This two-part meta-analysis combined data from eight prospective randomized trials designed to compare the nutritional efficacy of early enteral (TEN) and parenteral (TPN) nutrition in high-risk surgical patients. The combined data gave sufficient patient numbers (TEN, n = 118; TPN, n = 112) to adequately address whether route of substrate delivery affected septic complication incidence. Phase I (dropouts excluded) meta-analysis confirmed data homogeneity across study sites, that TEN and TPN groups were comparable, and that significantly fewer TEN patients experienced septic complications (TEN, 18%; TPN, 35%; p = 0.01). Phase II meta-analysis, an intent-to-treat analysis (dropouts included), confirmed that fewer TEN patients developed septic complications. Further breakdown by patient type showed that all trauma and blunt trauma subgroups had the most significant reduction in septic complications when fed enterally. In conclusion, this meta-analysis attests to the feasibility of early postoperative TEN in high-risk surgical patients and that these patients have reduced septic morbidity rates compared with those administered TPN.

Compared with placebo, concomitant prophylactic heparin was not equivalent, did not increase 28-day mortality, and had an acceptable safety profile in patients with severe sepsis receiving DrotAA. Heparin discontinuation should be carefully weighed in patients considered for DrotAA treatment. XPRESS clinical trial registered with www.clinicaltrials.gov (NCT 00049777). The study ID numbers are 6743; F1K-MC-EVBR.

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Background-Blood loss is a common complication of cardiac surgery. Evidence suggests that recombinant activated factor VII (rFVIIa) can decrease intractable bleeding in patients after cardiac surgery. Our objective was to investigate the safety and possible benefits of rFVIIa in patients who bleed after cardiac surgery. Methods and Results-In this phase II dose-escalation study, patients who had undergone cardiac surgery and were bleeding were randomized to receive placebo (nϭ68), 40 g/kg rFVIIa (nϭ35), or 80 g/kg rFVIIa (nϭ69). The primary end points were the number of patients suffering critical serious adverse events. Secondary end points included rates of reoperation, amount of blood loss, and transfusion of allogeneic blood. There were more critical serious adverse events in the rFVIIa groups. These differences did not reach statistical significance (placebo, 7%; 40 g/kg, 14%; Pϭ0.25; 80 g/kg, 12%; Pϭ0.43). After randomization, significantly fewer patients in the rFVIIa group underwent a reoperation as a result of bleeding (Pϭ0.03) or required allogeneic transfusions (Pϭ0.01). Conclusions-On the basis of this preliminary evidence, rFVIIa may be beneficial for treating bleeding after cardiac surgery, but caution should be applied and further clinical trials are required because there is an increase in the number of critical serious adverse events, including stroke, in those patients randomized to receive rFVIIa. (Circulation. 2009; 120:21-27.)Key Words: cardiac surgery Ⅲ cardiopulmonary bypass Ⅲ coagulation Ⅲ factor VIIa Ⅲ hemorrhage B leeding after cardiac surgery is a serious complication, and excessive blood loss frequently necessitates transfusion of allogeneic blood, blood products, and surgical reexploration. Five percent to 7% of patients lose Ͼ2 L blood within the first 24 hours after surgery, 1 and up to 5% require reoperation for bleeding. 2 Both transfusion and re-exploration are associated with prolonged intensive care and hospital stays and reduced survival rates. 3 Clinical Perspective on p 27Recombinant factor VIIa (rFVIIa; NovoSeven, Novo Nordisk A/S, Bagsvaerd, Denmark) is currently approved for the treatment of bleeding episodes and the prevention of bleeding in connection with surgical/invasive procedures in patients with hemophilia and inhibitors to coagulation factors VIII or IX, FVII deficiency, and acquired hemophilia. The mode of action of rFVIIa has been described and is localized predominantly to the site of vessel injury. 4,5 Numerous reports have indicated a reduction in bleeding and transfusion requirements in patients given rFVIIa in the setting of severe uncontrolled hemorrhage outside hemophilia and other bleeding disorders despite the potential for thrombotic complications. 6 -16 For patients bleeding after cardiac surgery, the risk, potential benefits, and optimal dose of rFVIIa have not been carefully assessed in a randomized, placebo-controlled trial.Our objective was therefore to investigate the safety and possible benefits of different doses of rFVIIa in patients bleedi...

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Absence of all three risk factors indicates a very low risk for DVT (1.1%). Screening of SICU patients is indicated because of a high prevalence of asymptomatic disease. Patients who have proximal DVT require active therapy and not prophylaxis. Costs and resources may be contained by using the above risk factors as a filter for duplex screening.

Care of patients who undergo tracheostomy for prolonged mechanical ventilation is expensive. The older the patient, the less satisfactory the outcome from an economic, clinical, and possibly social perspective.

These data suggest that PLV may be performed safely with few related severe adverse effects. Improvement in gas exchange was observed in this series of adult patients over the 48 hours after initiation of PLV.