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1. Early Profile and Clinical Significance of Hyperchloremic Acidosis in Patients Undergoing Cardiac Surgery

Author

Daniela Filipescu, Ioana Raileanu, Oana Ghenu, Mihail Luchian, and C. C. Iliescu

Subjects
medicine.medical_specialty, Endocrine and Autonomic Systems, business.industry, Endocrinology, Diabetes and Metabolism, Anion gap, Metabolic acidosis, medicine.disease, law.invention, Cardiac surgery, Endocrinology, law, Anesthesia, Hyperchloremic acidosis, medicine, Cardiopulmonary bypass, Arterial blood, Clinical significance, Base excess, business
Abstract

Objectives: to determine the 24-hours profile and the clinical implications of hyperchloremic metabolic acidosis (HCMA) following cardiac surgery with cardiopulmonary bypass (CPB). Subjects and methods: prospective and observational study set in cardiac anesthesia and intensive unit. One hundred patients with cardiac procedures with CPB, mean age 56 years, mean body weight 71 kg, were enrolled. Sampling of arterial blood for gas, acid-base parameters (pH, carbon dioxide partial pressure, base excess, concentration of bicarbonate and anion gap) and serum electrolytes (sodium, potassium, chloride) were performed at four time points: 30 min after induction of anesthesia (T1), after completion of CPB (T2), at 6 hours (T3) and at 24 hours postoperatively (T4). The volume of fluids administered intraoperatively and 24 hours postoperatively as well as major complications: bleeding, arrhythmias and organ dysfunctions (renal, pulmonary or neurological) were also registered. For statistical analysis we used a t-test (p

Published
2006

2. Pole Face Shape Design in High-Energy Accelerators

Author

C. C. Iliescu

Subjects
Physics, Nuclear and High Energy Physics, Ideal (set theory), Field (physics), business.industry, Computation, Mathematical analysis, Electrical engineering, Conformal map, Magnetic field, Nuclear Energy and Engineering, Magnet, Face (geometry), Equipotential, Electrical and Electronic Engineering, business
Abstract

An analytic method for designing pole face shape is presented, which gets the desired value of the field index in a given region, withaprescribed error. The method has three stages, corresponding to the successive computation of : - the ideal pole face shape and ideal equipotential set (previously developed by the author); - the equipotential set, taking into account fringing field effects, by means of conformal mapping; - the necessary corrections at the edges of the ideal pole face by means of conformal mapping, for obtaining the desired field distribution. As an example, the pole face shape for a 300-GeV synchrotron with n=5040 is computed. The method applies to every magnetic device having a radially constant field index.

Published
1965

5. [Diagnosis of interatrial septal defect]

Author

C C, ILIESCU, L, KLEINERMAN, G, GUTA, O, DUMITRESCU BOGDAN, E, ANGHEL, and I, BANDU

Subjects
Heart Septal Defects, Heart Septum, Heart Septal Defects, Atrial
Published
1960

9. [PHONOCARDIOGRAPHIC DATA IN PULMONARY ARTERIAL STENOSIS]

Author

C C, ILIESCU, L, KLEINERMAN, M, GITSE, and Zh, DOMOKOS

Subjects
Ephedrine, Heart Septal Defects, Ventricular, Pharmacology, Pulmonary Valve Stenosis, Cardiac Complexes, Premature, Heart Septal Defects, Phonocardiography, Tetralogy of Fallot, Humans, Amyl Nitrite, Constriction, Pathologic
Published
1964

11. [Late clinical results of mitral commissurotomy]

Author

C C, Iliescu, L, Kleinerman, D, Popescu, and H, Cionca

Subjects
Adult, Male, Postoperative Complications, Adolescent, Humans, Mitral Valve Stenosis, Female, Middle Aged
Published
1965

14. [Interauricular septal defects]

Author

C C, ILIESCU, L, KLEINERMAN, M, PANTZER, G, GUSTA, and D, HARNADZHA

Subjects
Heart Septal Defects, Heart Septum
Published
1959

41. [Favorable factors in electrocardioversion in atrial fibrillation]

Author

L, Serafim and C C, Iliescu

Subjects
Adult, Male, Age Factors, Electric Countershock, Heart Valve Diseases, Rheumatic Heart Disease, Digitalis Glycosides, Coronary Disease, Middle Aged, Prognosis, Quinidine, Sex Factors, Atrial Fibrillation, Methods, Humans, Female, Aged
Published
1970

42. [ABDOMINAL ANGINA]

Author

M, ILIESCU, V, PASTIU, M, SVET, G, DOMOCOS, L, HAGI-PARASCHIV, and C C, ILIESCU

Subjects
Intestinal Diseases, Infarction, Mesenteric Ischemia, Mesenteric Vascular Occlusion, Humans, Thromboangiitis Obliterans
Published
1963

44. THE MANNER IN WHICH QUINIDINE SULPHATE ACTS IN AURICULAR FIBRILLATION

Author

A. N. Drury, A. M. Wedd, Thomas Lewis, and C. C. Iliescu

Subjects
Quinidine sulphate, business.industry, General Engineering, General Earth and Planetary Sciences, Medicine, Articles, General Medicine, Pharmacology, business, Bioinformatics, General Environmental Science, Auricular fibrillation
Published
1921

46. The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition

Author

Beverley J. Hunt, Radko Komadina, Timothy J Coats, Vladimir Cerny, Arthur Schultz, Yves Ozier, Enrique Fernández-Mondéjar, Jean Louis Vincent, Jacques Duranteau, Giuseppe Nardi, Daniela Filipescu, Louis Riddez, Rolf Rossaint, Donat R. Spahn, Edmund Neugebauer, Bertil Bouillon, University of Zurich, Spahn, Donat R, [Rossaint,R] Department of Anaesthesiology, University Hospital Aachen, RWTH Aachen University, Aachen, Germany. [Bouillon,B] Department of Trauma and Orthopaedic Surgery, Witten/Herdecke University, Cologne-Merheim Medical Centre, Cologne, Germany. [Cerny,V] Department of Anaesthesiology, Perioperative Medicine and Intensive Care, J.E. Purkinje University, Masaryk Hospital, Usti nad Labem, Czech Republic. Department of Research and Development, Charles University in Prague, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic. Department of Anaesthesiology and Intensive Care, Charles University in Prague, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic. Department of Anaesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, QE II Health Sciences Centre, Halifax, Canada. [Coats,TJ] Emergency Medicine Academic Group, University of Leicester, Leicester, UK. [Duranteau,J] Department of Anaesthesia and Intensive Care, Hôpitaux Universitaires Paris Sud, University of Paris, Faculté de Médecine Paris-Sud, Le Kremlin-Bicêtre, Cedex, France. [Fernández-Mondéjar,E] Servicio de Medicina Intensiva, Complejo Hospitalario Universitario de Granada, Granada, Spain. [Filipescu,D] Department of Cardiac Anaesthesia and Intensive Care, C. C. Iliescu Emergency Institute of Cardiovascular Diseases, Bucharest, Romania. [Hunt,BJ] King’s College, Departments of Haematology, Pathology and Lupus, Guy’s and St Thomas’ NHS Foundation Trust,London, UK. [Komadina,R] Department of Traumatology, General and Teaching Hospital Celje, Celje, Slovenia. [Nardi,G] Shock and Trauma Centre, S. Camillo Hospital, Rome, Italy. [Neugebauer,EAM] Faculty of Health - School of Medicine, Witten/Herdecke University, Cologne, Germany. [Ozier,Y] Division of Anaesthesia, Intensive Care and Emergency Medicine, Brest University Hospital, Brest, France. [Riddez,L] Department of Surgery and Trauma, Karolinska University Hospital, Solna, Sweden. [Schultz,A] Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Lorenz Boehler Trauma Centre, Vienna, Austria. [Vincent,JL] Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium. [Spahn,DR] Institute of Anaesthesiology, University of Zurich and University Hospital Zurich, Zurich, Switzerland., and The development of this guideline was initiated and performed by the authors as members of the Task Force for Advanced Bleeding Care in Trauma. Members of the task force were compensated for their presence at one face-to-face meeting, but not for the time invested in developing and reviewing the recommendations or manuscript. Meeting organisation and medical writing support for literature searches and manuscript preparation were provided by Physicians World Europe GmbH (Mannheim, Germany). Costs incurred for medical writing support, travel, hotel accommodation, meeting facilities, honoraria and publication were supported by unrestricted grants from CSL Behring GmbH (Marburg, Germany) and LFB Biomédicaments (Courtaboeuf, France).

Subjects
Guiding Principles, Trastornos de la coagulación sanguínea, Diseases::Hemic and Lymphatic Diseases::Hematologic Diseases::Blood Coagulation Disorders [Medical Subject Headings], 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, Scientific evidence, Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings], 0302 clinical medicine, Hemorragia, Disease management (health), Metas, Resucitación, Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Hematologic Agents::Anticoagulants [Medical Subject Headings], Evidence-Based Medicine, Algoritmos, Geographicals::Geographic Locations::Europe [Medical Subject Headings], Disease Management, Health Care::Health Services Administration::Organization and Administration::Safety Management [Medical Subject Headings], Blood Coagulation Disorders, Humanos, Europe, Consenso, Health Care::Health Care Quality, Access, and Evaluation::Quality Assurance, Health Care::Guidelines as Topic [Medical Subject Headings], Centros Traumatológicos, Medical emergency, Safety management systems, 2706 Critical Care and Intensive Care Medicine, medicine.medical_specialty, Phenomena and Processes::Mathematical Concepts::Algorithms [Medical Subject Headings], 10216 Institute of Anesthesiology, 610 Medicine & health, Guidelines as Topic, Hemorrhage, Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Hemorrhage [Medical Subject Headings], Permissive hypotension, Health Care::Health Care Economics and Organizations::Social Control, Formal::Jurisprudence::Expert Testimony [Medical Subject Headings], 03 medical and health sciences, Testimonio de experto, Psychiatry and Psychology::Behavior and Behavior Mechanisms::Motivation::Goals [Medical Subject Headings], Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Emergency Treatment::Resuscitation [Medical Subject Headings], medicine, Humans, Europa (Continente), Emergency Treatment, Psychiatry and Psychology::Behavior and Behavior Mechanisms::Psychology, Social::Group Processes::Consensus [Medical Subject Headings], business.industry, Research, Généralités, 030208 emergency & critical care medicine, Evidence-based medicine, Guideline, medicine.disease, Health Care::Health Care Facilities, Manpower, and Services::Health Facilities::Hospital Administration::Hospital Departments::Emergency Service, Hospital::Trauma Centers [Medical Subject Headings], Anticoagulantes, Clinical trial, Emergency medicine, Wounds and Injuries, Guías como asunto, business, Gestión de la seguridad
Abstract

Background: Severe trauma continues to represent a global public health issue and mortality and morbidity in trauma patients remains substantial. A number of initiatives have aimed to provide guidance on the management of trauma patients. This document focuses on the management of major bleeding and coagulopathy following trauma and encourages adaptation of the guiding principles to each local situation and implementation within each institution. Methods: The pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma was founded in 2004 and included representatives of six relevant European professional societies. The group used a structured, evidence-based consensus approach to address scientific queries that served as the basis for each recommendation and supporting rationale. Expert opinion and current clinical practice were also considered, particularly in areas in which randomised clinical trials have not or cannot be performed. Existing recommendations were reconsidered and revised based on new scientific evidence and observed shifts in clinical practice; new recommendations were formulated to reflect current clinical concerns and areas in which new research data have been generated. This guideline represents the fourth edition of a document first published in 2007 and updated in 2010 and 2013. Results: The guideline now recommends that patients be transferred directly to an appropriate trauma treatment centre and encourages use of a restricted volume replacement strategy during initial resuscitation. Best-practice use of blood products during further resuscitation continues to evolve and should be guided by a goal-directed strategy. The identification and management of patients pre-treated with anticoagulant agents continues to pose a real challenge, despite accumulating experience and awareness. The present guideline should be viewed as an educational aid to improve and standardise the care of the bleeding trauma patients across Europe and beyond. This document may also serve as a basis for local implementation. Furthermore, local quality and safety management systems need to be established to specifically assess key measures of bleeding control and outcome. Conclusions: A multidisciplinary approach and adherence to evidence-based guidance are key to improving patient outcomes. The implementation of locally adapted treatment algorithms should strive to achieve measureable improvements in patient outcome., SCOPUS: ar.j, info:eu-repo/semantics/published

Published
2016

47. The STOP the Bleeding Campaign

Author

Arthur Schultz, Rolf Rossaint, Giuseppe Nardi, Daniela Filipescu, Beverley J. Hunt, Jacques Duranteau, Enrique Fernández-Mondéjar, Marc Maegele, Yves Ozier, Vladimir Cerny, Donat R. Spahn, Radko Komadina, Jean Louis Vincent, Bertil Bouillon, Timothy J Coats, Louis Riddez, Edmund Neugebauer, [Rossaint,R] Department of Anaesthesiology, University Hospital Aachen, RWTH Aachen University, Aachen, Germany. [Bouillon,B] Department of Trauma and Orthopaedic Surgery, University of Witten/Herdecke, Cologne-Merheim Medical Centre, Cologne, Germany. [Cerny,V] aculty of Medicine in Hradec Králové, Department of Anaesthesiology and Intensive Care Medicine, University Hospital Hradec Králové, Czech Republic, Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Canada. [Coats,TJ] Accident and Emergency Department, University of Leicester, Leicester , UK. [Duranteau,J] Department of Anaesthesia and Intensive Care, University of Paris XI, Faculté de Médecine Paris-Sud, Le Kremlin-Bicêtre, France. [Fernández-Mondéjar,E] Department of Emergency and Critical Care Medicine, University Hospital Virgen de las Nieves, Granada, Spain. [Filipescu,D] Department of Cardiac Anaesthesia and Intensive Care, C. C. Iliescu Emergency Institute of Cardiovascular Diseases, Bucharest, Romania. [Hunt,BJ] Guy's & St Thomas' Foundation Trust, Westminster, London, UK. [Komadina,R] Department of Traumatology, General and Teaching Hospital Celje, Celje, Slovenia. [Maegele,M] Department of Trauma and Orthopaedic Surgery, University of Witten/Herdecke, Cologne-Merheim Medical Centre, Cologne, Germany. [Nardi,G] Shock and Trauma Centre, S. Camillo Hospital, Rome, Italy. [Neugebauer,E] Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Campus Cologne, Cologne, Germany. [Ozier,Y] Division of Anaesthesia, Intensive Care and Emergency Medicine, Brest University Hospital, Brest, France. [Riddez,L] Department of Surgery and Trauma, Karolinska University Hospital, Solna, Sweden. [Schultz,A] Ludwig-Boltzmann-Institute for Experimental and Clinical Traumatology, Lorenz Boehler Trauma Centre, Vienna, Austria. [Vincent,JL] Jean-Louis Vincent, Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium. [Spahn,DR] Institute of Anaesthesiology, University Hospital Zurich, Switzerland., The experts initiating the STOP the Bleeding Campaign request the support of European professional societies, political bodies, national and international health and funding organisations as well as pharmaceutical and device manufacturers, University of Zurich, and Rossaint, Rolf

Subjects
Health Care::Environment and Public Health::Public Health::Accidents [Medical Subject Headings], 10216 Institute of Anesthesiology, Comparative effectiveness research, Trastornos de la coagulación sanguínea, Diseases::Hemic and Lymphatic Diseases::Hematologic Diseases::Blood Coagulation Disorders [Medical Subject Headings], Hemorrhage, 610 Medicine & health, Health Promotion, Critical Care and Intensive Care Medicine, Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Hemorrhage [Medical Subject Headings], World health, 03 medical and health sciences, 0302 clinical medicine, Exsanguination, Hemorragia, medicine, Coagulopathy, Humans, Heridas y traumatismos, Diseases::Wounds and Injuries [Medical Subject Headings], Hospital Mortality, 030212 general & internal medicine, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Emergency Treatment [Medical Subject Headings], Hemostasis, Trauma patient, business.industry, Accidentes, Promoción de la salud, Treatment options, Tratamiento de urgencia, Geographicals::Geographic Locations::Europe [Medical Subject Headings], Généralités, 030208 emergency & critical care medicine, Awareness, Blood Coagulation Disorders, medicine.disease, 3. Good health, Editorial, Traumatic injury, Health promotion, Health Care::Health Care Facilities, Manpower, and Services::Health Promotion [Medical Subject Headings], Commentary, Medical emergency, 2706 Critical Care and Intensive Care Medicine, business, Europa, Tranexamic acid, medicine.drug
Abstract

According to the World Health Organization, traumatic injuries worldwide are responsible for over 5 million deaths annually. Post-traumatic bleeding caused by traumatic injury-associated coagulopathy is the leading cause of potentially preventable death among trauma patients. Despite these facts, awareness of this problem is insufficient and treatment options are often unclear. The STOP the Bleeding Campaign therefore aims to increase awareness of the phenomenon of post-traumatic coagulopathy and its appropriate management by publishing European guidelines for the management of the bleeding trauma patient, by promoting and monitoring the implementation of these guidelines and by preparing promotional and educational material, organising activities and developing health quality management tools. The campaign aims to reduce the number of patients who die within 24 hours after arrival in the hospital due to exsanguination by a minimum of 20% within the next 5 years. © 2013 BioMed Central Ltd., SCOPUS: no.j, info:eu-repo/semantics/published

Published
2013

48. Management of bleeding and coagulopathy following major trauma: an updated European guideline

Author

Rolf Rossaint, Louis Riddez, Beverley J. Hunt, Radko Komadina, Giuseppe Nardi, Enrique Fernández-Mondéjar, Jean Louis Vincent, Jacques Duranteau, Timothy J Coats, Arthur Schultz, Donat R. Spahn, Vladimir Cerny, Daniela Filipescu, Yves Ozier, Bertil Bouillon, Edmund Neugebauer, [Spahn,DR] Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland. [Bouillon,B] Department of Trauma and Orthopaedic Surgery, University of Witten/Herdecke, Cologne-Merheim Medical Centre, Cologne, Germany. [Cerny,V] Faculty of Medicine in Hradec Králové, Department of Anaesthesiology and Intensive Care Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic. Dalhousie University, Department of Anesthesia, Pain Management and Perioperative Medicine, Halifax, Canada. [Coats,TJ] Accident and Emergency Department, University of Leicester, Leicester , UK. [Duranteau,J] Department of Anaesthesia and Intensive Care, University of Paris XI, Faculté de Médecine Paris-Sud, Le Kremlin-Bicêtre, France. [Fernández-Mondéjar,E] Department of Emergency and Critical Care Medicine, University Hospital Virgen de las Nieves, Granada, Spain. [Filipescu,D] Department of Cardiac Anaesthesia and Intensive Care, C. C. Iliescu Emergency Institute of Cardiovascular Diseases, Bucharest, Romania. [Hunt,BJ] Guy's and St Thomas Foundation Trust, London, UK. [Komadina,R] Department of Traumatology, General and Teaching Hospital Celje, Celje, Slovenia. [Nardi,G] Shock and Trauma Centre, S. Camillo Hospital, Rome, Italy. [Neugebauer,E] Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Cologne, Germany. [Ozier,Y] Division of Anaesthesia, Intensive Care and Emergency Medicine, Brest University Hospital, Brest, France. [Riddez,L] Department of Surgery and Trauma, Karolinska University Hospital, Solna, Sweden. [Schultz,A] Ludwig-Boltzmann-Institute for Experimental and Clinical Traumatology, Lorenz Boehler Trauma Centre, Vienna, Austria. [Vincent,JL] Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium. [Rossaint,R] Department of Anaesthesiology, University Hospital Aachen, RWTH Aachen University, Aachen, Germany., Costs incurred for medical writing support, travel, hotel accommodation, meeting facilities, honoraria and publication were supported by unrestricted grants from CSL Behring GmbH (Marburg, Germany) and LFB Biomédicaments (Courtaboeuf, France), University of Zurich, and Rossaint, Rolf

Subjects
Soins intensifs réanimation, Phenomena and Processes::Physical Phenomena::Time::Time Factors [Medical Subject Headings], Trastornos de la coagulación sanguínea, Diseases::Hemic and Lymphatic Diseases::Hematologic Diseases::Blood Coagulation Disorders [Medical Subject Headings], Choque Hemorrágico, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, Heridas y Traumatismos, Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings], 0302 clinical medicine, Hemorragia, Nominal group technique, Medicine, Diseases::Wounds and Injuries [Medical Subject Headings], Disease management (health), Antifibrinolíticos, Resucitación, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Emergency Treatment [Medical Subject Headings], education.field_of_study, Major trauma, Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Hematologic Agents::Coagulants::Hemostatics::Antifibrinolytic Agents [Medical Subject Headings], Tratamiento de Urgencia, Humanos, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Therapeutic Occlusion::Embolization, Therapeutic [Medical Subject Headings], 3. Good health, Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Hematologic Agents::Blood Substitutes [Medical Subject Headings], Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Hemostatic Techniques [Medical Subject Headings], 2706 Critical Care and Intensive Care Medicine, medicine.medical_specialty, 10216 Institute of Anesthesiology, Population, MEDLINE, 610 Medicine & health, Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Hemorrhage [Medical Subject Headings], Hierarchy of evidence, 03 medical and health sciences, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Emergency Treatment::Resuscitation [Medical Subject Headings], Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Biological Therapy::Blood Transfusion [Medical Subject Headings], Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Hemorrhage::Shock, Hemorrhagic [Medical Subject Headings], Intensive care medicine, education, Embolización terapéutica, Protocol (science), business.industry, 030208 emergency & critical care medicine, Guideline, medicine.disease, Técnicas hemostáticas, Transfusión Sanguínea, business, Factores de Tiempo, Sustitutos Sanguíneos
Abstract

Introduction: Evidence-based recommendations are needed to guide the acute management of the bleeding trauma patient. When these recommendations are implemented patient outcomes may be improved.Methods: The multidisciplinary Task Force for Advanced Bleeding Care in Trauma was formed in 2005 with the aim of developing a guideline for the management of bleeding following severe injury. This document represents an updated version of the guideline published by the group in 2007 and updated in 2010. Recommendations were formulated using a nominal group process, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) hierarchy of evidence and based on a systematic review of published literature.Results: Key changes encompassed in this version of the guideline include new recommendations on the appropriate use of vasopressors and inotropic agents, and reflect an awareness of the growing number of patients in the population at large treated with antiplatelet agents and/or oral anticoagulants. The current guideline also includes recommendations and a discussion of thromboprophylactic strategies for all patients following traumatic injury. The most significant addition is a new section that discusses the need for every institution to develop, implement and adhere to an evidence-based clinical protocol to manage traumatically injured patients. The remaining recommendations have been re-evaluated and graded based on literature published since the last edition of the guideline. Consideration was also given to changes in clinical practice that have taken place during this time period as a result of both new evidence and changes in the general availability of relevant agents and technologies.Conclusions: A comprehensive, multidisciplinary approach to trauma care and mechanisms with which to ensure that established protocols are consistently implemented will ensure a uniform and high standard of care across Europe and beyond. © 2013 Spahn et al. licensee BioMed Central Ltd., SCOPUS: ar.j, info:eu-repo/semantics/published

Published
2013

49. Patient Blood Management in 2023: a Nationwide Survey of Anesthesiologists in Romania following the 2018 Guidelines.

Author

Filipescu D, Ştefan MG, Turconi ŞIB, Corneci D, Droc G, Goicea R, Grigoraş I, Grinţescu IM, Mirea L, Predoi C, Ristescu AI, Negoiţă S, Săndesc D, Scărlătescu E, Văleanu L, Andrei Ş, and Tomescu D

Abstract

Background: In 2018, Romania established national guidelines for patient blood management (PBM), endorsed by the Romanian Society of Anesthesia and Intensive Care (SRATI) and approved by the Ministry of Health. These guidelines emphasize managing anemia, coagulation issues, and the cautious use of allogeneic transfusions to improve patient outcomes., Materials and Methods: A national survey was conducted among Romanian anesthesiologists to assess PBM guideline adoption. It included 38 questions addressing PBM strategies, resources, transfusion practices, and barriers to implementation. The survey was distributed via email to the SRATI database., Results: Out of 512 professionals who opened the survey, 74% had adopted some PBM measures, and 97% recognized PBM's efficacy in improving outcomes. However, only 33% of anesthesiologists worked in hospitals with formal PBM groups, and 39% had attended PBM-related educational events. Preoperative anemia management was inconsistent, with only 33.5% routinely treating anemia. Access to diagnostic and therapeutic tools was limited; transferrin saturation testing was available in 27% of cases, and erythropoietin was used in 24%. Despite these limitations, 72% of respondents treated anemia with intravenous iron. The main challenges to implementation included insufficient time for pre-surgical assessments, lack of standardized procedures, and difficulties in surgeon-anesthetist collaboration., Discussion: The survey highlights the need for systemic improvements in PBM adoption. Recommendations include enhancing organizational structures, standardizing protocols, and improving interdisciplinary collaboration to boost PBM implementation in Romania. While progress has been made, a national program with dedicated funding and auditing could facilitate widespread PBM integration into clinical practice.

Published
2024
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50. Systematic hand-held echocardiography in patients hospitalized with acute coronary syndrome.

Author

Geers J, Balfour A, Molek P, Barron P, Botezatu S, Joshi SS, White A, Buchwald M, Everett R, McCarley J, Cusack D, Japp AG, Gibson PH, Lang CCE, Stirrat C, Grubb NR, Bing R, Cruden NL, Denvir MA, Soliman Aboumarie H, Cosyns B, Newby DE, and Dweck MR

Subjects
Humans, Male, Female, Aged, Middle Aged, Feasibility Studies, Hospitalization, Cohort Studies, Acute Coronary Syndrome diagnostic imaging, Echocardiography methods
Abstract

Aims: Transthoracic echocardiography is recommended in all patients with acute coronary syndrome but is time-consuming and lacks an evidence base. We aimed to assess the feasibility, diagnostic accuracy, and time efficiency of hand-held echocardiography in patients with acute coronary syndrome and describe the impact of echocardiography on clinical management in this setting., Methods and Results: Patients with acute coronary syndrome underwent both hand-held and transthoracic echocardiographies with agreement between key imaging parameters assessed using kappa statistics. The immediate clinical impact of hand-held echocardiography in this population was systematically evaluated. Overall, 262 patients (65 ± 12 years, 71% male) participated. Agreement between hand-held and transthoracic echocardiographies was good-to-excellent (kappa 0.60-1.00) with hand-held echocardiography having an overall negative predictive value of 95%. Hand-held echocardiography was performed rapidly (7.7 ± 1.6 min) and completed a median of 5 (interquartile range 3-20) h earlier than transthoracic echocardiography. Systematic hand-held echocardiography in all patients with acute coronary syndrome identified an important cardiac abnormality in 50%, and the clinical management plan was changed by echocardiography in 42%. In 85% of cases, hand-held echocardiography was sufficient for patient decision-making, and transthoracic echocardiography was no longer deemed necessary., Conclusion: In patients with acute coronary syndrome, hand-held echocardiography provides comparable results to transthoracic echocardiography, can be more rapidly applied, and gives sufficient imaging information for decision-making in the vast majority of patients. Systematic echocardiography has clinical impact in half of patients, supporting the clinical utility of echocardiography in this population and providing an evidence base for current guidelines., Competing Interests: Conflict of interest: None declared., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Published
2024
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