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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Prehospital monitoring in resuscitation : today and the future

Abstract

There is growing evidence that early detection and response to physiological deterioration can improve outcome for patients. Working out-of-hospital, we often find ourselves in diagnostic dilemmas, thus more reliable data could change our actions as well as give better assessment of patient’s condition. Therefore, we are always exploring new perspectives that could be transferred from experimental laboratory settings to our primary working area in the field to help us improve decision-making leading to better outcome. In the following sections, we represent our previous studies about the utility of continuous capnometry and the importance of point-of-care ultrasound in cardiopulmonary resuscitation (CPR), and discuss about the possible future use of transthoracic and transesophageal ultrasound, point-of-care biochemical monitoring, tissue oxygen saturation, pupillometry, and mixed and central venous oxygen saturation monitoring in the prehospital setting.

Keywords: cardiopulmonary resuscitation, pre-hospital monitoring, capnometry, point-of care ultrasound and biochemical monitoring, pupillometry, mixed and central venous oxygen saturation, review

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Human protein C concentrate in pediatric septic patients

Abstract

Severe sepsis and septic shock are leading causes of morbidity and mortality in the pediatric population. Unlike what is suggested for the adult population, recombinant human activated protein C (rhAPC) is contraindicated in children. Long before rhAPC was considered for use in pediatric patients, case reports appeared on the safe administration of protein C zymogen. Therefore, we conducted a systemic review of currently available data on protein C zymogen (PC) use among children affected by severe sepsis or septic shock.

A total number of 13 case series or case reports and a dose-finding study were found on the use of PC in the pediatric intensive care unit, reporting on 118 treated children, with an overall survival of 84%. There was no bleeding complication, the only reported complication being a single mild allergic reaction.

These studies show that PC is safe, not associated with bleeding and possibly useful for improving coagulation abnormalities of sepsis.

 

Key words: sepsis, pediatric, protein C, drug therapy, review

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