5 research outputs found
Supervivencia de circuitos de técnicas de depuración extrarrenal continua en pacientes críticos con o sin anticoagulación convencional: estudio observacional prospectivo
Fundamento. El objetivo del presente estudio es describir
la eficacia, seguridad y viabilidad, en pacientes críticos con
técnica de depuración extrarrenal continua (TDEC) y diferente riesgo de hemorragia, de un sistema de anticoagulación convencional con perfusión continua de heparina no
fraccionada (HNF) frente a no anticoagular usando lavados
son suero fisiológico.
Material y métodos. Se trata de un estudio observacional
prospectivo realizado en la Unidad de Cuidados Intensivos
(UCI) desde octubre de 2013 hasta abril de 2016. Se incluyeron 61 pacientes que presentaron insuficiencia renal aguda
(IRA) con requerimientos de TDEC y un total de 122 circuitos. Tanto los pacientes como los circuitos fueron divididos
para su análisis en dos grupos: anticoagulados (AC) y no
anticoagulados (No AC). La variable principal fue la supervivencia de los circuitos. Además se recogieron diferentes
parámetros analíticos al comienzo del tratamiento y en el
momento de coagulación del circuito.
Resultados. La distribución de pacientes anticoagulados y
no anticoagulados fue similar. No se han encontrado diferencias significativas en la supervivencia de los circuitos
entre ambos grupos (30,5 horas AC vs 34,9 horas No AC).
Los pacientes con mayor morbilidad (trombopenia severa,
coagulopatía, etc.) pertenecían al grupo que no recibió anticoagulación, sino lavados con suero fisiológico.
Conclusiones. En pacientes críticos con alto riesgo de
sangrado las TDEC son viables sin anticoagulación más el
empleo de lavados periódicos con suero fisiológico se comporta como una medida viable, segura y eficaz obteniendo
una supervivencia de los circuitos similar a la de pacientes
anticoagulados con HNF, evitando los riesgos y costes asociados a la anticoagulación.Background. The aim of this study was to describe the
efficacy, security and viability of an anticoagulation system
with continuous infusion of unfractionated heparin (UFH)
versus one without any type of anticoagulant using 0.9%
physiological saline washings, in critically ill patients with
continuous renal replacement therapy (CRRT) and different
risks of bleeding.
Methods. From October 2013 to April 2015 we conducted an
observational prospective study in the intensive care unit
(ICU). Sixty-one patients with acute kidney injury (AKI) and
requiring CRRT were included, with 122 filters. Patients and
filters were divided in two groups: anticoagulated (AC) and
not anticoagulated (No AC). The main outcome measure was
filter life span. Different analytical parameters were also collected at the beginning of treatment and at the moment of
circuit coagulation
Results. The number of patients was similar in both groups.
We did not find statistically significant differences between
the two groups in filter life span (30.5 hours AC vs 34.9 hours
No AC). Patients with increased morbidity (severe thrombocytopenia, coagulopathy, etc.) were included in the group
that did not received anticoagulation but saline flushes.
Conclusions. CRRT without anticoagulation with saline
flushes is a viable, safe and effective strategy in critically ill
patients with high risk of bleeding. This approach achieves
a circuit life span similar to that observed in anticoagulated
patients with UFH; avoiding the risks and costs associated
with anticoagulation
Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries
Abstract
Background
Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres.
Methods
This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries.
Results
In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia.
Conclusion
This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries
Supervivencia de circuitos de técnicas de depuración extrarrenal continua en pacientes críticos con o sin anticoagulación convencional: estudio observacional prospectivo
Fundamento. El objetivo del presente estudio es describir
la eficacia, seguridad y viabilidad, en pacientes críticos con
técnica de depuración extrarrenal continua (TDEC) y diferente riesgo de hemorragia, de un sistema de anticoagulación convencional con perfusión continua de heparina no
fraccionada (HNF) frente a no anticoagular usando lavados
son suero fisiológico.
Material y métodos. Se trata de un estudio observacional
prospectivo realizado en la Unidad de Cuidados Intensivos
(UCI) desde octubre de 2013 hasta abril de 2016. Se incluyeron 61 pacientes que presentaron insuficiencia renal aguda
(IRA) con requerimientos de TDEC y un total de 122 circuitos. Tanto los pacientes como los circuitos fueron divididos
para su análisis en dos grupos: anticoagulados (AC) y no
anticoagulados (No AC). La variable principal fue la supervivencia de los circuitos. Además se recogieron diferentes
parámetros analíticos al comienzo del tratamiento y en el
momento de coagulación del circuito.
Resultados. La distribución de pacientes anticoagulados y
no anticoagulados fue similar. No se han encontrado diferencias significativas en la supervivencia de los circuitos
entre ambos grupos (30,5 horas AC vs 34,9 horas No AC).
Los pacientes con mayor morbilidad (trombopenia severa,
coagulopatía, etc.) pertenecían al grupo que no recibió anticoagulación, sino lavados con suero fisiológico.
Conclusiones. En pacientes críticos con alto riesgo de
sangrado las TDEC son viables sin anticoagulación más el
empleo de lavados periódicos con suero fisiológico se comporta como una medida viable, segura y eficaz obteniendo
una supervivencia de los circuitos similar a la de pacientes
anticoagulados con HNF, evitando los riesgos y costes asociados a la anticoagulación.Background. The aim of this study was to describe the
efficacy, security and viability of an anticoagulation system
with continuous infusion of unfractionated heparin (UFH)
versus one without any type of anticoagulant using 0.9%
physiological saline washings, in critically ill patients with
continuous renal replacement therapy (CRRT) and different
risks of bleeding.
Methods. From October 2013 to April 2015 we conducted an
observational prospective study in the intensive care unit
(ICU). Sixty-one patients with acute kidney injury (AKI) and
requiring CRRT were included, with 122 filters. Patients and
filters were divided in two groups: anticoagulated (AC) and
not anticoagulated (No AC). The main outcome measure was
filter life span. Different analytical parameters were also collected at the beginning of treatment and at the moment of
circuit coagulation
Results. The number of patients was similar in both groups.
We did not find statistically significant differences between
the two groups in filter life span (30.5 hours AC vs 34.9 hours
No AC). Patients with increased morbidity (severe thrombocytopenia, coagulopathy, etc.) were included in the group
that did not received anticoagulation but saline flushes.
Conclusions. CRRT without anticoagulation with saline
flushes is a viable, safe and effective strategy in critically ill
patients with high risk of bleeding. This approach achieves
a circuit life span similar to that observed in anticoagulated
patients with UFH; avoiding the risks and costs associated
with anticoagulation