Despite mounting evidence, a question still exists as to the true clinical relevance of varying degrees of malnutrition, the role of currently measured nutritional parameters in identifying malnutrition and predicting clinical risk in individual patients, and the efficacy of nutritional therapy. This study was designed to document the usefulness of the Prognostic Nutritional Index (PNI) as a predictor of clinical course. The nutritional assessments and clinical records of 328 subjects in a Veterans Administration Hospital were reviewed, PNI and complication rates were determined for each of the subjects, and the data statistically analyzed. The PNI was found to be a useful indicator of malnutrition and predictor of clinical course. The PNI appeared to be a more sensitive index of clinical outcome than did comparison of individual nutritional parameters to accepted norms, although it accounted for only 17% of the information needed to predict clinical course perfectly.
This is a reprint of a Cochrane protocol, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library 2013, Issue 3 http://www.thecochranelibrary.com Thromboelastography (TEG) and thromboelastometry (ROTEM) for trauma induced coagulopathy in adult trauma patients with bleeding (Protocol)
Heparinless venoarterial bypass (HL-VAB) was carried out in 16 sheep for 6 days, by means of a closed circuit tubing coated with nonthrombogenic polyurethane-polyvinyl-graphite (PPG) and a roller pump. Nine experiments were completed uneventfully. Seven sheep died during bypass. The causes of death were pneumonia (2), caseous granulomatous lung abscess (3) or abdominal abscess (1), and thromboembolism (1). The last complication was caused by inadverten trauma to the PPG coating at the time of tubing connection. In the animals in which HL-VAB was uneventful, no significant changes were noted in the hematologic studies including white blood counts, platelet counts, hematocrit, plasma fibrinogen levels, prothrombin time, thrombin time, activated partial thromboplastin time, Factors V and VIII, and free plasma hemoglobin levels. Inconsistant changes in the above parmeters were noted in the animals which died of complications. In conclusion, prolonged HL-VAB has no adverse effects on blood coagulation mechanism.
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