Transfusion of fresh frozen plasma in non-bleeding ICU patients -TOPIC TRIAL: study protocol for a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Fresh frozen plasma (FFP) is an effective therapy to correct for a deficiency of multiple coagulation factors during bleeding. In past years, use of FFP has increased, in particular in patients on the Intensive Care Unit (ICU), and has expanded to include prophylactic use in patients with a coagulopathy prior to undergoing an invasive procedure. Retrospective studies suggest that prophylactic use of FFP does not prevent bleeding, but carries the risk of transfusion-related morbidity. However, up to 50% of FFP is administered to non-bleeding ICU patients. With the aim to investigate whether prophylactic FFP transfusions to critically ill patients can be safely omitted, a multi-center randomized clinical trial is conducted in ICU patients with a coagulopathy undergoing an invasive procedure.</p> <p>Methods</p> <p>A non-inferiority, prospective, multicenter randomized open-label, blinded end point evaluation (PROBE) trial. In the intervention group, a prophylactic transfusion of FFP prior to an invasive procedure is omitted compared to transfusion of a fixed dose of 12 ml/kg in the control group. Primary outcome measure is relevant bleeding. Secondary outcome measures are minor bleeding, correction of International Normalized Ratio, onset of acute lung injury, length of ventilation days and length of Intensive Care Unit stay.</p> <p>Discussion</p> <p>The Transfusion of Fresh Frozen Plasma in non-bleeding ICU patients (TOPIC) trial is the first multi-center randomized controlled trial powered to investigate whether it is safe to withhold FFP transfusion to coagulopathic critically ill patients undergoing an invasive procedure.</p> <p>Trial Registration</p> <p>Trial registration: Dutch Trial Register NTR2262 and ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT01143909">NCT01143909</a></p

Transformerless Bandpass Matching Network Design for Y-Shaped Monopole Antenna

In this paper, a transformerless bandpass matching network design procedure is presented. The Real Frequency Techniques are powerful numerical methods to design wideband lossless 2-port networks such that filters and matching networks. In these techniques, the value of the termination resistance of the designed network could not be yielded as 50 ohm by numerical package. Hence, a transformer is also required for 50 ohm termination which is not practical for high frequency applications. Also in this study a novel wideband monopole antenna is presented. The proposed antenna is consisting of two major elements; Y-shaped impedance matching plate and hemi-circular radiator. Moreover Y-shaped impedance matching plate connected to a feeding probe excites the suspended hemi-circular radiator via air gap. and its frequency band is expanded by using transformerless bandpass design procedure

Turkish patient relatives' attitudes towards family-witnessed resuscitation and affecting sociodemographic factors

Background Witnessed resuscitation is the process of resuscitation in the presence of family members. Study objective Our goal was to determine the attitudes of relatives of the patients presenting to our emergency department regarding witnessed resuscitation and to elucidate the sociodemographic variables affecting their perspectives

A design technique of 50 Omega terminated bandpass matching network and its implementation to a Y-shaped monopole antenna matching

In this paper, a 50 a"broken vertical bar terminated or in other words transformerless bandpass matching network design methodology and an implementation example are presented. The real frequency techniques are powerful numerical methods to design wideband lossless two-port networks such as filters, matching networks and amplifiers. In these techniques, the value of the termination resistance of the designed network could not be yielded as 50 a"broken vertical bar by numerical package. Hence, a transformer is also required for 50 a"broken vertical bar termination which is not practical for high frequency applications. By employing the proposed procedure, it is guaranteed to obtain transformerless bandpass matching network. Also in this study a wideband suspended monopole antenna is examined. The proposed antenna consists of two major elements; Y-shaped impedance matching plate and hemi-circular radiator. Moreover Y-shaped impedance matching plate connected to a feeding probe excites the suspended hemi-circular radiator via air gap. Consequently, a transformerless bandpass matching network is designed to filter and expand the operational frequency bandwidth of the proposed antenna. It has been observed that ideal circuit and the layout of the matching network simulation have good agreement

Ultra wideband matching network design for a V-shaped square planar monopole antenna

In this paper, design, manufacture, and measurement of a wideband matching network for a broadband V-shaped square planar monopole antenna (V-SPMA) is presented. Matching network design is unavoidable in most cases even vital to facilitate a maximally flat power transfer gain for an antenna. In the work, a bandpass matching network (BPMN) design is done for a particular square monopole antenna with V-shaped coupling element that has essentially bandwidth increasing effect. Designed BPMN and the antenna forms a VSPMA-BPMN matched antenna structure. "real frequency technique" is employed in the BPMN design. BPMN prototype circuit has been constructed on an FR4 laminate with commercial microwave chip inductors and capacitors. Vector network analyzer gain and reflectance measurements of the matched antenna structure have shown highly compatible results to those of the theoretical design simulations along the passband (similar to 0.8-4.7 GHz). Furthermore, newly proposed distributed capacitor-resistor lossy model for microstrip lines used in the BPMN circuit have exhibited that it can successfully mimic the measured gain and reflectance performance of the matched structure in passband and even in stopband upto 8 GHz. Designed structure can be utilized as a one single wideband broadcasting medium suitable for many communication standards such as GSM, 3G, and Wi-Fi

The effects of boron nitride/hydroxyapatite compounds on bone defects in osteoporotic rats

This study investigated the effects of poly-(lactide-co-glycolide) (PLGA) scaffolds containing different concentrations of boron nitride (BN) and/or hydroxyapatite (HA) on bone defects in osteoporotic rats. The control group consisted of healthy rats. A standard non-critical size defect was induced in the osteoporotic rat femurs 12 weeks post-ovariectomy. PLGA scaffolds containing different concentrations of BN+HA were then applied to the defect area. In one group, defect was induced but no PLGA was applied. Computed tomography images were obtained and tissue samples were collected in the first, second, and fourth weeks postoperatively. PLGA scaffolds were classified as no BN + HA, only 10% HA, 2.5% BN + 10% HA, 5% BN + 10% HA, 10% BN + 10% HA or only 2.5%, 5% or 10% BN. No healing was determined in the first and second weeks postoperatively. However, in the fourth week healing was observed in the groups treated with PLGA scaffolds containing 10% HA, 2.5% BN + 10% HA, 2.5% BN and 5% BN, and especially in the 2.5% BN + 10% HA group. The findings of this study suggest that BN may represent a novel target for treating osteoporotic bone defects for physicians and engineers

Transfusion of fresh-frozen plasma in critically ill patients with a coagulopathy before invasive procedures: a randomized clinical trial (CME)

Prophylactic use of fresh-frozen plasma (FFP) is common practice in patients with a coagulopathy undergoing an invasive procedure. Evidence that FFP prevents bleeding is lacking, while risks of transfusion-related morbidity after FFP have been well demonstrated. We aimed to assess whether omitting prophylactic FFP transfusion in nonbleeding critically ill patients with a coagulopathy who undergo an intervention is noninferior to a prophylactic transfusion of FFP. A multicenter randomized open-label trial with blinded endpoint evaluation was performed in critically ill patients with a prolonged international normalized ratio (INR; 1.5-3.0). Patients undergoing placement of a central venous catheter, percutaneous tracheostomy, chest tube, or abscess drainage were eligible. Patients with clinically overt bleeding, thrombocytopenia, or therapeutic use of anticoagulants were excluded. Patients were randomly assigned to omitting or administering a prophylactic transfusion of FFP (12 mL/kg). Outcomes were occurrence of postprocedural bleeding complications, INR correction, and occurrence of lung injury. Due to slow inclusion, the trial was stopped before the predefined target enrollment was reached. Eighty-one patients were randomly assigned, 40 to FFP and 41 to no FFP transfusion. Incidence of bleeding did not differ between groups, with a total of one major and 13 minor bleedings (p = 0.08 for noninferiority). FFP transfusion resulted in a reduction of INR to less than 1.5 in 54% of transfused patients. No differences in lung injury scores were observed. In critically ill patients undergoing an invasive procedure, no difference in bleeding complications was found regardless whether FFP was prophylactically administered or no