Anemia in critically ill patients. Intensive Care Training Program Radboud University Medical Centre Nijmegen

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Anemia in critically ill patients. Intensive Care Training Program Radboud University Medical Centre Nijmegen"

Transcription

1 Anemia in critically ill patients Intensive Care Training Program Radboud University Medical Centre Nijmegen

2 Anemia during ICU stay 60-80% of all patients become anemic during the course of their ICU stay (50-70% < 6 mmol/l) Aetiology includes inflammation, erythropoietin production, blunting of erythropoietin response, blood loss, nutritional deficiencies, renal failure Both anemia and transfusion (20-50%) are associated with increased morbidity/ mortality

3 30-60 ml/d Hb mmol/l/d

4

5

6

7 Treatment of shock Macrocirculation Microcirculation Mitochondria Cardiac output Hemoglobin SaO2 Serious defects Serious defects Preload - volume therapy Contractility - inotropic agents Afterload - vasodilators Transfusion Oxygenation No treatment Vasodilators? No treatment

8 Transfusion Trigger TRICC Trial Inclusion criteria Expected IC stay > 24 h Hb < 5.6 mmol/l within 72 h Euvolemia Exclusion criteria Age < 16 y Active blood loss Chronic anemia (Hb < 5.6) Power of study based on N = 2300 Pregnancy Brain death or imminent death Admission after cardiac surgery versus mmol/l Hébert PC. N Engl J Med 1999;340:

9 Results TRICC trial N = 838 Restrictive Liberal 30 NS NS NS 0.05 Mortality (%) D mortality 60 D mortality ICU mortality Hospital mortality Decreased 30 D mortality if APACHE II < 20 or age < 55 years Hébert PC. N Engl J Med 1999;340:

10 Mechanical ventilation N = 713 Restrictive Liberal Duration MV (D) 8.3 ± ± 8.7 Mortality 30 D (%) 21,3 26,4 Mortality 60 D (%) ICU mortality (%) Hospital mortality (%) Hébert PC. Chest 2001;119:

11 Safety with cardiovascular disease N = 357 Restrictive Liberal 30 NS NS NS NS Mortality (%) D mortality 60 D mortality ICU mortality Hospital mortality Hébert PC. Crit Care Med 2001;29:

12 Safety with ischemic heart disease N = 257 Restrictive Liberal 30 NS NS NS NS Mortality (%) D mortality 60 D mortality ICU mortality Hospital mortality Hébert PC. Crit Care Med 2001;29:

13

14 Transfusion after trauma N = 203 Restrictive Liberal 10 NS NS NS NS Mortality (%) D mortality 60 D mortality ICU mortality Hospital mortality McIntyre L. J Trauma 2004;57:

15 Transfusion after TBI N = Restrictive NS Liberal (%) No differences in LOS D mortality McIntyre L. J Neurocrit Care 2006;5:4-9

16 TRACS trial N = 502 (single centre) Adult patients after cardiac surgery with CPB Hematocrit 0.24 versus 0.30 Composite end-point 30 day mortality and cardiogenic shock/ards/aki Hajjar LA. JAMA 2010;304:

17 TRACS trial P < % receiving transfucion % primary end-point Restrictive Liberal 0 Restrictive Liberal Hajjar LA. JAMA 2010;304:

18

19 Neurocritical care Prevention of secondary cerebral insults Hypotension Hypoxia Hypocapnia Fever ICP increase

20 Cerebral blood flow DO2 (ml O2/min) = CO (l/min) [{Hb (mmol/l) SaO2 (%) 2.24 (ml O2/mmol Hb)} + (0.003 PO2)] Cerebral DO2 (ml O2/min) = CBF (l/min) [{Hb (mmol/l) SaO2 (%) 2.24 (ml O2/mmol Hb)} + (0.003 PO2)] Hagen - Poiseuille equation Flow = πr4 CPP 8 L η

21 Determinants of CBF Cerebral Blood Flow Cerebral Blood Flow Cerebral Perfusion Pressure Cerebral Metabolic Rate of Oxygen Autoregulatie + Autoregulatie - Cerebral Blood Flow Cerebral Blood Flow Partial Pressure of Carbon Dioxide Cerebral oxygenation CaO2 PaO2

22 General cardiovascular response to anemia Increase heart rate and contractility Reduction in blood viscosity decreases afterload and enhances venous return Isovolemic anemia increases cardiac output and blood pressure - if cardiac function is normal Increases in oxygen extraction ration protects against tissue hypoxia

23 Diringer MN. Curr Opin Crit Care 2007;13:

24 Cerebrovascular response to anemia Higher CPP and lower viscocity increase CBF Anemia induces cerebral vasodilation by pervascular neuron NO synthesis and sympathetic β2-stimulation

25 The effect of anemia Cerebral Oxygen Delivery More severe if combined with hypotension CBF CaO2 Normal Mild hemodilution Moderate anemia Severe anemia

26 Risk of RBC transfusion

27 Minimising blood loss

28

29 TRALI New ALI within 6h of blood transfusion Neutrophilic aggregates in pulmonary vasculature + pulmonary edema Recipient and transfusion related factors Mortality up to 20% Sachs UJ. Curr Opin Hemat 2011;18:

30 TRALI threshold model Sachs UJ. Curr Opin Hemat 2011;18:

31 Individual risk factors Sachs UJ. Curr Opin Hemat 2011;18:

32 Transfusion related risk factors - Plasma Antibodies in plasma directed against HLA (mostly class II) and HNA (mostly 3a) Usually female donors with history of pregnancy Sachs UJ. Curr Opin Hemat 2011;18:

33 Mechanisms Direct activation of neutrophils by antibodies (HLA class I) Binding of antibodies to endothelial antigens with neutrophil activation through Fc-segment (HLA-I) Antibodies bind to monocytes releasing IL-8 and activating neutrophils (HLA class II) Substances accumulating during storage activate neutrophils (CD40L) (soluble mediators) Sachs UJ. Curr Opin Hemat 2011;18:

34 Transfusion related risk factors - RBC s Lowest risk per component Soluble mediator (??) responsible for TRALI Relation with storage time unclear Sachs UJ. Curr Opin Hemat 2011;18:

35 Transfusion related risk factors - platelets Intermediate risk Either by antibodies in plasma (storage), soluble mediators accumulating during storage or changes in platelet during storage Sachs UJ. Curr Opin Hemat 2011;18:

36 Sachs UJ. Curr Opin Hemat 2011;18:

The Sepsis Puzzle: Identification, Monitoring and Early Goal Directed Therapy

The Sepsis Puzzle: Identification, Monitoring and Early Goal Directed Therapy The Sepsis Puzzle: Identification, Monitoring and Early Goal Directed Therapy Cindy Goodrich RN, MS, CCRN Content Description Sepsis is caused by widespread tissue injury and systemic inflammation resulting

More information

By Dr. Nicole Spurlock, DACVECC

By Dr. Nicole Spurlock, DACVECC Hypoxia occurs in a variety of critical illnesses and results in inadequate delivery of oxygen to the tissues. Hypoxia occurs secondary to low oxygen levels in the plasma (hypoxemic hypoxia), low hematocrit

More information

Blood Transfusion Therapy in Trauma and Massive Hemorrhage Putting the Patient First

Blood Transfusion Therapy in Trauma and Massive Hemorrhage Putting the Patient First FACULTY OF MEDICINE, DENTISTRY AND HEALTH SCIENCES Blood Transfusion Therapy in Trauma and Massive Hemorrhage Putting the Patient First ALBERT FARRUGIA Historical Background Over last 40 years, transfusion

More information

Cytomegalovirus in the immunocompent: Prevent, Treat, or Ignore?

Cytomegalovirus in the immunocompent: Prevent, Treat, or Ignore? Cytomegalovirus in the immunocompent: Prevent, Treat, or Ignore? Gordon D. Rubenfeld, MD MSc Professor of Medicine, University of Toronto Chief, Program in Trauma, Emergency, and Critical Care Sunnybrook

More information

Clinical practice guideline: Red blood cell transfusion in adult trauma and critical care*

Clinical practice guideline: Red blood cell transfusion in adult trauma and critical care* Special Article Clinical practice guideline: Red blood cell transfusion in adult trauma and critical care* Lena M. Napolitano, MD; Stanley Kurek, DO; Fred A. Luchette, MD; Howard L. Corwin, MD; Philip

More information

STAGES OF SHOCK. IRREVERSIBLE SHOCK Heart deteriorates until it can no longer pump and death occurs.

STAGES OF SHOCK. IRREVERSIBLE SHOCK Heart deteriorates until it can no longer pump and death occurs. STAGES OF SHOCK SHOCK : A profound disturbance of circulation and metabolism, which leads to inadequate perfusion of all organs which are needed to maintain life. COMPENSATED NONPROGRESSIVE SHOCK 30 sec

More information

EDUCATIONAL COMMENTARY TRANSFUSION-RELATED ACUTE LUNG INJURY (TRALI)

EDUCATIONAL COMMENTARY TRANSFUSION-RELATED ACUTE LUNG INJURY (TRALI) EDUCATIONAL COMMENTARY TRANSFUSION-RELATED ACUTE LUNG INJURY (TRALI) Educational commentary is provided through our affiliation with the American Society for Clinical Pathology (ASCP). To obtain FREE CME/CMLE

More information

Introduction to Blood Management

Introduction to Blood Management Introduction to Blood Management What is Blood Management? Preventing a blood transfusion to the patient who doesn t need one Right blood product, at the right time, in the right dose, to the right patient

More information

The Initial and 24 h (After the Patient Rehabilitation) Deficit of Arterial Blood Gases as Predictors of Patients Outcome

The Initial and 24 h (After the Patient Rehabilitation) Deficit of Arterial Blood Gases as Predictors of Patients Outcome Biomedical & Pharmacology Journal Vol. 6(2), 259-264 (2013) The Initial and 24 h (After the Patient Rehabilitation) Deficit of Arterial Blood Gases as Predictors of Patients Outcome Vadod Norouzi 1, Ali

More information

Year in Review 2013 Intensive Care. J.G. van der Hoeven Radboud University Medical Centre Nijmegen

Year in Review 2013 Intensive Care. J.G. van der Hoeven Radboud University Medical Centre Nijmegen Year in Review 2013 Intensive Care J.G. van der Hoeven Radboud University Medical Centre Nijmegen Contents ARDS Ventilator associated pneumonia Tracheostomy and endotracheal intubation General ICU care

More information

Blood Sticky, opaque fluid with a metallic taste (Fe 2+ ) Varies from scarlet (P O2 = 100) to dark red (P O2 = 40) ph is between 7.35 and 7.45 Average volume in an adult is 5 L (7% of body weight) 2 L

More information

TACO vs. TRALI: Recognition, Differentiation, and Investigation of Pulmonary Transfusion Reactions

TACO vs. TRALI: Recognition, Differentiation, and Investigation of Pulmonary Transfusion Reactions TACO vs. TRALI: Recognition, Differentiation, and Investigation of Pulmonary Transfusion Reactions Shealynn Harris, M.D. Assistant Medical Director American Red Cross Blood Services Southern Region Case

More information

Exercise and the Cardiovascular System

Exercise and the Cardiovascular System Exercise and the Cardiovascular System Chapter 13: The Physiology of Training 1 CARDIOVASCULAR FITNESS Aerobic fitness measured by VO 2max VO 2max is a product of maximal cardiac output (Q) and arteriovenous

More information

Ischemia and Infarction

Ischemia and Infarction Harvard-MIT Division of Health Sciences and Technology HST.035: Principle and Practice of Human Pathology Dr. Badizadegan Ischemia and Infarction HST.035 Spring 2003 In the US: ~50% of deaths are due to

More information

Appendix G - Identification and Selection of Studies

Appendix G - Identification and Selection of Studies FINAL Emergency framework for rationing of blood for massively bleeding patients during a red phase of a Appendix G - Identification and Selection of Studies Inclusion/Exclusion Criteria We included studies

More information

Cardiovascular Regulation

Cardiovascular Regulation Cardiovascular Regulation Regulation of hemodynamics occurs via local autoregulation, neural control and hormones. Spring 2004 1 Autoregulation of Blood Flow Local regulation of blood flow occurs by vasoconstriction

More information

Chapter 6. Fig What are the functions of blood? What is the composition of blood? Cardiovascular System: Blood

Chapter 6. Fig What are the functions of blood? What is the composition of blood? Cardiovascular System: Blood Cardiovascular System: Blood Chapter 6 6.1 Blood: An overview What are the functions of blood? Transportation: oxygen, nutrients, wastes, carbon dioxide and hormones Defense: against invasion by pathogens

More information

240- PROBLEM SET INSERTION OF SWAN-GANZ SYSTEMIC VASCULAR RESISTANCE. Blood pressure = f(cardiac output and peripheral resistance)

240- PROBLEM SET INSERTION OF SWAN-GANZ SYSTEMIC VASCULAR RESISTANCE. Blood pressure = f(cardiac output and peripheral resistance) 240- PROBLEM SET INSERTION OF SWAN-GANZ 50 kg Pig Rt Jugular 0 cm Rt Atrium 10 cm Rt ventricle 15 cm Wedge 20-25 cm SYSTEMIC VASCULAR RESISTANCE Blood pressure = f(cardiac output and peripheral resistance)

More information

Hydroxyurea Treatment for Sickle Cell Disease

Hydroxyurea Treatment for Sickle Cell Disease Hydroxyurea Treatment for Sickle Cell Disease Before hydroxyurea After hydroxyurea Hydroxyurea Treatment for Sickle Cell Disease 1 This document is not intended to take the place of the care and attention

More information

Sepsis: Identification and Treatment

Sepsis: Identification and Treatment Sepsis: Identification and Treatment Daniel Z. Uslan, MD Associate Clinical Professor Division of Infectious Diseases Medical Director, UCLA Sepsis Task Force Severe Sepsis: A Significant Healthcare Challenge

More information

Optimal fluid therapy in 2013. Eric Hoste Department of Intensive Care Medicine Ghent University Hospital Ghent University

Optimal fluid therapy in 2013. Eric Hoste Department of Intensive Care Medicine Ghent University Hospital Ghent University Optimal fluid therapy in 2013 Eric Hoste Department of Intensive Care Medicine Ghent University Hospital Ghent University EGDT: fluids are good & prevent AKI Lin et al, Shock 2006 EGDT and AKI Prowle et

More information

Used to treat tissue hypoxia Improve oxygen supply Reduce the work of breathing Potential to improve medical outcomes and save lives if used

Used to treat tissue hypoxia Improve oxygen supply Reduce the work of breathing Potential to improve medical outcomes and save lives if used Used to treat tissue hypoxia Improve oxygen supply Reduce the work of breathing Potential to improve medical outcomes and save lives if used appropriately Can cause harm if used inappropriately Main indication

More information

Preoperative Laboratory and Diagnostic Studies

Preoperative Laboratory and Diagnostic Studies Preoperative Laboratory and Diagnostic Studies Preoperative Labratorey and Diagnostic Studies The concept of standardized testing in all presurgical patients regardless of age or medical condition is no

More information

OXYGEN THERAPY. Pulmonary System The pulmonary system is responsible for external and internal respiration.

OXYGEN THERAPY. Pulmonary System The pulmonary system is responsible for external and internal respiration. WHY DOES THE BODY NEED OXYGEN? Every function in the body requires oxygen. Oxygen is needed to complete the metabolism of glucose to produce ATP which provides energy. If inadequate amounts of oxygen reach

More information

2. In the Event of Persistent Arterial Hypotension Despite Volume Resuscitation (Septic Shock) or Initial Lactate 4 mmol/l (36 mg/dl):

2. In the Event of Persistent Arterial Hypotension Despite Volume Resuscitation (Septic Shock) or Initial Lactate 4 mmol/l (36 mg/dl): 2. In the Event of Persistent Arterial Hypotension Despite Volume Resuscitation (Septic Shock) or Initial Lactate 4 mmol/l (36 mg/dl): b. Maintain Adequate Central Venous Oxygen Saturation In the event

More information

Fundamentals of Critical Care: Hemodynamics, Monitoring, Shock

Fundamentals of Critical Care: Hemodynamics, Monitoring, Shock Fundamentals of Critical Care: Hemodynamics, Monitoring, Shock Joshua Goldberg, MD Assistant Professor of Surgery Associate Medical Director, Burn Unit UCHSC Definitions and Principles The measurement

More information

Blood Transfusion. There are three types of blood cells: Red blood cells. White blood cells. Platelets.

Blood Transfusion. There are three types of blood cells: Red blood cells. White blood cells. Platelets. Blood Transfusion Introduction Blood transfusions can save lives. Every second, someone in the world needs a blood transfusion. Blood transfusions can replace the blood lost from a serious injury or surgery.

More information

Clinical Practice Guidelines for Blood Transfusions

Clinical Practice Guidelines for Blood Transfusions Clinical Practice Guidelines for Blood Transfusions Purpose: To provide practice guidelines regarding the transfusion of blood and blood components and to advance the safety and quality of care for the

More information

4. is an increased rate of red blood cell destruction. A) Sickle-cell disease B) Hemolytic anemia C) Pernicious anemia Ans: B

4. is an increased rate of red blood cell destruction. A) Sickle-cell disease B) Hemolytic anemia C) Pernicious anemia Ans: B Chapter 11: Blood 1. The hematocrit is composed mainly of A) plasma. B) white blood cells. C) platelets. D) red blood cells. 2. Fifty-five percent of blood is A) liquid. B) plasma. C) formed elements.

More information

Yvette Marie Miller, M.D. Executive Medical Officer American Red Cross October 20, 2012 45 th Annual Great Lakes Cancer Nursing Conference Troy, MI

Yvette Marie Miller, M.D. Executive Medical Officer American Red Cross October 20, 2012 45 th Annual Great Lakes Cancer Nursing Conference Troy, MI Yvette Marie Miller, M.D. Executive Medical Officer American Red Cross October 20, 2012 45 th Annual Great Lakes Cancer Nursing Conference Troy, MI Overview of Hematology, http://www.nu.edu.sa/userfiles/mhmorsy/h

More information

Early Warning Scores (EWS) Clinical Sessions 2011 By Bhavin Doshi

Early Warning Scores (EWS) Clinical Sessions 2011 By Bhavin Doshi Early Warning Scores (EWS) Clinical Sessions 2011 By Bhavin Doshi What is EWS? After qualifying, junior doctors are expected to distinguish between the moderately sick patients who can be managed in the

More information

Interpretation of Laboratory Values

Interpretation of Laboratory Values Interpretation of Laboratory Values Konrad J. Dias PT, DPT, CCS Overview Electrolyte imbalances Renal Function Tests Complete Blood Count Coagulation Profile Fluid imbalance Sodium Electrolyte Imbalances

More information

Atrial Fibrillation in the ICU: Attempting to defend 4 controversial statements

Atrial Fibrillation in the ICU: Attempting to defend 4 controversial statements Atrial Fibrillation in the ICU: Attempting to defend 4 controversial statements Salmaan Kanji, Pharm.D. The Ottawa Hospital The Ottawa Hospital Research Institute Conflict of Interest No financial, proprietary

More information

SARASOTA MEMORIAL HOSPITAL BLOOD COMPONENT CRITERIA AND INDICATIONS SCREENING GUIDELINES

SARASOTA MEMORIAL HOSPITAL BLOOD COMPONENT CRITERIA AND INDICATIONS SCREENING GUIDELINES SARASOTA MEMORIAL HOSPITAL BLOOD COMPONENT CRITERIA AND INDICATIONS SCREENING GUIDELINES TABLE OF CONTENTS SUBJECT PAGE ADULT CRITERIA Red Blood Cells/Autologous 2 Washed Red Blood Cells 2 Cryoprecipitate

More information

Oxygen Therapy. Oxygen therapy quick guide V3 July 2012.

Oxygen Therapy. Oxygen therapy quick guide V3 July 2012. PRESENTATION Oxygen (O 2 ) is a gas provided in a compressed form in a cylinder. It is also available in a liquid form. It is fed via a regulator and flow meter to the patient by means of plastic tubing

More information

Understanding Blood Tests

Understanding Blood Tests PATIENT EDUCATION patienteducation.osumc.edu Blood delivers oxygen and nutrients to all the parts of the body. It also carries away waste products. The heart pumps blood in your body through a system of

More information

Cerebral blood flow (CBF) is dependent on a number of factors that can broadly be divided into:

Cerebral blood flow (CBF) is dependent on a number of factors that can broadly be divided into: Cerebral Blood Flow and Intracranial Pressure Dr Lisa Hill, SpR Anaesthesia, Royal Oldham Hospital, UK. Email lambpie10@hotmail.com Dr Carl Gwinnutt, Consultant Neuroanaesthetist, Hope Hospital, UK. The

More information

BLOOD-Chp. Chp.. 6 What are the functions of blood? What is the composition of blood? 3 major types of plasma proteins

BLOOD-Chp. Chp.. 6 What are the functions of blood? What is the composition of blood? 3 major types of plasma proteins 6.1 Blood: An overview BLOOD-Chp Chp.. 6 What are the functions of blood? Transportation: oxygen, nutrients, wastes, carbon dioxide and hormones Defense: against invasion by pathogens Regulatory functions:

More information

Section 02: The Cardiovascular System

Section 02: The Cardiovascular System Section 02: The Cardiovascular System Chapter 15 The Cardiovascular System Chapter 16 Cardiovascular Regulation and Integration Chapter 17 Functional Capacity of the Cardiovascular System HPHE 6710 Exercise

More information

Medical Direction and Practices Board WHITE PAPER

Medical Direction and Practices Board WHITE PAPER Medical Direction and Practices Board WHITE PAPER Use of Pressors in Pre-Hospital Medicine: Proper Indication and State of the Science Regarding Proper Choice of Pressor BACKGROUND Shock is caused by a

More information

Chapter 16. Learning Objectives. Learning Objectives 9/11/2012. Shock. Explain difference between compensated and uncompensated shock

Chapter 16. Learning Objectives. Learning Objectives 9/11/2012. Shock. Explain difference between compensated and uncompensated shock Chapter 16 Shock Learning Objectives Explain difference between compensated and uncompensated shock Differentiate among 5 causes and types of shock: Hypovolemic Cardiogenic Neurogenic Septic Anaphylactic

More information

C. No nucleus and no mitochondria 1. Where did it go relationship to reticulocytes? 4. Does this mean you can t make new RBCs?

C. No nucleus and no mitochondria 1. Where did it go relationship to reticulocytes? 4. Does this mean you can t make new RBCs? I. Characteristics of Erythrocytes A. Biconcave discs--what purpose does this serve? B. 1/3 hemoglobin by volume (remember this with hematocrit) (Fig. 19.4, pg. 673) 1. Heme 2. Globin 3. Fe 4. Oxyhemoglobin

More information

The Cardiovascular System: Blood

The Cardiovascular System: Blood Essentials of Anatomy & Physiology, 4th Edition Martini / Bartholomew The Cardiovascular System: Blood PowerPoint Lecture Outlines prepared by Alan Magid, Duke University Slides 1 to 54 The Functions of

More information

Complete blood count. Definition. 1

Complete blood count. Definition.  1 Complete blood count Definition A complete blood count (CBC) test measures the following: The number of red blood cells (RBCs) The number of white blood cells (WBCs) The total amount of hemoglobin in the

More information

BLOOD GROUP ANTIGENS AND ANTIBODIES

BLOOD GROUP ANTIGENS AND ANTIBODIES BLOOD GROUP ANTIGENS AND ANTIBODIES Over 20 blood group systems having approximately 400 blood group antigens are currently recognised. The ABO and Rhesus (Rh) blood group systems are of major clinical

More information

GUIDELINES FOR MANAGEMENT OF PEDIATRIC DKA IMMEDIATE ASSESSMENT

GUIDELINES FOR MANAGEMENT OF PEDIATRIC DKA IMMEDIATE ASSESSMENT GUIDELINES FOR MANAGEMENT OF PEDIATRIC DKA IMMEDIATE ASSESSMENT PLEASE NOTE: the DKA protocol and supplementary material are designed as a guideline/algorithm for treating the majority of cases of DKA

More information

Milwaukee School of Engineering Gerrits@msoe.edu. Case Study: Factors that Affect Blood Pressure Instructor Version

Milwaukee School of Engineering Gerrits@msoe.edu. Case Study: Factors that Affect Blood Pressure Instructor Version Case Study: Factors that Affect Blood Pressure Instructor Version Goal This activity (case study and its associated questions) is designed to be a student-centered learning activity relating to the factors

More information

Pediatric Shock Recognition / Resuscitation. Edward J. Cullen Jr., D.O. Pediatric Critical Care Medicine

Pediatric Shock Recognition / Resuscitation. Edward J. Cullen Jr., D.O. Pediatric Critical Care Medicine Pediatric Shock Recognition / Resuscitation Edward J. Cullen Jr., D.O. Pediatric Critical Care Medicine 2003 Shock Oxygen Delivery can not support Metabolic Demands of the Body Is the child in shock? Mental

More information

Transfusion Medicine

Transfusion Medicine Transfusion Medicine Chapter 5 Transfusion Medicine Routine Transfusion Therapy Blood products should not be transfused on a unit basis in children Base the volume of transfusion products on weight to

More information

VASOPRESSOR AGENTS IN SEPTIC SHOCK

VASOPRESSOR AGENTS IN SEPTIC SHOCK VASOPRESSOR AGENTS IN SEPTIC SHOCK Daniel De Backer Head Dept Intensive Care, CHIREC hospitals, Belgium Professor of Intensive Care, Université Libre de Bruxelles President European Society of Intensive

More information

Circulatory System Review

Circulatory System Review Circulatory System Review 1. Draw a table to describe the similarities and differences between arteries and veins? Anatomy Direction of blood flow: Oxygen concentration: Arteries Thick, elastic smooth

More information

Anemia and chronic kidney disease

Anemia and chronic kidney disease Anemia and chronic kidney disease THE KIDNEY FOUNDATION OF CANADA 1 Anemia and chronic kidney disease What is anemia? Anemia is a condition in which the red cells in the blood are at a low level. The red

More information

Acute Care of Patients with Intracerebral Hemorrhage

Acute Care of Patients with Intracerebral Hemorrhage Acute Care of Patients with Intracerebral Hemorrhage Cyrus K. Dastur, MD Assistant Professor Director, Neurocritical Care Departments of Neurology and Neurological Surgery UC Irvine None Declarations Definitions

More information

Vasopressors. Judith Hellman, M.D. Associate Professor Anesthesia and Perioperative Care University of California, San Francisco

Vasopressors. Judith Hellman, M.D. Associate Professor Anesthesia and Perioperative Care University of California, San Francisco Vasopressors Judith Hellman, M.D. Associate Professor Anesthesia and Perioperative Care University of California, San Francisco Overview Define shock states Review drugs commonly used to treat hypotension

More information

ARDS Berlin Definition Is more usefully?

ARDS Berlin Definition Is more usefully? ARDS Berlin Definition.2011. Is more usefully? Dr. Andrei Schwartz, Ben Gurion University of the Negev, Faculty of the Health Science,Soroka Medical Center,Division of Anesthesiology and Intensive Care,Beer

More information

Septic Shock: Pharmacologic Agents for Hemodynamic Support. Nathan E Cope, PharmD PGY2 Critical Care Pharmacy Resident

Septic Shock: Pharmacologic Agents for Hemodynamic Support. Nathan E Cope, PharmD PGY2 Critical Care Pharmacy Resident Septic Shock: Pharmacologic Agents for Hemodynamic Support Nathan E Cope, PharmD PGY2 Critical Care Pharmacy Resident Objectives Define septic shock and briefly review pathophysiology Outline receptor

More information

ANTIBODY PRODUCTION ANTIBODY PRODUCTION 5/20/2015 IMPLICATION OF HLA ANTIBODIES & TRALI MITIGATION PROGRAM

ANTIBODY PRODUCTION ANTIBODY PRODUCTION 5/20/2015 IMPLICATION OF HLA ANTIBODIES & TRALI MITIGATION PROGRAM IMPLICATION OF HLA ANTIBODIES & TRALI MITIGATION PROGRAM Massimo Mangiola, Ph.D. Director, Special Services Rhode Island Blood Center LEARN Webinars: Management of TRALI May 21, 2015 2:00 3:30 pm (EDT)

More information

The River of Life. Blood. Chapter 17

The River of Life. Blood. Chapter 17 The River of Life Blood Chapter 17 Overview: Blood Composition and Function Describe the composition and physical characteristics of whole blood. Explain why it is classified as a connective tissue.! List

More information

Disorders of Red Blood Cells

Disorders of Red Blood Cells Disorders of Red Blood Cells The function of RBC, facilitated by hemoglobin molecule, is to transport oxygen to the tissue. Oxygen is poorly soluble in plasma, So about 95%-98% is carried bound to hemoglobin.

More information

Cardiovascular System. Blood Components

Cardiovascular System. Blood Components Cardiovascular System Blood Components 1 Components of Blood Formed elements: erythrocytes, leukocytes, platelets Plasma: water, proteins, other solutes The components of blood can be divided into two

More information

Decreasing Sepsis Mortality at the University of Colorado Hospital

Decreasing Sepsis Mortality at the University of Colorado Hospital Decreasing Sepsis Mortality at the University of Colorado Hospital Maureen Dzialo, RN, BSN - Nurse Manager, Cardiac Intensive Care Unit Olivia Kerveillant, RN Clinical Nurse III, Medical Intensive Care

More information

Oxygen - update April 2009 OXG

Oxygen - update April 2009 OXG PRESENTATION Oxygen (O 2 ) is a gas provided in compressed form in a cylinder. It is also available in liquid form, in a system adapted for ambulance use. It is fed via a regulator and flow meter to the

More information

F.E.E.A. FONDATION EUROPEENNE D'ENSEIGNEMENT EN ANESTHESIOLOGIE FOUNDATION FOR EUROPEAN EDUCATION IN ANAESTHESIOLOGY

F.E.E.A. FONDATION EUROPEENNE D'ENSEIGNEMENT EN ANESTHESIOLOGIE FOUNDATION FOR EUROPEAN EDUCATION IN ANAESTHESIOLOGY créée sous le Patronage de l'union Européenne Detailed plan of the program of six courses 1. RESPIRATORY 1. ESPIRATORY AND THORAX 1.1 Physics and principles of measurement 1.1.1 Physical laws 1.1.2 Vaporizers

More information

Blood Transfusion. Red Blood Cells White Blood Cells Platelets

Blood Transfusion. Red Blood Cells White Blood Cells Platelets Blood Transfusion Introduction Blood transfusions are very common. Each year, almost 5 million Americans need a blood transfusion. Blood transfusions are given to replace blood lost during surgery or serious

More information

KEY CHAPTER 14: BLOOD OBJECTIVES. 1. Describe blood according to its tissue type and major functions.

KEY CHAPTER 14: BLOOD OBJECTIVES. 1. Describe blood according to its tissue type and major functions. KEY CHAPTER 14: BLOOD OBJECTIVES 1. Describe blood according to its tissue type and major functions. TISSUE TYPE? MAJOR FUNCTIONS connective Transport Maintenance of body temperature 2. Define the term

More information

Visual Acuity. Hearing. Height and Weight. Blood Pressure MEASURED VALUE

Visual Acuity. Hearing. Height and Weight. Blood Pressure MEASURED VALUE TEST ITEM DESCRIPTION STANDARD LEVEL Standard level varies among different examination methods. Please check with your medical facility about normal level. MEASURED VALUE Visual Acuity You look at rings

More information

Recommendations: Other Supportive Therapy of Severe Sepsis*

Recommendations: Other Supportive Therapy of Severe Sepsis* Recommendations: Other Supportive Therapy of Severe Sepsis* K. Blood Product Administration 1. Once tissue hypoperfusion has resolved and in the absence of extenuating circumstances, such as myocardial

More information

Hyperbaric Oxygen Therapy WWW.RN.ORG

Hyperbaric Oxygen Therapy WWW.RN.ORG Hyperbaric Oxygen Therapy WWW.RN.ORG Reviewed September, 2015, Expires September, 2017 Provider Information and Specifics available on our Website Unauthorized Distribution Prohibited 2015 RN.ORG, S.A.,

More information

Causes of Anemia in Patients with Heart Failure. Adriaan Voors, MD, PhD, Cardiologist Professor of Cardiology, UMC Groningen, Netherlands

Causes of Anemia in Patients with Heart Failure. Adriaan Voors, MD, PhD, Cardiologist Professor of Cardiology, UMC Groningen, Netherlands Causes of Anemia in Patients with Heart Failure Adriaan Voors, MD, PhD, Cardiologist Professor of Cardiology, UMC Groningen, Netherlands Background Anemia is common in patients with CHF Prevalence 15 55%

More information

THERAPY INTENSITY LEVEL

THERAPY INTENSITY LEVEL THERAPY INTENSITY LEVEL TILBasic = TIL Basic. CDE Variable TILBasic = TIL Basic; Global summary measure of Therapy Intensity Level for control of Intracranial Pressure (ICP).. CDE Definition This summary

More information

James F. Kravec, M.D., F.A.C.P

James F. Kravec, M.D., F.A.C.P James F. Kravec, M.D., F.A.C.P Chairman, Department of Internal Medicine, St. Elizabeth Health Center Chair, General Internal Medicine, Northeast Ohio Medical University Associate Medical Director, Hospice

More information

Homeostasis. The body must maintain a delicate balance of acids and bases.

Homeostasis. The body must maintain a delicate balance of acids and bases. Homeostasis The body must maintain a delicate balance of acids and bases. Metabolic and respiratory processes must work together to keep hydrogen ion (H+) levels normal and stable. ph of Blood The ph of

More information

Ventilation Perfusion Relationships

Ventilation Perfusion Relationships Ventilation Perfusion Relationships VENTILATION PERFUSION RATIO Ideally, each alveolus in the lungs would receive the same amount of ventilation and pulmonary capillary blood flow (perfusion). In reality,

More information

Acute heart failure may be de novo or it may be a decompensation of chronic heart failure.

Acute heart failure may be de novo or it may be a decompensation of chronic heart failure. Management of Acute Left Ventricular Failure Acute left ventricular failure presents as pulmonary oedema due to increased pressure in the pulmonary capillaries. It is important to realise though that left

More information

Update on Small Animal Cardiopulmonary Resuscitation (CPR)- is anything new?

Update on Small Animal Cardiopulmonary Resuscitation (CPR)- is anything new? Update on Small Animal Cardiopulmonary Resuscitation (CPR)- is anything new? DVM, DACVA Objective: Update on the new Small animal guidelines for CPR and a discussion of the 2012 Reassessment Campaign on

More information

Chapter 12 Blood. Blood composition: Blood, a type of tissue, is a complex mixture of what three things?

Chapter 12 Blood. Blood composition: Blood, a type of tissue, is a complex mixture of what three things? Chapter 12 Blood Blood composition: Blood, a type of tissue, is a complex mixture of what three things? Functions: What are the functions of blood? Blood cells: The blood includes what three types of cells?

More information

Human Anatomy & Physiology II with Dr. Hubley

Human Anatomy & Physiology II with Dr. Hubley Human Anatomy & Physiology II with Dr. Hubley Exam #1 Name: Instructions This exam consists of 40 multiple-choice questions. Each multiple-choice question answered correctly is worth one point, and the

More information

Welcome to esessions This session contains audio. Review the information on each slide before continuing.

Welcome to esessions This session contains audio. Review the information on each slide before continuing. Welcome to esessions This session contains audio. Review the information on each slide before continuing. 2012 Terumo BCT, Inc. 306670723 RED BLOOD CELL EXCHANGE AND DEPLETION PROCEDURES COBE SPECTRA APHERESIS

More information

Head Injury. Dr Sally McCarthy Medical Director ECI

Head Injury. Dr Sally McCarthy Medical Director ECI Head Injury Dr Sally McCarthy Medical Director ECI Head injury in the emergency department A common presentation 80% Mild Head Injury = GCS 14 15 10% Moderate Head Injury = GCS 9 13 10% Severe Head Injury

More information

NON-INVASIVE VENTILATION

NON-INVASIVE VENTILATION Barcelona Devices for severe heart failure NON-INVASIVE VENTILATION Josep Masip MD, PhD, FESC Intensive Care Medicine Department H. Moisès Broggi - Sant Joan Despí. Barcelona Consorci Sanitari Integral

More information

Oxygenation and Oxygen Therapy Michael Billow, D.O.

Oxygenation and Oxygen Therapy Michael Billow, D.O. Oxygenation and Oxygen Therapy Michael Billow, D.O. The delivery of oxygen to all body tissues is the essence of critical care. Patients in respiratory distress/failure come easily to mind as the ones

More information

The largest clinical study of Bayer's Xarelto (rivaroxaban) Wednesday, 14 November 2012 07:38

The largest clinical study of Bayer's Xarelto (rivaroxaban) Wednesday, 14 November 2012 07:38 Bayer HealthCare has announced the initiation of the COMPASS study, the largest clinical study of its oral anticoagulant Xarelto (rivaroxaban) to date, investigating the prevention of major adverse cardiac

More information

Session Number 405 CERTIFICATION REVIEW: HEMATOLOGY AND IMMUNOLOGY

Session Number 405 CERTIFICATION REVIEW: HEMATOLOGY AND IMMUNOLOGY Session Number 405 CERTIFICATION REVIEW: HEMATOLOGY AND IMMUNOLOGY Eleanor Fitzpatrick, RN, MSN, CCRN Thomas Jefferson University Hospital Philadelphia, PA Content Description This session will provide

More information

Biology 2402 A & P II Exam 2 Notes - Cardiovascular System : Blood Ch 12

Biology 2402 A & P II Exam 2 Notes - Cardiovascular System : Blood Ch 12 Biology 2402 A & P II Exam 2 Notes - Cardiovascular System : Blood Ch 12 Cardiovascular system links all cells with the environment. Composed of 12.1 - heart, a pump that produces pressure to move fluid

More information

Inotropes/Vasoactive Agents Hina N. Patel, Pharm.D., BCPS Cathy Lawson, Pharm.D., BCPS

Inotropes/Vasoactive Agents Hina N. Patel, Pharm.D., BCPS Cathy Lawson, Pharm.D., BCPS Inotropes/Vasoactive Agents Hina N. Patel, Pharm.D., BCPS Cathy Lawson, Pharm.D., BCPS 1. Definition -an agent that affects the contractility of the heart -may be positive (increases contractility) or

More information

perfusion pressure: Definitions. Implication on management protocols. What happens when CPP is too low, and when it is too high? Non-invasive CPP?

perfusion pressure: Definitions. Implication on management protocols. What happens when CPP is too low, and when it is too high? Non-invasive CPP? 7. Cerebral perfusion pressure: Definitions. Implication on management protocols. What happens when CPP is too low, and when it is too high? Non-invasive CPP? Definitions of CPP Thanks to Dr. E. Schmidt

More information

Medical management of CHF: A New Class of Medication. Al Timothy, M.D. Cardiovascular Institute of the South

Medical management of CHF: A New Class of Medication. Al Timothy, M.D. Cardiovascular Institute of the South Medical management of CHF: A New Class of Medication Al Timothy, M.D. Cardiovascular Institute of the South Disclosures Speakers Bureau for Amgen Background Chronic systolic congestive heart failure remains

More information

Blood and Bone Marrow Basics

Blood and Bone Marrow Basics Blood and Bone Marrow Basics Introduction Blood helps distribute the nutrients, oxygen, and hormones the body needs. It also carries toxins and waste materials to the liver and kidneys to be removed from

More information

PULMONARY PHYSIOLOGY

PULMONARY PHYSIOLOGY I. Lung volumes PULMONARY PHYSIOLOGY American College of Surgeons SCC Review Course Christopher P. Michetti, MD, FACS and Forrest O. Moore, MD, FACS A. Tidal volume (TV) is the volume of air entering and

More information

Thibodeau: Anatomy and Physiology, 5/e. Chapter 17: Blood

Thibodeau: Anatomy and Physiology, 5/e. Chapter 17: Blood Thibodeau: Anatomy and Physiology, 5/e Chapter 17: Blood This chapter begins a new unit. In this unit, the first four chapters deal with transportation one of the body's vital functions. It is important

More information

Clinical Indications for Hyperbaric Oxygen Therapy in 2011 Part 1

Clinical Indications for Hyperbaric Oxygen Therapy in 2011 Part 1 Clinical Indications for Hyperbaric Oxygen Therapy in 2011 Part 1 Med LtCol Peter GERMONPRE Centre for Hyperbaric Oxygen Therapy Military Hospital Brussels What is HBO therapy? Breathing oxygen under pressure

More information

Blood Physiology. Practical 4. Contents. Practical tasks. Erythrocytes The blood types

Blood Physiology. Practical 4. Contents. Practical tasks. Erythrocytes The blood types Blood Physiology Practical 4 Contents Erythrocytes The blood types Practical tasks Determination of blood groups of the ABO system Determination of the Rhesus system (Rh factor) The cross matching test

More information

ACS Don t worry. I know a hundred tricks to get this closed. G Merlotti 1988

ACS Don t worry. I know a hundred tricks to get this closed. G Merlotti 1988 ABDOMINAL COMPARTMENT SYNDROME Gary Merlotti, M.D. Chairperson,Department of Surgery Mount Sinai Medical Center ACS Don t worry. I know a hundred tricks to get this closed. G Merlotti 1988 ACS - DEFINITION

More information

Leanna R. Miller, RN, MN, CCRN-CMC, PCCN-CSC, CEN, CNRN, NP Education Specialist LRM Consulting Nashville, TN

Leanna R. Miller, RN, MN, CCRN-CMC, PCCN-CSC, CEN, CNRN, NP Education Specialist LRM Consulting Nashville, TN Leanna R. Miller, RN, MN, CCRN-CMC, PCCN-CSC, CEN, CNRN, NP Education Specialist LRM Consulting Nashville, TN Learning Outcomes Identify triggers to the IIR. Describe the pathophysiologic changes that

More information

Expert Commentary. A response to the recent JAMA meta analysis on omega 3 supplementation and cardiovascular events

Expert Commentary. A response to the recent JAMA meta analysis on omega 3 supplementation and cardiovascular events Expert Commentary A response to the recent JAMA meta analysis on omega 3 supplementation and cardiovascular events Dr. Bruce J. Holub, Ph.D., Professor Emeritus, University of Guelph Expert Commentary:

More information

BOLETIN BIBLIOGRAFICO BIBLIOTECA MEDICA-HCG JUNIO 2014

BOLETIN BIBLIOGRAFICO BIBLIOTECA MEDICA-HCG JUNIO 2014 BOLETIN BIBLIOGRAFICO BIBLIOTECA MEDICA-HCG JUNIO 2014 Am J Clin Pathol 1. 2013 Statement on Human Papillomavirus DNA Test Utilization. AJCP 141 (4): 459-461, abr. 2014 2. Pathology Consultation on Electronic

More information

Acute Oxygen Therapy

Acute Oxygen Therapy Oxygen Therapy Acute Oxygen Therapy A life saving drug, very often given without careful evaluation of its potential benefits and side effects Like any drug there are clear indications for treatment with

More information

ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) S. Agarwal, MD, S. Kache MD

ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) S. Agarwal, MD, S. Kache MD ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) S. Agarwal, MD, S. Kache MD Definition ARDS is a clinical syndrome of lung injury with hypoxic respiratory failure caused by intense pulmonary inflammation that

More information

Blood. The only fluid tissue in the human body. Classified as a connective tissue

Blood. The only fluid tissue in the human body. Classified as a connective tissue Blood The only fluid tissue in the human body Classified as a connective tissue Blood If blood is centrifuged Erythrocytes sink to the bottom Buffy coat contains leukocytes and platelets Buffy coat is

More information

UNDERSTANDING CONTINUOUS MIXED VENOUS OXYGEN SATURATION (SvO 2 ) MONITORING WITH THE SWAN-GANZ OXIMETRY TD SYSTEM

UNDERSTANDING CONTINUOUS MIXED VENOUS OXYGEN SATURATION (SvO 2 ) MONITORING WITH THE SWAN-GANZ OXIMETRY TD SYSTEM UNDERSTANDING CONTINUOUS MIXED VENOUS OXYGEN SATURATION (SvO 2 ) MONITORING WITH THE SWAN-GANZ OXIMETRY TD SYSTEM UNDERSTANDING CONTINUOUS MIXED VENOUS OXYGEN SATURATION (SvO2) MONITORING WITH THE EDWARDS

More information