Implementation of a comprehensive unit-based safety program to reduce surgical site infections in cesarean delivery.

Background: To evaluate whether using a comprehensive and multidisciplinary approach to implement an evidence-based bundle can reduce 30-day surgical site infection rates in women undergoing cesarean delivery.

Methods: This observational study with a preintervention and postintervention design included 2576 consecutive women undergoing cesarean delivery at our tertiary care hospital between January 1, 2013 and December 31, 2017. The primary outcome was 30-day surgical site infection rate after cesarean delivery defined according to the Centers for Disease Control and Prevention criteria.

[Definitions, decision-making and documentation in end of life situations in the intensive care unit].

The present work provides assistance for physicians concerning decision making in clinical borderline situations in the ICU. Based on a structured checklist the two fundamental aspects of any medical decision, the medical indication and the patient's preference are queried in a systematic way. Four possible steps of withholding and/or withdrawing therapy are discussed.

[Coagulation management in trauma-related massive bleeding. - Recommendations of the Task Force for Coagulation (AGPG) of the Austrian Society of Anesthesiology, Resuscitation and Intensive Care Medicine (OGARI)].

Even nowadays and at specialized centers, one of the leading causes of death is exsanguination. Trauma-induced coagulopathy (TIC) occuring with massive blood loss primarily results from loss of coagualtion factors and platelets and is aggravated by hemodilution. In addition, hyperfibrinolysis, hypothermia, acidosis and hypocalcaemia also contribute to the development of severe haemostatic derangement.

Airway stenosis-related increase of pulmonary pressure during high-frequency jet ventilation depends on injector's position.

Background: High-frequency jet ventilation (HFJV) can lead to high-airway pressures under certain conditions. In this laboratory study, we evaluated the influence of the injector's position relative to a fixed airway obstruction on peak pressures in a tracheal-lung model.

Methods: We administered HFJV via a metal jet injector at varying distances from connectors simulating laryngotracheal airway stenosis.

Evaluation of antiinflammatory and antiadhesive effects of heparins in human endotoxemia.

Objective: Cytokines and adhesion molecules have a decisive role in the development of early inflammatory response as well as the late sequelae of sepsis. Because L-selectin-deficient mice are protected from lethal endotoxemia, blockade of L-selectin may provide a useful therapeutic option in human sepsis. Heparin has immunomodulatory properties and effectively inhibits L- and P-selectin binding in vitro.

Point of care measurement of lepirudin and heparin anticoagulation during systemic inflammation.

Background: The number of indications for recombinant human hirudin lepirudin therapy has increased in recent years, and now includes acute coronary syndromes and heparin-induced thrombocytopenia. Hence, point of care monitoring appears desirable for therapy with lepirudin. As CoaguChek Plus (CCP) provides a rapid bedside test to monitor therapy with other anticoagulants, we aimed to determine its suitability for lepirudin therapy.

Effect of factor X inhibition on coagulation activation and cytokine induction in human systemic inflammation.

Anticoagulants have gained increasing attention in the treatment of sepsis. This study used danaparoid to investigate the role of factor Xa in endotoxin-induced coagulation and inflammation and its effectiveness when coagulation activation has already occurred. Thirty healthy volunteers were enrolled in the randomized, placebo-controlled trial.

Acenocoumarol decreases tissue factor-dependent coagulation during systemic inflammation in humans.

Background: Coumarin derivatives are still widely used for prophylaxis of thromboembolic events and therefore represent important comparator substances for new anticoagulants. Measurement of the efficacy of such novel compounds in a human coagulation model with adequate biomarkers could be useful for early-phase clinical drug development. To evaluate the applicability of a well-established model of tissue factor-dependent coagulation for defining anticoagulant potency, we investigated the effects of acenocoumarol in experimental human endotoxemia.