–3 days after baseline in all groups. At the end of the investigation period, platelet aggregation variables had recovered and reached (or even exceeded) baseline values. Within the entire investigation period, the course of platelet aggregation variables did not differ significantly between HA and HES-treated patients irrespective of whether they were trauma or sepsis patients. Conclusions: Alterations in hemostasis may occur for several reasons in the critically ill. Human albumin is the preferred first-line volume therapy in patients at risk for coagulation disorders. With respect to platelet function, volume replacement with (lower-priced) low-molecular-weight HES solutions can be recommended in this situation without any risk.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01699231
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Paper (German National Licenses)
    Fulltext
  • 3
    Electronic Resource
    Electronic Resource
    Influence of different volume therapies on platelet function in the critically ill (1996)
    Springer
    Intensive care medicine 22 (1996), S. 1075-1081 
    Details
    ISSN: 1432-1238
    Keywords: Critically ill ; Sepsis ; Trauma ; Volume therapy ; Platelet function ; Aggregometry ; Hydroxyethyl starch solution ; Albumin
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective Both albumin and synthetic colloids such as hydroxyethyl starch (HES) solution are used to optimize hemodynamics in the critically ill. The influence of different long-term infusion regimes on platelet function was studied. Design Prospective, randomized study. Setting Clinical investigation on a university hospital surgical intensive care unit. Patients Twenty-eight consecutive trauma patients (injury severity score〉15 points) and 28 consecutive nontraumatized surgical patients with sepsis. Interventions The patients received either 20% human albumin (HA trauma,n=14; HA sepsis,n=14) or 10% low-molecular-weight HES solution HES 200/0.5 (HES trauma,n=14; HES sepsis;n=14) for 5 days to maintain central venous pressure and/or pulmonary capillary wedge pressure between 12 and 16 mmHg. Measurements and results Platelet function was assessed by aggregometry (=turbidimetric technique) using adenosine diphosphate 2.0 μmol/l, collagen 4 μl/ml, and epinephrine 25 μmol/l as inductors. Arterial blood was sampled on the day of admission or the day of diagnosis of sepsis (=baseline value) and over the next 5 days. Standard coagulation parameters (antithrombin III, fibrinogen, partial thromboplastin time) were also measured. Total use of HES by the 5th day totalled 4870±990 ml in the trauma and 3260±790 ml in the sepsis patients (HA trauma: 1850±380 ml; HA sepsis: 1790±400 ml). Maximum platelet aggregation decreased significantly during the first 2–3 days after baseline in all groups. At the end of the investigation period, platelet aggregation variables had recovered and reached (or even exceeded) baseline values. Within the entire investigation period, the course of platelet aggregation variables did not differ significantly between HA and HES-treated patients irrespective of whether they were trauma or sepsis patients. Conclusions Alterations in hemostasis may occur for several reasons in the critically ill. Human albumin is the preferred first-line volume therapy in patients at risk for coagulation disorders. With respect to platelet function, volume replacement with (lower-priced) low-molecular-weight HES solutions can be recommended in this situation without any risk.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01699231
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Paper (German National Licenses)
    Fulltext
  • 4
    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
  • 5
    Electronic Resource
    Electronic Resource
    Does continuous heparinization influence platelet function in the intensive care patient? (1997)
    Springer
    Intensive care medicine 23 (1997), S. 567-573 
    Details
    ISSN: 1432-1238
    Keywords: Key words Critically ill ; Sepsis ; Trauma ; Neurosurgery ; Heparin ; Anticoagulation ; Platelet function ; Aggregometry ; Adenosine diphosphate ; Epinephrine ; Collagen
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To study the influence of continuous administration of heparin on platelet function in intensive care patients. Design: Prospective, serial investigation. Setting: Clinical investigation on a surgical and neurosurgical intensive care unit in a university hospital. Patients: The study included 45 patients: 15 postoperative with patients sepsis (Acute Physiology and Chronic Health Evaluation II score between 15 and 25), 15 trauma patients (Injury Severity Score 15 to 25), and 15 neurosurgical patients. Interventions: Management of the patients was carried out according to the guidelines for modern intensive care therapy. Sepsis and trauma patients received standard (unfractionated) heparin continuously [aim: an activated partial thromboplastin time (aPTT) approximately 2.0 times normal value; sepsis-heparin and trauma-heparin patients], whereas neurosurgical patients received no heparin (neurosurgical patients). Measurements and results: From arterial blood samples, platelet aggregation was measured by the turbidimetric method. Platelet aggregation was induced by adenosine diphosphate (ADP; 2.0 μmol/l), collagen (10 μg/ml), and epinephrine (25 μmol/l). Measurements were carried out on the day of diagnosis of sepsis or 12 h after hemodynamic stabilization (trauma and neurosurgery patients) (baseline) and during the next 5 days at 12.00 noon. Standard coagulation parameters [platelet count and fibrinogen and antithrombin III (AT III) plasma concentrations] were also monitored. Heparin 4–10 U/kg per h (mean dose: approximately 500 U/h) was necessary to reach an aPTT of about 2.0 times normal. Platelet count was highest in the neurosurgical patients, but it did not decrease after heparin administration to the trauma and sepsis patients. AT III and fibrinogen plasma levels were similar in the three groups of patients. In the sepsis group, platelet aggregation variables decreased significantly (e. g., epinephrine-induced maximum platelet aggregation: − 45 relative % from baseline value). Platelet function recovered during the study and even exceeded baseline values (e. g., ADP-induced maximum platelet aggregation: + 42.5 relative % from baseline value). Continuous heparinization did not blunt this increase of platelet aggregation variables. In the heparinized trauma patients, platelet aggregation variables remained almost stable and were no different to platelet aggregation data in the untreated neurosurgical patients. Conclusions: 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.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050374
    Library Location Call Number Volume/Issue/Year Availability
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    Paper (German National Licenses)
    Fulltext
  • 6
    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
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    Paper (German National Licenses)
    Fulltext
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