8 research outputs found
Procalcitonin-Guided Antibiotic Therapy after Stroke
Background: Pneumonia is among the most common acute complications after
stroke and is associated with poor long-term outcome. Biomarkers may help
identifying stroke patients at high risk for developing stroke-associated
pneumonia (SAP) and to guide early treatment. Aims: This trial investigated
whether procalcitonin (PCT) ultrasensitive (PCTus)-guided antibiotic treatment
of SAP can improve functional outcome after stroke. Methods: In this
international, multicenter, randomized, controlled clinical trial with blinded
assessment of outcomes, patients with severe ischemic stroke in the middle
cerebral artery territory were randomly assigned within 40 h after symptom
onset to PCTus-based antibiotic therapy guidance in addition to stroke unit
care or standard stroke unit care alone. The primary endpoint was functional
outcome at 3 months, defined according to the modified Rankin Scale (mRS) and
dichotomized as acceptable (≤4) or unacceptable (≥5). Secondary endpoints
included usage of antibiotics, infection rates, days of fever, and mortality.
The trial was registered with http://ClinicalTrials.gov (Identifier
NCT01264549). Results: In the intention-to-treat-analysis based on 227
patients (112 in PCT and 115 in control group), 197 patients completed the
3-month follow-up. Adherence to PCT guidance was 65%. PCT-guided therapy did
not improve functional outcome as measured by mRS (odds ratio 0.79; 95%
confidence interval 0.45–1.35, p = 0.47). Pneumonia rate and mortality were
similar in both groups. Days with fever tended to be lower (p = 0.055),
whereas total number of days treated with antibiotics were higher (p = 0.004)
in PCT compared to control group. A post hoc analysis including all PCT values
in the intention-to-treat population demonstrated a significant increase on
the first day of infection in patients with pneumonia and sepsis compared to
patients with urinary tract infections or without infections (p < 0.0001).
Conclusion: PCTus-guided antibiotic therapy did not improve functional outcome
at 3 months after severe ischemic stroke. PCT is a promising biomarker for
early detection of pneumonia and sepsis in acute stroke patients
Проблема источников палеолитического сырья - горного хрусталя на местонахождении мамонтовой фауны Волчья грива
Plasma Transfusion and Procoagulant Product Administration in Extracorporeal Membrane Oxygenation:A Secondary Analysis of an International Observational Study on Current Practices
OBJECTIVES: To achieve optimal hemostatic balance in patients on extracorporeal membrane oxygenation (ECMO), a liberal transfusion practice is currently applied despite clear evidence. We aimed to give an overview of the current use of plasma, fibrinogen concentrate, tranexamic acid (TXA), and prothrombin complex concentrate (PCC) in patients on ECMO.DESIGN: A prespecified subanalysis of a multicenter retrospective study. Venovenous (VV)-ECMO and venoarterial (VA)-ECMO are analyzed as separate populations, comparing patients with and without bleeding and with and without thrombotic complications. SETTING: Sixteen international ICUs.PATIENTS: Adult patients on VA-ECMO or VV-ECMO.INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 420 VA-ECMO patients, 59% (n = 247) received plasma, 20% (n = 82) received fibrinogen concentrate, 17% (n = 70) received TXA, and 7% of patients (n = 28) received PCC. Fifty percent of patients (n = 208) suffered bleeding complications and 27% (n = 112) suffered thrombotic complications. More patients with bleeding complications than patients without bleeding complications received plasma (77% vs. 41%, p < 0.001), fibrinogen concentrate (28% vs 11%, p < 0.001), and TXA (23% vs 10%, p < 0.001). More patients with than without thrombotic complications received TXA (24% vs 14%, p = 0.02, odds ratio 1.75) in VA-ECMO, where no difference was seen in VV-ECMO. Of 205 VV-ECMO patients, 40% (n = 81) received plasma, 6% (n = 12) fibrinogen concentrate, 7% (n = 14) TXA, and 5% (n = 10) PCC. Thirty-nine percent (n = 80) of VV-ECMO patients suffered bleeding complications and 23% (n = 48) of patients suffered thrombotic complications. More patients with than without bleeding complications received plasma (58% vs 28%, p < 0.001), fibrinogen concentrate (13% vs 2%, p < 0.01), and TXA (11% vs 2%, p < 0.01). CONCLUSIONS: The majority of patients on ECMO receive transfusions of plasma, procoagulant products, or antifibrinolytics. In a significant part of the plasma transfused patients, this was in the absence of bleeding or prolonged international normalized ratio. This poses the question if these plasma transfusions were administered for another indication or could have been avoided.</p
Assessment of automatic associations with bodily sensations and agoraphobic situations in panic disorder
The Randomized Controlled STRAWINSKI Trial: Procalcitonin-Guided Antibiotic Therapy after Stroke
Background: Pneumonia is among the most common acute complications after stroke
and is associated with poor long-term outcome. Biomarkers may help identifying stroke
patients at high risk for developing stroke-associated pneumonia (SAP) and to guide
early treatment.
aims: This trial investigated whether procalcitonin (PCT) ultrasensitive (PCTus)-guided
antibiotic treatment of SAP can improve functional outcome after stroke.
Methods: In this international, multicenter, randomized, controlled clinical trial with
blinded assessment of outcomes, patients with severe ischemic stroke in the middle
cerebral artery territory were randomly assigned within 40 h after symptom onset to
PCTus-based antibiotic therapy guidance in addition to stroke unit care or standard
stroke unit care alone. The primary endpoint was functional outcome at 3 months,
defined according to the modified Rankin Scale (mRS) and dichotomized as acceptable
(≤4) or unacceptable (≥5). Secondary endpoints included usage of antibiotics, infection
rates, days of fever, and mortality. The trial was registered with http://ClinicalTrials.gov
(Identifier NCT01264549).
results: In the intention-to-treat-analysis based on 227 patients (112 in PCT and
115 in control group), 197 patients completed the 3-month follow-up. Adherence to
PCT guidance was 65%. PCT-guided therapy did not improve functional outcome as
measured by mRS (odds ratio 0.79; 95% confidence interval 0.45–1.35, p = 0.47).
Pneumonia rate and mortality were similar in both groups. Days with fever tended to
be lower (p = 0.055), whereas total number of days treated with antibiotics were higher (p = 0.004) in PCT compared to control group. A post hoc analysis including all PCT
values in the intention-to-treat population demonstrated a significant increase on the first
day of infection in patients with pneumonia and sepsis compared to patients with urinary
tract infections or without infections (p < 0.0001).
Conclusion: PCTus-guided antibiotic therapy did not improve functional outcome at
3 months after severe ischemic stroke. PCT is a promising biomarker for early detection
of pneumonia and sepsis in acute stroke patients.peerReviewe