Burden of Illness in venous ThromboEmbolism in Critical care: a multicenter observational study

Patel, Rakesh; Cook, Deborah J.; Meade, Maureen O.; Griffith, Lauren; Mehta, Geeta; Rocker, Graeme; Marshall, John C.; Hodder, Rick; Martin, Claudio M.; Heyland, Daren K.; Peters, Sharon; Muscedere, John; Soth, Mark; Campbell, Nicole; Guyatt, Gordon

doi:10.1016/j.jcrc.2005.09.014

Cited by 97 publications

(65 citation statements)

References 20 publications

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“…This is of considerable clinical relevance because early acceleration of neurological recovery post-CA can reduce comorbidities, such as deep vein thrombosis, ventilator-associated pneumonia, and critical illness neuromyopathy, ultimately improving outcome. [41][42][43] Another important implication of our findings is the possible consequence of inadvertent blockade of orexin for people who suffer cardiac arrest. For example, suvorexant has recently been approved for treatment of insomnia.…”

Section: Implications For Clinical Practicementioning

confidence: 79%

Recovery from Coma Post-Cardiac Arrest Is Dependent on the Orexin Pathway

Kang

Guo

Bazrafkan

et al. 2017

Journal of Neurotrauma

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Cardiac arrest (CA) affects >550,000 people annually in the United States whereas 80-90% of survivors suffer from a comatose state. Arousal from coma is critical for recovery, but mechanisms of arousal are undefined. Orexin-A, a hypothalamic excitatory neuropeptide, has been linked to arousal deficits in various brain injuries. We investigated the orexinergic system's role in recovery from CA-related neurological impairments, including arousal deficits. Using an asphyxial CA and resuscitation model in rats, we examine neurological recovery post-resuscitation in conjunction with changes in orexin-A levels in cerebrospinal fluid (CSF) and orexin-expressing neurons. We also conduct pharmacological inhibition of orexin post-resuscitation. We show that recovery from neurological deficits begins between 4 and 24 h postresuscitation, with additional recovery by 72 h post-resuscitation. Orexin-A levels in the CSF are lowest during periods of poorest arousal post-resuscitation (4 h) and recover to control levels by 24 h. Immunostaining revealed that the number of orexin-A immunoreactive neurons declined at 4 h post-resuscitation, but increased to near normal levels by 24 h. There were no significant changes in the number of neurons expressing melanin-concentrating hormone, another neuropeptide localized in similar hypothalamus regions. Last, administration of the dual orexin receptor antagonist, suvorexant, during the initial 24 h post-resuscitation, led to sustained neurological deficits. The orexin pathway is critical during early phases of neurological recovery post-CA. Blocking this early action leads to persistent neurological deficits. This is of considerable clinical interest given that suvorexant recently received U.S. Food and Drug Administration approval for insomnia treatment.

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Section: Implications For Clinical Practicementioning

confidence: 79%

Recovery from Coma Post-Cardiac Arrest Is Dependent on the Orexin Pathway

Kang

Guo

Bazrafkan

et al. 2017

Journal of Neurotrauma

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“…Fifty per cent of patients with proximal lower limb DVT [13] and 14% (4/29) of patients with symptomatic upper limb DVT have PE that is asymptomatic at the time of presentation [14]. Unexpected pulmonary emboli were found in 3-8% of autopsies performed in patients who died in the ICU [15,16]. In another study, autopsies of ICU patients revealed undiagnosed pulmonary emboli in 20% of cases [17].…”

Section: Discussionmentioning

confidence: 96%

Effect of time of admission on compliance with deep vein thrombosis prophylaxis in a tertiary medical intensive care unit

Dabbagh

Adams

Haddadin

et al. 2009

Journal of Thrombosis and Haemostasis

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Summary. Objective: We sought to evaluate deep vein thrombosis (DVT) prophylaxis compliance according to time of admission in a medical intensive care unit (MICU). Methods: This was a retrospective cohort study at a closed tertiary MICU. We classified patients into three groups (week days, weekends, and week nights), according to time of admission. An unweighted risk factor score (RFS) was calculated from 20 known risk factors. We defined DVT prophylaxis compliance as any type of prophylaxis (mechanical or pharmacologic) for RFS £ 3 or both types of prophylaxis for RFS > 3. Noncompliance was defined as no prophylaxis or single-type prophylaxis for RFS > 3. Results: We analyzed 105 admissions. Eighty (76.19%) patients received compliant DVT prophylaxis, and 25 (23.81%) patients received non-compliant regimens of whom 11 (10.48%) were not on any prophylaxis. DVT prophylaxis compliance was not different across the three admission groups. The non-compliant DVT prophylaxis group had a higher RFS (3.48 ± 2.1 vs. 2.25 ± 1.5; P = 0.011), a trend towards fewer female patients (40% vs. 60%; P = 0.079), and a higher percentage of admissions by interns at the first postgraduate year (PGY) level (28% vs. 5.4%; P = 0.01). Logistic regression revealed that only RFS and PGY level were independent predictors for compliance (P = 0.015 and 0.005 respectively). Time of admission was not a significant factor. Conclusions: Time of admission did not influence DVT prophylaxis compliance. Compliance improved with higher PGY level and lower RFS. A higher level of knowledge probably explains the association with PGY level; however, we cannot explain the inverse relationship between RFS and compliance.

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“…Sin embargo, hay pacientes que a pesar de recibir medidas preventivas tienen ETE que incluso puede llegar a ser mortal (26,27). Según un reciente estudio (20), la utilización de HBPM en pacientes hospitalizados no quirúrgi-cos como medida profiláctica no disminuye la mortalidad, aunque si disminuyó el hallazgo de TEP en las autopsias sin llegar a ser estadísticamente significativo.…”

Section: Discussionunclassified

Tromboembolismo pulmonar en pacientes hospitalizados entre 1994-2000: serie de autopsia

Fernández

Holguín

García

et al. 2006

An. Med. Interna (Madrid)

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RESUMENIntroducción: El tromboembolismo pulmonar (TEP) ha sido durante muchos años una causa muy importante de morbi-mortalidad en los pacientes hospitalizados. El empleo de forma profiláctica de Heparinas de Bajo Peso Molecular (HBPM) en pacientes ingresados en la última década del siglo XX parece haber disminuido de forma significativa su incidencia clí-nica. Pretendemos ver si el empleo de HBPM como medida de tromboprofilaxis ha modificado el hallazgo de esta patología en autopsias.Material y métodos: Estudio retrospectivo de todas las autopsias realizadas en adultos en el Hospital Clínico San Carlos (Madrid) en un periodo de 6 años (Enero 1994-Diciembre 1999. Se incluyeron en el estudio todas aquellas que presentaron hallazgos anatomopatológicos (AP) de TEP y se rellenó un protocolo en el que se incluyeron datos AP, datos epidemiológicos, clínicos y terapéuticos.Resultados: En el periodo estudiado se realizaron 483 necropsias, de las cuales 40 (8,3%) tenían datos de TEP. La mayor parte de ellos tenían más de 50 años (85%) y entre los factores de riesgo destacaron el reposoencamamiento, la enfermedad crónica médica y la presencia de tumores malignos (adenocarcinomas). Sólo se sospechó el diagnóstico pre-mortem en 5 (12,5 %) y 15 (37,5 %) desarrollaron la ETE a pesar de haber recibido tratamiento profiláctico con HBPM.Conclusiones: El TEP continúa siendo una causa muy importante de mortalidad de los pacientes ingresados en el hospital. El aumento de la esperanza de vida, de la supervivencia de enfermedades crónicas médicas y tumorales determina que hay que tener muy en cuenta esta patología. El empleo de una HBPM como profilaxis no excluye la posibilidad de esta entidad.PALABRAS CLAVE: Autopsia. Tromboembolismo pulmonar. HBPM. ABSTRACT Background: Pulmonary thromboembolism (PTE) has been for a long time a significant cause of morbidity and mortality in hospitalized patients. The utility of Low-Molecular Weight Heparins (LMWH) in these patients in the last decade of the XX century has decreased the incidence of this disease. We try to know if the massive useful of LMWH as thromboprophylasis is diminishing its incidence in autopsies.Material

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Burden of Illness in venous ThromboEmbolism in Critical care: a multicenter observational study

Cited by 97 publications

References 20 publications

Recovery from Coma Post-Cardiac Arrest Is Dependent on the Orexin Pathway

Recovery from Coma Post-Cardiac Arrest Is Dependent on the Orexin Pathway

Effect of time of admission on compliance with deep vein thrombosis prophylaxis in a tertiary medical intensive care unit

Tromboembolismo pulmonar en pacientes hospitalizados entre 1994-2000: serie de autopsia

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