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Francis Leclerc - One of the best experts on this subject based on the ideXlab platform.
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pelod 2 an update of the pediatric logistic Organ Dysfunction Score
Critical Care Medicine, 2013Co-Authors: Stephane Leteurtre, Alain Duhamel, Julia Salleron, Bruno Grandbastien, Jacques Lacroix, Francis LeclercAbstract:Objective:Multiple Organ Dysfunction syndrome is the main cause of death in adult ICUs and in PICUs. The PEdiatric Logistic Organ Dysfunction Score developed in 1999 was primarily designed to describe the severity of Organ Dysfunction. This study was undertaken to update and improve the PEdiatric Lo
Marie E Steiner - One of the best experts on this subject based on the ideXlab platform.
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massive transfusion in cardiac surgery the impact of blood component ratios on clinical outcomes and survival
Anesthesia & Analgesia, 2017Co-Authors: Meghan Delaney, Darrell J. Triulzi, Paul Stark, Minhyung Suh, John R Hess, Marie E Steiner, Christopher P Stowell, Steven R SloanAbstract:Background Cardiac surgery is the most common setting for massive transfusion in medically advanced countries. Studies of massive transfusion after injury suggest that the ratios of administered plasma and platelets (PLT) to red blood cells (RBCs) affect mortality. Data from the Red Cell Storage Duration Study (RECESS), a large randomized trial of the effect of RBC storage duration in patients undergoing complex cardiac surgery, were analyzed retrospectively to investigate the association between blood component ratios used in massively transfused patients and subsequent clinical outcomes. Methods Massive transfusion was defined as those who had ≥6 RBC units or ≥8 total blood components. For plasma, high ratio was defined as ≥1 plasma unit:1 RBC unit. For PLT transfusion, high ratio was defined as ≥0.2 PLT doses:1 RBC unit; PLT dose was defined as 1 apheresis PLT or 5 whole blood PLT equivalents. The clinical outcomes analyzed were mortality and the change in the Multiple Organ Dysfunction Score (ΔMODS) comparing the preoperative Score with the highest composite Score through the earliest of death, discharge, or day 7. Outcomes were compared between patients transfused with high and low ratios. Linear and Cox regression were used to explore relationships between predictors and continuous outcomes and time to event outcomes. Results A total of 324 subjects met the definition of massive transfusion. In those receiving high plasma:RBC ratio, the mean (SE) 7- and 28-day ΔMODS was 1.24 (0.45) and 1.26 (0.56) points lower, (P = .007 and P = .024), respectively, than in patients receiving lower ratios. In patients receiving high PLT:RBC ratio, the mean (SE) 7- and 28-day ΔMODS were 1.55 (0.53) and 1.49 (0.65) points lower (P = .004 and P = .022), respectively. Subjects who received low-ratio plasma:RBC transfusion had excess 7-day mortality compared with those who received high ratio (7.2% vs 1.7%, respectively, P = .0318), which remained significant at 28 days (P = .035). The ratio of PLT:RBCs was not associated with differences in mortality. Conclusions This analysis found that in complex cardiac surgery patients who received massive transfusion, there was an association between the composition of blood products used and clinical outcomes. Specifically, there was less Organ Dysfunction in those who received high-ratio transfusions (plasma:RBCs and PLT:RBCs), and lower mortality in those who received high-ratio plasma:RBC transfusions.
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effects of red cell storage duration on patients undergoing cardiac surgery
The New England Journal of Medicine, 2015Co-Authors: Marie E Steiner, Darrell J. Triulzi, Meghan Delaney, Steven R Sloan, Paul M Ness, Susan F Assmann, Suzanne Granger, Elliott Bennettguerrero, Morris A Blajchman, Vincent A ScavoAbstract:BackgroundSome observational studies have reported that transfusion of red-cell units that have been stored for more than 2 to 3 weeks is associated with serious, even fatal, adverse events. Patients undergoingcardiac surgery may be especially vulnerable to the adverse effects of transfusion. MethodsWe conducted a randomized trial at multiple sites from 2010 to 2014. Participants 12 years of age or older who were undergoing complex cardiac surgery and were likely to undergo transfusion of red cells were randomly assigned to receive leukocyte-reduced red cells stored for 10 days or less (shorter-term storage group) or for 21 days or more (longer-term storage group) for all intraoperative and postoperative transfusions. The primary outcome was the change in Multiple Organ Dysfunction Score (MODS; range, 0 to 24, with higher Scores indicating more severe Organ Dysfunction) from the preoperative Score to the highest composite Score through day 7 or the time of death or discharge. ResultsThe median storage tim...
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addressing the question of the effect of rbc storage on clinical outcomes the red cell storage duration study recess section 7
Transfusion and Apheresis Science, 2010Co-Authors: Marie E Steiner, Darrell J. Triulzi, Steven R Sloan, Susan F Assmann, Jerrold H Levy, J Marshall, Shelley Pulkrabek, Christopher P StowellAbstract:Abstract The question of whether storage of red blood cells (RBCs) alters their capacity to deliver oxygen and affects patient outcomes remains in a state of clinical equipoise. Studies of the changes which occur while RBCs are stored have led to several physiologically plausible hypotheses that these changes impair RBC function when the units are transfused. Although there is some evidence of this effect in vivo from animal model experiments, the results of several largely retrospective patient studies have not been consistent. Some studies have shown an association between worse clinical outcomes and transfusion of RBC which have been stored for longer periods of time, while others have found no effect. Three multicenter, randomized, controlled trials have been developed to address this important, but currently unanswered, question. Two clinical trials, one in low birth weight neonates and the other in intensive care unit patients, are enrolling subjects in Canada (the Age of Red Blood Cells in Premature Infants; the Age of Blood Study). The third trial, which is being developed in the United States, is the Red Cell Storage Duration Study (RECESS). This is a multicenter, randomized, controlled trial in which patients undergoing complex cardiac surgical procedures who are likely to require RBC transfusion will be randomized to receive RBC units stored for either 10 or fewer days or 21 or more days. Randomization will only occur if the blood bank has enough units of RBC of both storage times to meet the crossmatch request; hence, subjects randomized to the ⩾21 day arm will receive RBC of the same storage time as they would have following standard inventory practice of “oldest units out first”. The primary outcome is the change in the Multiple Organ Dysfunction Score (MODS), a composite measure of multiOrgan Dysfunction, by day 7. Secondary outcomes include the change in the MODS by day 28, all-cause mortality, and several composite and single measures of specific Organ system function. The estimated total sample size required will be 1434 evaluable subjects (717 per arm). The RECESS trial is registered through the US National Institutes of Health (clinicaltrials.gov) as NCT00991341 .
Steven R Sloan - One of the best experts on this subject based on the ideXlab platform.
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massive transfusion in cardiac surgery the impact of blood component ratios on clinical outcomes and survival
Anesthesia & Analgesia, 2017Co-Authors: Meghan Delaney, Darrell J. Triulzi, Paul Stark, Minhyung Suh, John R Hess, Marie E Steiner, Christopher P Stowell, Steven R SloanAbstract:Background Cardiac surgery is the most common setting for massive transfusion in medically advanced countries. Studies of massive transfusion after injury suggest that the ratios of administered plasma and platelets (PLT) to red blood cells (RBCs) affect mortality. Data from the Red Cell Storage Duration Study (RECESS), a large randomized trial of the effect of RBC storage duration in patients undergoing complex cardiac surgery, were analyzed retrospectively to investigate the association between blood component ratios used in massively transfused patients and subsequent clinical outcomes. Methods Massive transfusion was defined as those who had ≥6 RBC units or ≥8 total blood components. For plasma, high ratio was defined as ≥1 plasma unit:1 RBC unit. For PLT transfusion, high ratio was defined as ≥0.2 PLT doses:1 RBC unit; PLT dose was defined as 1 apheresis PLT or 5 whole blood PLT equivalents. The clinical outcomes analyzed were mortality and the change in the Multiple Organ Dysfunction Score (ΔMODS) comparing the preoperative Score with the highest composite Score through the earliest of death, discharge, or day 7. Outcomes were compared between patients transfused with high and low ratios. Linear and Cox regression were used to explore relationships between predictors and continuous outcomes and time to event outcomes. Results A total of 324 subjects met the definition of massive transfusion. In those receiving high plasma:RBC ratio, the mean (SE) 7- and 28-day ΔMODS was 1.24 (0.45) and 1.26 (0.56) points lower, (P = .007 and P = .024), respectively, than in patients receiving lower ratios. In patients receiving high PLT:RBC ratio, the mean (SE) 7- and 28-day ΔMODS were 1.55 (0.53) and 1.49 (0.65) points lower (P = .004 and P = .022), respectively. Subjects who received low-ratio plasma:RBC transfusion had excess 7-day mortality compared with those who received high ratio (7.2% vs 1.7%, respectively, P = .0318), which remained significant at 28 days (P = .035). The ratio of PLT:RBCs was not associated with differences in mortality. Conclusions This analysis found that in complex cardiac surgery patients who received massive transfusion, there was an association between the composition of blood products used and clinical outcomes. Specifically, there was less Organ Dysfunction in those who received high-ratio transfusions (plasma:RBCs and PLT:RBCs), and lower mortality in those who received high-ratio plasma:RBC transfusions.
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effects of red cell storage duration on patients undergoing cardiac surgery
The New England Journal of Medicine, 2015Co-Authors: Marie E Steiner, Darrell J. Triulzi, Meghan Delaney, Steven R Sloan, Paul M Ness, Susan F Assmann, Suzanne Granger, Elliott Bennettguerrero, Morris A Blajchman, Vincent A ScavoAbstract:BackgroundSome observational studies have reported that transfusion of red-cell units that have been stored for more than 2 to 3 weeks is associated with serious, even fatal, adverse events. Patients undergoingcardiac surgery may be especially vulnerable to the adverse effects of transfusion. MethodsWe conducted a randomized trial at multiple sites from 2010 to 2014. Participants 12 years of age or older who were undergoing complex cardiac surgery and were likely to undergo transfusion of red cells were randomly assigned to receive leukocyte-reduced red cells stored for 10 days or less (shorter-term storage group) or for 21 days or more (longer-term storage group) for all intraoperative and postoperative transfusions. The primary outcome was the change in Multiple Organ Dysfunction Score (MODS; range, 0 to 24, with higher Scores indicating more severe Organ Dysfunction) from the preoperative Score to the highest composite Score through day 7 or the time of death or discharge. ResultsThe median storage tim...
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addressing the question of the effect of rbc storage on clinical outcomes the red cell storage duration study recess section 7
Transfusion and Apheresis Science, 2010Co-Authors: Marie E Steiner, Darrell J. Triulzi, Steven R Sloan, Susan F Assmann, Jerrold H Levy, J Marshall, Shelley Pulkrabek, Christopher P StowellAbstract:Abstract The question of whether storage of red blood cells (RBCs) alters their capacity to deliver oxygen and affects patient outcomes remains in a state of clinical equipoise. Studies of the changes which occur while RBCs are stored have led to several physiologically plausible hypotheses that these changes impair RBC function when the units are transfused. Although there is some evidence of this effect in vivo from animal model experiments, the results of several largely retrospective patient studies have not been consistent. Some studies have shown an association between worse clinical outcomes and transfusion of RBC which have been stored for longer periods of time, while others have found no effect. Three multicenter, randomized, controlled trials have been developed to address this important, but currently unanswered, question. Two clinical trials, one in low birth weight neonates and the other in intensive care unit patients, are enrolling subjects in Canada (the Age of Red Blood Cells in Premature Infants; the Age of Blood Study). The third trial, which is being developed in the United States, is the Red Cell Storage Duration Study (RECESS). This is a multicenter, randomized, controlled trial in which patients undergoing complex cardiac surgical procedures who are likely to require RBC transfusion will be randomized to receive RBC units stored for either 10 or fewer days or 21 or more days. Randomization will only occur if the blood bank has enough units of RBC of both storage times to meet the crossmatch request; hence, subjects randomized to the ⩾21 day arm will receive RBC of the same storage time as they would have following standard inventory practice of “oldest units out first”. The primary outcome is the change in the Multiple Organ Dysfunction Score (MODS), a composite measure of multiOrgan Dysfunction, by day 7. Secondary outcomes include the change in the MODS by day 28, all-cause mortality, and several composite and single measures of specific Organ system function. The estimated total sample size required will be 1434 evaluable subjects (717 per arm). The RECESS trial is registered through the US National Institutes of Health (clinicaltrials.gov) as NCT00991341 .
Tobias Liebregts - One of the best experts on this subject based on the ideXlab platform.
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Intestinal T lymphocyte homing is associated with gastric emptying and epithelial barrier function in critically ill: a prospective observational study
Critical Care, 2017Co-Authors: Christian Greis, Zohal Rasuly, Rolf A. Janosi, Lambros Kordelas, Dietrich W. Beelen, Tobias LiebregtsAbstract:Background Impaired gastric emptying is common in critically ill patients. Intestinal dysmotility, a major cause of feed intolerance, may foster infectious complications due to mucosal barrier disruption. However, little is known about gut-directed immune activation, intestinal barrier function and its association with impaired gastric emptying in critically ill patients at ICU admission. Methods We conducted a prospective observational study at two tertiary care medical ICUs. Fifty consecutive patients needing invasive mechanical ventilation were recruited within 24 h of ICU admission, prior to any nutritional support. The acute physiology and chronic health evaluation (APACHE) II Score, the sequential Organ failure assessment (SOFA) Score and the multiple Organ Dysfunction Score (MODS) were used to assess illness severity and multiple Organ Dysfunction. Gastric emptying was assessed by paracetamol absorption test. Peripheral blood mononuclear cells were freshly isolated and cultured for 24 h, and TNF-α, IL-1β and IL-10 measured in cell culture supernatants and in serum by ELISA. The intestinal epithelial barrier was assessed, quantifying serum concentrations of intestinal fatty acid binding protein (I-FABP), ileal bile-acid binding protein (I-BABP) and zonulin-1 by ELISA. Small bowel homing T lymphocytes (CD4+ α4β7 + CCR9+) were analyzed by flow cytometry. The Mann-Whitney test and Spearman correlation were used in statistical evaluation. Results CD4 + α4β7 + CCR9+ T lymphocytes were inversely correlated with gastric emptying. Patients with delayed gastric emptying at ICU admission (n = 35) had significantly higher serum and PBMC-induced TNF-α and IL-1β and increased intestinal barrier disruption reflected by higher I-FABP, I-BABP and zonulin-1. Patients who died in the ICU had significantly impaired gastric empting at admission compared to ICU survivors. No differences were observed in APACHE II, SOFA or MODS in patients with delayed gastric emptying compared to patients with normal gastric emptying. Conclusions Exaggerated CD4 + α4β7 + CCR9+ T lymphocyte homing with increased pro-inflammatory cytokine release and intestinal epithelial barrier disruption are associated with delayed gastric emptying. This is not simply due to differences in overall severity of illness at ICU admission and may represent a pathophysiological mechanism of gut-directed immune activation leading to impaired barrier function in the critically ill.
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intestinal t lymphocyte homing is associated with gastric emptying and epithelial barrier function in critically ill a prospective observational study
Critical Care, 2017Co-Authors: Christian Greis, Zohal Rasuly, Rolf A. Janosi, Lambros Kordelas, Dietrich W. Beelen, Tobias LiebregtsAbstract:Impaired gastric emptying is common in critically ill patients. Intestinal dysmotility, a major cause of feed intolerance, may foster infectious complications due to mucosal barrier disruption. However, little is known about gut-directed immune activation, intestinal barrier function and its association with impaired gastric emptying in critically ill patients at ICU admission. We conducted a prospective observational study at two tertiary care medical ICUs. Fifty consecutive patients needing invasive mechanical ventilation were recruited within 24 h of ICU admission, prior to any nutritional support. The acute physiology and chronic health evaluation (APACHE) II Score, the sequential Organ failure assessment (SOFA) Score and the multiple Organ Dysfunction Score (MODS) were used to assess illness severity and multiple Organ Dysfunction. Gastric emptying was assessed by paracetamol absorption test. Peripheral blood mononuclear cells were freshly isolated and cultured for 24 h, and TNF-α, IL-1β and IL-10 measured in cell culture supernatants and in serum by ELISA. The intestinal epithelial barrier was assessed, quantifying serum concentrations of intestinal fatty acid binding protein (I-FABP), ileal bile-acid binding protein (I-BABP) and zonulin-1 by ELISA. Small bowel homing T lymphocytes (CD4+ α4β7 + CCR9+) were analyzed by flow cytometry. The Mann-Whitney test and Spearman correlation were used in statistical evaluation. CD4 + α4β7 + CCR9+ T lymphocytes were inversely correlated with gastric emptying. Patients with delayed gastric emptying at ICU admission (n = 35) had significantly higher serum and PBMC-induced TNF-α and IL-1β and increased intestinal barrier disruption reflected by higher I-FABP, I-BABP and zonulin-1. Patients who died in the ICU had significantly impaired gastric empting at admission compared to ICU survivors. No differences were observed in APACHE II, SOFA or MODS in patients with delayed gastric emptying compared to patients with normal gastric emptying. Exaggerated CD4 + α4β7 + CCR9+ T lymphocyte homing with increased pro-inflammatory cytokine release and intestinal epithelial barrier disruption are associated with delayed gastric emptying. This is not simply due to differences in overall severity of illness at ICU admission and may represent a pathophysiological mechanism of gut-directed immune activation leading to impaired barrier function in the critically ill.
Thomas Mphansa - One of the best experts on this subject based on the ideXlab platform.
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the multiple Organ Dysfunction Score as a descriptor of patient outcome in septic shock compared with two other scoring systems
Critical Care Medicine, 1999Co-Authors: Sydney Jacobs, Mehrun Zuleika, Thomas MphansaAbstract:Objective: To demonstrate if daily Multiple Organ Dysfunction scoring could describe outcome groups in septic shock better than daily Acute Physiology and Chronic Health Evaluation (APACHE) II and Organ Failure Scores. Design: A prospective cohort study. Setting: A medical and surgical adult intensive care unit (ICU) at a tertiary referral center. Measurements and Main Results: Daily data collection over a 14-month period was performed on 368 ICU patients, 39 of whom developed septic shock while in the ICU. These data were entered into a computer programmed to calculate APACHE II, Organ Failure, and Multiple Organ Dysfunction Scores. The admission Multiple Organ Dysfunction Scores for nonsurvivors and survivors of septic shock in the ICU was 6.5 ± 2.7 and 6.6 ± 2.8 (SD), respectively. These patients deteriorated due to the development of septic shock during their ICU stay resulting in a maximum Multiple Organ Dysfunction Score of 12.2 ± 3.7 in nonsurvivors and 9.4 ± 2.7 in survivors (p <.05). The difference between the maximum and initial Multiple Organ Dysfunction Scores (delta Score) was also significantly greater in nonsurvivors than in survivors (5.6 ± 4.7 vs. 2.8 ± 3.0) (p <.05). There were no significant differences between the maximum and delta Scores in the outcome groups using the APACHE II and Organ Failure scoring systems. These results were mirrored by 2.3 ± 0.7 and 1.7 ± 0.5 Organ failures in nonsurvivors and survivors, respectively (p <.01). For all 368 patients, the initial and maximum Multiple Organ Dysfunction Scores were 3.5 ± 2.5 and 10.5 ± 3.6, respectively. Conclusion: Maximum and delta Multiple Organ Dysfunction Scores mirrored Organ Dysfunction and could accurately describe the outcome groups, whereas daily APACHE II and Organ Failure Scores could not.