|
#17
28.03.2007, 21:05
|
||||
|
||||
|
У меня тоже не открываются, а нужны
 
|
|
#18
28.03.2007, 21:08
|
||||
|
||||
|
Цитата:
|
|
#19
28.03.2007, 23:10
|
||||
|
||||
Цитата:
|
|
#20
28.03.2007, 23:52
|
||||
|
||||
|
Цитата:
Palumbo D, Servillo G, D'Amato L, Volpe ML, Capogrosso G, De Robertis E, Piazza O, Tufano R. The effects of hydroxyethyl starch solution in critically ill patients. Minerva Anestesiol. 2006 Jul-Aug;72(7-8):655-64. [Ссылки доступны только зарегистрированным пользователям ] ----------------------- Boldt J, Suttner S. Plasma substitutes. Minerva Anestesiol. 2005 Dec;71(12):741-58. [Ссылки доступны только зарегистрированным пользователям ]
|
|
#22
29.03.2007, 02:08
|
||||
|
||||
|
Наверное, лучше обратиться к первоисточникам, напр.:
Evidence-based Colloid Use in the Critically Ill: American Thoracic Society Consensus Statement. Am. J. Respir. Crit. Care Med. 170: 1247-1259(2004). Summary Points Colloids have various nononcotic properties that may influence vascular integrity, inflammation, and pharmacokinetics, although the clinical relevance of these properties has not been elucidated (NR). All colloids affect the coagulation system, with dextran and starch solutions having the most potent antithrombotic effects (II-A). HES may be deposited in the reticuloendothelial tissues for prolonged periods; the clinical significance of this is unknown (II-C). Colloids restore intravascular volume and tissue perfusion more rapidly than crystalloids in all shock states, regardless of vascular permeability (II-A). There is conflicting evidence that HES increases the risk of bleeding after cardiopulmonary bypass surgery (I). Although hydrostatic pressure is more important than COP for accumulation of pulmonary edema, colloid administration reduces tissue edema and may ameliorate pulmonary edema as a consequence of shock resuscitation (II-A). There is no evidence of a benefit of colloids in treating ischemic brain injury (I) or subarachnoid hemorrhage (II-A). Colloids may adversely impact survival in traumatic brain injury (I). HES administration may increase the risk of acute renal failure in patients with sepsis (II-A). Treatment of dialysis-related hypotension with colloids is superior to crystalloids for chronic dialysis patients; presumably, colloids are similarly superior for acutely ill patients (II-A). Colloids are superior to crystalloids in intravascular volume replacement with large-volume paracentesis (II-A) and as adjunctive therapy to antibiotics in treating spontaneous bacterial peritonitis (II-A). Meta-analyses of critical care colloid use are conflicting because of entry trial heterogeneity and varied analytic techniques, and a large prospective trial suggests a neutral influence of colloids on clinical outcomes. Therapeutic Implications Crystalloids should be administered first in nonhemorrhagic shock resuscitation (III). Hydroxyethyl starch solutions should be used with caution in cardiopulmonary bypass (meta-analysis) and in patients with sepsis (II-A). Colloids should be avoided or used with caution in patients with traumatic brain injury (I). Fluid restriction is appropriate for patients with hemodynamically stable ALI/ARDS (II-A); the combination of colloids and diuretics may be considered in patients with hypo-oncotic ALI/ARDS (III). Colloids are preferred for treating dialysis-associated hypotension and in maintaining hemodynamics to achieve dialysis goals (II-A). Hyperoncotic albumin should be administered in conjunction with large-volume paracentesis for diuretic-refractory ascites (II-A). Albumin may be administered in conjunction with antimicrobial therapy to patients with spontaneous bacterial peritonitis (II-A).
|
|
|
|
#23
29.03.2007, 02:14
|
||||
|
||||
|
По желатинам инфы не слишком много:
The various gelatin solutions have comparable volume-restoring efficacy. However, the increase in blood volume is less than the infused volume of gelatin, due to a rapid, but transient passage of gelatins in the interstitial space. Moreover, gelatins are rapidly cleared from the bloodstream by glomerular filtration and, to a lesser part, undergo cleavage by proteases into small peptides in the reticuloendоthelial system. Therefore, repeated infusions of gelatin are necessary to maintain adequate blood volume. This disadvantage is balanced by the fact that there are no dose limitations with gelatins as occurs with dextrans and HES solutions. Gelatins do not accumulate in the body and appear to be almost without adverse on kidney function. Although for a long time gelatins were considered not to influence blood coagulation other than by dilution, there is some evidence that gelatins do influence platelet function and blood coagulation.
|
|
#24
07.04.2007, 10:49
|
||||
|
||||
|
Цитата:
|
|
#25
17.04.2007, 16:35
|
||||
|
||||
|
Кстати,интересное сообщение(свежее) по поводу методики инфузии гидрокортизона при септическом шоке(вроде предпочтительнее постоянная)([Ссылки доступны только зарегистрированным пользователям ]
|
|
#27
17.04.2007, 21:50
|
||||
|
||||
|
Printer-Friendly Email This
Hydrocortisone by Continuous Infusion Favored for Septic Shock Patients NEW YORK (Reuters Health) Feb 23 - Continuous infusion of hydrocortisone offers advantages over bolus administration in patients with septic shock, according to a February 16th online report in Critical Care. "This is the first study that has compared bolus versus continuous hydrocortisone infusion in the treatment of septic shock," Dr. Pekka Loisa from Paijat-Hame Central Hospital, Lahti, Finland told Reuters Health. "Minor differences (favoring continuous infusion) can be observed in the glycemic control between these two regimens." Dr. Loisa and colleagues investigated how the two corticosteroid treatment modalities would influence glucose profiles in septic shock and compared the reversal of shock and nursing workload needed between the two regimens. The study involved 48 patients who received 200 mg/day hydrocortisone either as a continuous infusion or by 50-mg bolus every 6 hours. Mean daily blood glucose levels, insulin requirements, and calorie intake were similar between the two treatment groups (bolus administration and continuous infusion), the researchers report. Despite similar mean blood glucose levels, they say, hyperglycemic episodes were significantly more common in the bolus group than in the continuous infusion group. There were also more hypoglycemic episodes in the bolus group (3 episodes) than in the continuous infusion group (1 episode). Nursing workload needed to maintain normoglycemia was higher in the bolus group due to an increased number of insulin infusion rate adjustments, the results indicate. The reversal of shock did not differ between the study groups, the report shows. Overall ICU mortality was 23%, with 4 deaths from refractory hypotension in the continuous infusion group and 2 such deaths in the bolus group. "Our findings suggest that, in septic shock, strict normoglycemia is more easily achieved with continuous hydrocortisone infusion," the investigators conclude. "However, the differences between the study groups were rather marginal and in both groups the normoglycemic goal could be achieved quite successfully." "There was a tendency that the amount of insulin needed, adjusted to administered calories, was lower in the infusion treated patients throughout the study period," Dr. Loisa said. "Unfortunately this difference was not statistically significant, but it may reflect that the insulin resistance is resolved more rapidly in those patients who received hydrocortisone by continuous infusion." Crit Care 2007;11:R21.
|
|
#28
17.04.2007, 21:53
|
||||
|
||||
|
Цитата:
|
|
#29
18.04.2007, 14:27
|
|||
|
|||
|
Цитата:
Двумя руками за, если есть свободный шприц-дозатор (и место под него у постели шокового пациента  ) с расходником и гидрокортизон.
|
|
#30
18.04.2007, 20:07
|
|||
|
|||
|
Цитата:
В исследовании CORTICUS, которому была недавно посвящена отдельная тема на форуме, смертность в группе больных, получавших ГКС была примерно такой же, как в группе плацебо. Авторы, совершенно справедливо на мой взгляд, делают вывод : Цитата:
|
Линейный вид
