Impact on Blood Product Utilization with Thromboelastography Guided Resuscitation for Gastrointestinal Hemorrhage

BACKGROUND: Thromboelastography (TEG) can guide transfusion therapy in trauma and has been associated with decreased transfusion requirements. This population differs from the medical population where the most common bleeding source is gastrointestinal hemorrhage (GIB). The utility of TEG in patients with acute GIB is not well described. We sought to assess whether the use of TEG impacts blood product utilization in patients with medical GIB. METHODS: A retrospective study looking at all adult patients admitted with a primary diagnosis of GIB to the George Washington University Intensive Care Unit (ICU) between 01/01/2017 to 12/31/2019. The primary intervention was the use of TEG to guide blood product resuscitation in addition to standard of care (TEG arm) versus standard of care alone (non-TEG arm). RESULTS: The primary outcome was the total number of blood products utilized. Patients in the TEG arm used more blood products compared to the non-TEG arm (9.10 vs 3.60, p \u3c 0.001). There was no difference in secondary endpoints except for an increased requirement for mechanical ventilation within the TEG arm (26.2% vs 13.4%, p  =  0.018). CONCLUSIONS: The use of TEG to guide resuscitation in patients with acute GIB may be associated with increased blood product utilization without any clinical benefit to patient-centered outcomes

Biocompatible polymer blends : Effects of physical processing on the molecular interaction of poly(vinyl alcohol) and poly(vinyl pyrrolidone)

The original article can be found at: http://www3.interscience.wiley.com Copyright John Wiley & Sons DOI: 10.1002/app.22390 [ Full text of this article is not available in the UHRA ]Blending is a very effective method for manufacturing new polymeric materials; however, the process used to combine two polymers can influence the physicochemical properties of the final product. As such, the aim of this study was to investigate how the rapid removal of a solvent from a composite by the spray drying of partially hydrolyzed poly(vinyl alcohol) (PVA)/poly(vinyl pyrrolidone) (PVP) altered the solid-state properties of the material compared to casting the blend within a film. Although thermal analysis showed that PVP acted as a plasticizer, reducing the melting point of PVA, spray drying the product rather than using a film-casting procedure improved its solid-state stability (increasing the glass transition) and resulted in the formation of a second crystalline phase within the material. Spectroscopic studies suggested that the manufacturing-induced variance in the solid-state properties of the PVA/PVP blends originated from structural differences in the composite caused by the processing method employed to form the blend. Although blending should still be considered a viable method of generating novel polymeric material, this study illustrated that through careful manipulation of the actual manufacturing process, the solid-state properties of the product can be altered. This could open a whole range of novel applications for traditionally used polymer composites.Peer reviewe