Jozef Kesecioglu

Decreased circulating levels of von Willebrand factor after intravenous administration of a rapidly degradable hydroxyethyl starch (HES 200/0.5/6) in healthy human subjects

Abstract.Objective: Impairment of haemostasis has been described with slowly degradable medium molecular weight hydroxyethyl starch (MMW-HES), whereas rapidly degradable MMW-HES is generally considered to have no important effects on blood coagulation. This study was undertaken to investigate the effects of a rapidly degradable MMW-HES plasma substitute on primary haemostasis and blood coagulation in human subjects. Design: Randomised, cross-over study. Setting: Research unit of a university hospital. Participants: Nine healthy, adult male volunteers. Interventions: A 60-min intravenous infusion of 1xa0l HES 200/0.5/6 (HAES-steril 6%) or 4% albumin (control). Measurement and results: The infusion of HES resulted in decreased circulating levels of von Willebrand factor antigen (from 85±8% to 59±6% after HES vs from 80±7% to 69±8% after albumin, p<0.05) and ristocetin cofactor activity (from 93±4 to 67±4% after HES vs from 79±5 to 75±5% after albumin, p<0.01). This was associated with an impairment of in vitro platelet function as determined with the PFA-100 platelet function analyser (closure time with collagen/epinephrine from 120±7 to 159±14xa0s after HES vs from 121±7 to 137±10xa0s after albumin, p<0.05; with collagen/ADP from 88±3 to 116±9xa0s and from 103±4 to 114±7xa0s after HES and albumin, respectively, p=0.01). Conclusions: The infusion of 1xa0l of HES 200/0.5/6 in healthy human subjects results in moderately decreased plasma levels of von Willebrand factor associated with impairment of platelet function.

Magnesium levels in critically ill patients. What should we measure

We studied the relation between ionized magnesium, total magnesium, and albumin levels in serum of 115 critically ill patients and the role of extracellular and intracellular magnesium in outcome prediction. Levels of serum total and ionized magnesium, serum albumin, and magnesium in mononuclear blood cells and erythrocytes were measured and the APACHE II score and 1-month mortality recorded. Of all patients, 51.3% had a serum total magnesium concentration below the reference range. In 71% of these hypomagnesemic patients, a normal serum ionized magnesium concentration was measured. None of the patients had an intracellular magnesium concentration below the reference limit. Except for serum total and ionized magnesium, none of the magnesium parameters correlated significantly with each other. A significantly negative correlation was found between serum albumin and the fraction ionized magnesium. There was no association between low extracellular or intracellular magnesium and clinical outcome. The observation of hypomagnesemia in critically ill patients depends on which magnesium fraction is measured. The lack of correlation with clinical outcome suggests hypomagnesemia to be merely an epiphenomenon. Reliable concentrations of serum ionized magnesium can be obtained only by direct measurement and not by calculation from serum total magnesium and albumin.

The Critical Nursing Situation Index for safety assessment in intensive care

Abstract. Objective: The assessment of critical nursing situations can be a valuable tool in the detection of weak elements in the safety of patients and the quality of care in the ICU. A critical nursing situation can be defined as any observable situation, which deviates from good clinical practice and which may potentially lead to an adverse event. The aim of our study was to establish the feasibility, reliability and validity of the Critical Nursing Situation Index (CNSI) as a tool for assessing the safety and the quality of nursing in the ICU. Design: We described the deviations from standards and protocols in daily ICU nursing care, selected those with an implicit, clear risk for the patients and translated them into explicitly observable items. If an item was applicable during observation of the ICU practice, a critical nursing situation could be recorded as either true or false. The reliability of the CNSI was defined in terms of inter-observer agreement. The validity was assessed by exploring the relationship between the nursing time available (more or less than 30xa0min per patient per hour) and the incidence of critical nursing situations. Setting: The study was performed in the ICU of a teaching hospital (30 IC beds) in which all disciplines, including cardiothoracic surgery and neurosurgery, were represented. Patients: The CNSI was randomly applied to 83 ICU patients over a period of 3xa0months (200 times). Measurements and results: The reliability of the index was substantial (Kappa values in the range ≥0.70 to >0.80). In terms of validity, less nursing time resulted in more critical situations (pooled relative risk (RR) 1.36; 95% confidence limits 1.11/1.67). Conclusion: The CNSI is simple to use and has encouraging metric properties, whereas the assessments are closely related to direct patient care. Moreover, the CNSI provides a tool for safety assessment by monitoring potentially dangerous situations that are generally regarded as needing to be avoided.

Comparison of Gastric Intramucosal pH Measurements with Oxygen Supply, Oxygen Consumption and Arterial Lactate in Patients with Severe Sepsis

Tissue hypoxia caused by the imbalance between the oxygen demand and the oxygen uptake, is considered to be the most important factor to the mortality and morbidity in patients with severe sepsis. However, the assessment of tissue oxygenation is still contraversial, since direct measurement of the adequacy of tissue oxygenation has not yet been available in the clinical setting.

Percutaneous dilatational tracheostomy: Safety and ease of performance at the bedside in the ICU

ConclusionPDT can be used safely to manage airway of critically ill patients.

Effect of ketanserine on oxygenation and ventilation inhomogeneity in pigs with ARDS.

The lung dynamics in ARDS are characterized by alveolar units with different time constants. This is due to the nonhomogenous distribution of the disease in the alveoli, where the changes in compliance and airways resistance cause an unequal distribution of pressure and volume during mechanical ventilation. This nonhomogenous distribution of time constants results in ventilation inhomogeneity. A multi breath indicator gas washout technique has recently been reported to measure this inhomogeneity.1

Modulation of the innate immune response during respiratory tract infections

Both the growing number of immunocompromised patients susceptible to pneumonia, and the widespread use of antibiotics that has led to a rise of antibiotic resistance among microorganisms, have made the treatment of pneumonia more difficult. Hence, there is a need for novel therapeutic approaches for respiratory tract infections. Immunotherapy, aimed at modulating the immune response, may serve as an important adjuvant to antibiotic therapy in the treatment of infectious diseases. However, before immunomodulation can become a serious tool in the treatment of severe pneumonia, knowledge of the pulmonary host defense needs to increase.