In Response to Colloids Use in Asian ICU Patients: Do not Mix Oranges with Apples. Consider the Proven Concerns on Hydroxyethyl Starch Use in ICU patients

How to cite this article: Ertmer C. In Response to Colloids Use in Asian ICU Patients: Do not Mix Oranges with Apples. Consider the Proven Concerns on Hydroxyethyl Starch Use in ICU Patients. Indian J Crit Care Med 2021;25(5):597.

SirWe would like to address the aforementioned points and thank the authors for giving us the opportunity to further elaborate on the topic. They raise an important issue when they point out that evidence concerning safety of different colloid solutions in the intensive care unit (ICU) is inconsistent. For example, there are no large interventional studies with gelatin in ICU patients, so these colloids rather lack substantial safety data that would allow the conclusion that they have a better safety record than hydroxyethyl starch (HES). Yet, our intention was not to provide an analysis of different colloids, but to get an overview of colloid use overall in the Asian ICU setting. As the authors of the letter mention themselves, HES was given to a minority of patients and therefore, the study does not allow any conclusions whether HES specifically provided any benefit or caused harm compared to other colloids. However, most colloids given in the RAFTA registry were used early and with comparably low dose. The studies that reported harm with HES (VISEP,¹ CHEST,² 6S³) have used high doses over prolonged time periods, which both were substantially above those reported in RAFTA. Possibly, as the intensivists in RAFTA were free to adapt their use of colloids to the individual situation instead of following a rigid study protocol, they were able to use colloids as they should be used—timely and with the minimal effective dose. In this context, as with all medication, the dose makes the poison. In fact, analysis of mixed colloid use is a valid scientific approach: the CRISTAL⁴ study, which collected data from an international ICU population that received timely fluid resuscitation with predominantly HES, gelatins, and albumin, found a comparable 28 days mortality and a reduced 90 days mortality with colloids vs crystalloids.The authors of the letter also seem to indicate that the sponsorship of the RAFTA registry by Fresenius Kabi is a somewhat dubious fact. They may be reminded that VISEP and 6S were sponsored by B. Braun, another manufacturer of HES solutions, and CHEST by Fresenius Kabi. The letter also seems to indicate that HES might have been used outside its indication. Again, they may be reminded that this was not a randomized study, but reflects best practice in a real world setting, where doctors decide what is best for each individual patient. There was a substantial number of patients without sepsis or chronic kidney disease, which makes it perfectly possible that intensivists decided individually that use of colloids and even of HES—which has not been banned completely in any country worldwide—might have been the right choice.The real issue with colloid therapy is the fact that colloids are a small part of a multimodal approach to stabilize hemodynamics in very ill patients. Of course, they have indications, contraindications, and dose-specific benefit and harm. Completely banning them in the setting of hemodynamic stabilization without reflecting the individual patient''s complex clinical situation might cause more harm than good. The intensivists participating in RAFTA seem to have been well aware of this fact.     

Report on Psychotherapy Audit in the NHS: How Long Do Patients Stay in Therapy?

The results of an audit project on treatment length from an NHS department of psychoanalytic psychotherapy are outlined. Average lengths of treatment in individual and group therapy are reported. A discrepancy was found between the 'prescribed' length of therapy and length of time actually spent in therapy. The change of practice prompted by the findings of this audit project is explained.     

Efficacy of Bronchoscopic Lung Volume Reduction by Endobronchial Valves in Patients with Heterogeneous Emphysema: Report on the First Asian Cases

Although many patients with severe emphysema have benefited from bronchoscopic lung volume reduction (BLVR) worldwide, experience of BLVR in Asian emphysema patients is scarce. Between July 2012 and March 2013, seven patients with advanced heterogeneous emphysema underwent BLVR in the Asan Medical Center. They had severe dyspnea and poor lung function (Modified Medical Research Council dyspnea scale 3-4; median forced expiratory volume in 1 sec [FEV₁], 0.59 L [19.0 % predicted]; median 6-min walk distance [6MWD], 195 m). Endobronchial valves were inserted into the target lobe which was most hyperinflated and least perfused, and had no collateral ventilation with other lobes. Six patients showed clinical improvement after 1 month. Of them, 2 patients improved to dyspnea scale 1 and 4 patients did to scale 2 (P = 0.026). The median FEV₁ increased from 0.59 to 0.89 L (51%; P = 0.028) and the median 6MWD increased from 195 to 252 m (29.2%; P = 0.028). Two patients developed a pneumothorax (one requiring drainage) and one patient experienced slight hemoptysis; however, there were no other serious adverse events. BLVR is effective in Asian advanced emphysema patients, with noted clinical improvements in lung function and exercise capacity.

Graphical Abstract

相似文献   

Adalimumab: A Review of Its Use in the Treatment of Patients with Ulcerative Colitis

Adalimumab is a fully human, recombinant, monoclonal IgG1 antibody specific for the cytokine tumor necrosis factor-α. It is approved for the treatment of patients with inflammatory diseases, including adults with moderately to severely active ulcerative colitis who are refractory to, or intolerant of, corticosteroids and/or immunomodulators. In two well-designed 8- and 52-week clinical trials in patients with moderately to severely active ulcerative colitis despite treatment with corticosteroids and/or immunomodulators, subcutaneous adalimumab (160 mg, week 0; 80 mg, week 2; 40 mg every other week starting at week 4) was more effective than placebo for inducing and maintaining clinical remission. A statistically significant effect size (albeit <10 %) over placebo for the remission per Mayo score (primary endpoint) was observed with adalimumab at 8 weeks in both trials and at 52 weeks in one trial. Compared with placebo, adalimumab was associated with reductions in hospitalizations and improvements in other secondary endpoints, including clinical response, mucosal healing, corticosteroid-sparing, and health-related quality of life measures. Additionally, an early response to adalimumab was shown to be predictive of long-term efficacy. Adalimumab was generally well tolerated, compared with placebo, during clinical trials in patients with ulcerative colitis; the adverse event profile was similar to that in patients with Crohn’s disease or other approved indications. Adalimumab provides a new treatment option for patients with moderately to severely active ulcerative colitis who are refractory to, or intolerant of, corticosteroids and/or immunomodulators.     

Medications and the Risk of Colorectal Cancer in Patients with Inflammatory Bowel Diseases: Use of the Landmark Method

PurposeThis study aimed to determine whether the use of drugs in the treatment of inflammatory bowel disease is related to the risk of colorectal cancer using a Cox proportional hazards model with the landmark method to minimize immortal time bias.Materials and MethodsThis study was conducted as national cohort-based study using data from Korea''s Health Insurance Corporation. Newly diagnosed patients with inflammatory bowel disease from 2006 to 2010 were monitored for colorectal cancer until 2015. Hazard ratios and 95% confidence intervals were calculated and compared with the incidence of colorectal cancer with or without medications by applying various landmark points.ResultsIn patients with Crohn''s disease, the prevention of colorectal cancer in the group exposed to immunomodulators was significant in the basic Cox model; however, the effect was not statistically significant in the model using the landmark method. The preventive effect of 5-aminosalicylic acid in patients with ulcerative colitis was significant in the basic and 6-month landmark point application models, but not in the remaining landmark application models.ConclusionIn patients with inflammatory bowel disease, the preventive effect of drug exposure on colorectal cancer varies depending on the application of the landmark method. Hence, the possibility of immortal time bias should be considered.     

Effect of Transport Time on the Use of Reperfusion Therapy for Patients with Acute Ischemic Stroke in Korea

BackgroundWe investigated the association between geographic proximity to hospitals and the administration rate of reperfusion therapy for acute ischemic stroke.MethodsWe identified patients with acute ischemic stroke who visited the hospital within 12 hours of symptom onset from a prospective nationwide multicenter stroke registry. Reperfusion therapy was classified as intravenous thrombolysis (IVT), endovascular therapy (EVT), or combined therapy. The association between the proportion of patients who were treated with reperfusion therapy and the ground transport time was evaluated using a spline regression analysis adjusted for patient-level characteristics. We also estimated the proportion of Korean population that lived within each 30-minute incremental service area from 67 stroke centers accredited by the Korean Stroke Society.ResultsOf 12,172 patients (mean age, 68 ± 13 years; men, 59.7%) who met the eligibility criteria, 96.5% lived within 90 minutes of ground transport time from the admitting hospital. The proportion of patients treated with IVT decreased significantly when stroke patients lived beyond 90 minutes of the transport time (P = 0.006). The proportion treated with EVT also showed a similar trend with the transport time. Based on the residential area, 98.4% of Korean population was accessible to 67 stroke centers within 90 minutes.ConclusionThe use of reperfusion therapy for acute stroke decreased when patients lived beyond 90 minutes of the ground transport time from the hospital. More than 95% of the South Korean population was accessible to 67 stroke centers within 90 minutes of the ground transport time.     

Transference‐focused Psychotherapy for Patients with Personality Disorders: Overview and Case Example with a Focus on the Use of Contracting

Transference‐focused psychotherapy (TFP) is a manualized treatment for patients with a personality disorder based on 18 months of once‐weekly or twice‐weekly therapy. TFP is suitable for publicly funded psychotherapy and private practice. Devised by Kernberg and colleagues, its conceptual framework is based on Kleinian theory of primitive defences in the paranoid schizoid position. A TFP ‘structural assessment’ is carried out before negotiating a treatment contract, which must be agreed before therapy can begin. Contracting addresses destructive acting‐out and isolative lifestyles, and requires a commitment to active engagement with therapy and its agreed aims. The therapist closely attends to relationships outside therapy and transference parallels. The goal is greater integration of the self and self‐object relations. In addition to changes in symptoms, TFP can lead to changes in patients’ defensive structures with concomitant shifts in personality structure, improved satisfaction in life, and fuller engagement in work and relationships. A case example is given of a patient with a withdrawn lifestyle. Her object relationships were interpreted as they unfolded in life outside therapy and in the transference, leading to personality structure changes which enabled her to be able to function successfully in work and in her personal relationships.     

Coxsackievirus induced myocarditis in mice: cardiac myosin autoantibodies do not cross-react with the virus.

After infection with Coxsackievirus B3 (CB3), H-2 congenic strains of mice on an A-background develop an immunologically mediated myocarditis associated with autoantibodies directed mainly against cardiac myosin. We tested these autoantibodies for cross-reactivity with the virus. Using immunoblotting and virus neutralizing assays with affinity purified antibodies and absorbed sera, we found that the autoantibodies to heart myosin did not cross react with CB3. In addition, myosin autoantibodies induced by immunization with cardiac myosin did not react with the virus. Western immunoblotting revealed that the anti-CB3 antibodies in the infected mice are directed against the capsid protein VP 2. We conclude that CB3 antigens do not stimulate an immune response that cross-reacts with cardiac myosin.     

Effect of Opioids on All-cause Mortality and Sustained Opioid Use in Elderly Patients with Hip Fracture: a Korea Nationwide Cohort Study

BackgroundThe purpose of our study was to assess the use of opioids before and after hip fracture in elderly patients in order to determine the effect of opioid use on all-cause mortality, and to analyze how the history of opioid use before fracture increases the risk of sustained use following hip fracture using a Korea nationwide cohort.MethodsOur study identified hip fracture patients from the Korean National Health Insurance Service-Senior cohort. The index date was defined as 90-days after admission to the acute care hospital that fulfilled the eligibility criteria of elderly hip fracture. Patients were classified into past user, current user, and sustained user according to the use of opioid at each period based on the time of admission and index date. The opioids were classified into strong opioids and tramadol. A generalized estimating equation model with a Poisson distribution and logarithmic link function was performed to estimate the adjusted rate ratios (aRRs) and 95% confidence intervals (CIs) to assess the association between past use and sustained use. A multivariable-adjusted Cox proportional hazard model was used to investigate the effects of strong opioid and tramadol use on all-cause mortality.ResultsA total of 12,927 patients were included in our study. There were 7,384 (57.12%) opioid past-users, 11,467 (88.71%) opioid current-users, and 7,172 (55.48%) sustained users. In comparison of the death risk according to current use or the defined daily dose of the opioids or past opioid use, there were no significant differences in the adjusted hazard ratio for death in all groups, compared to the current non-users (P > 0.05). Among survivors 1 year after hip fracture, opioid past-use increased the risk of opioid sustained use by 1.52-fold (aRR; 95% CI, 1.45–1.8; P < 0.001).ConclusionCurrent use and past use of opioid did not increase all-cause mortality after hip fracture in elderly patients over 65 years of age. Past use of opioid before hip fracture increased risk of sustained use of opioid compared to the current opioid used without past use.     

早期合并促大脑代谢药物治疗酒精所致老年精神障碍的作用

目的:探讨早期合并应用促大脑代谢药物在酒精所致精神和行为障碍治疗中的作用。方法:将72例使用酒精所致精神和行为障碍的老年患者随机分为早期合并应用促大脑代谢药物配合地西泮、奥氮平治疗组(研究组36例)和单纯使用地西泮、奥氮平治疗组(对照组36例),给予12周相应的治疗。分别于治疗前及治疗2、4、8、12周采用中文版简易智能状态检查(MMSE)、阳性症状与阴性症状量表(PANSS)、临床疗效总评量表病情严重程度(CGI-SI)、治疗时出现的症状量表(TESS)进行评定;患者出院后随访6及12个月观察患者的社会功能恢复情况及复饮率。结果:研究组和对照组分别有34例和32例完成12周疗程。治疗前两组患者的MMSE、PANSS评分差异无统计学意义;治疗后两组各时间点MMSE评分较前提升、PANSS评分较治疗前明显下降(P均0.01)。治疗2~4周末研究组MMSE评分明显高于对照组、PANSS评分明显低于对照组(P均0.01);8~12周两组间各量表评分及疗效比较差异无统计学意义。治疗6及12个月时研究组社会功能恢复情况显著高于对照组(χ~2=4.942,7.675;P均0.01);12个月时复饮率研究组显著低于对照组(χ~2=9.021,P0.01)。结论:早期合并应用促大脑代谢药物配合地西泮、奥氮平治疗能够更快地改善使用酒精所致精神和行为障碍患者的记忆及智能情况,提高患者的社会功能恢复程度,降低复饮率。     

Impact of Glycemic Control and Metformin Use on the Recurrence and Progression of Non-Muscle Invasive Bladder Cancer in Patients with Diabetes Mellitus

The purpose of the present study was to determine the potential relationships of glycemic control and use of metformin with non-muscle invasive bladder cancer characteristics. We reviewed data from 645 patients with non-muscle invasive bladder cancer between January 2004 and May 2015. We analyzed the association of pre and post-operative glycemic control and use of metformin with clinical characteristics of bladder tumors. We also analyzed the association of glycemic control and use of metformin with recurrence-free and progression-free survivals. Diabetes mellitus patients showed decreased recurrence-free survival (hazard ratio 1.42; 95% confidence interval 1.1–1.9; P = 0.021) and progression-free survival (hazard ratio 1.79; 95% confidence interval 1.1–2.8; P = 0.013). Diabetes mellitus patients with a HbA1c ≥ 7.0% demonstrated a higher rate of progression (P = 0.026). Kaplan-Meier analysis showed that progression-free survival rate was associated with poor baseline glycemic control (P = 0.026) and post-operative glycemic control (P = 0.025). However, use of metformin had no impact on the recurrence (P = 1.00) and progression (P = 0.282). In conclusion, poor baseline and post-operative glycemic control was related with shorter progression-free survival of patients with non-muscle invasive bladder cancer. Use of metformin had no impact on the recurrence and progression. Therefore, tight glycemic control and close follow-up for bladder tumor may be beneficial in patients with poor glycemic control.     

度洛西汀与舍曲林对老年抑郁症伴焦虑患者疗效对照研究

目的 探讨度洛西汀与舍曲林对老年抑郁症伴焦虑的疗效对照.方法 82例患者随机分为研究组和对照组,分别采用度洛西汀和舍曲林治疗6周.用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、临床疗效总评量表(CGI-S)分别在基线、治疗1、2、4和6周末进行疗效评定比较,运用副反应量表(TESS)评价药物的安全性.结...     

难治性抑郁症与非难治性抑郁症患者甲状腺激素水平的比较

目的 通过难治性抑郁症与非难治性抑郁症患者甲状腺激素水平的检测与比较,探讨甲状腺激素治疗难治性抑郁症的依据.方法 选取难治性抑郁症患者和非难治性抑郁症患者各32例,采用放射免疫法测定两组血清TSH,T3,FT3,T4,FT4水平.结果 难治性抑郁症组异常者18例,占56.25％,非难治性抑郁症组异常者5例,占15.63...     

Use of an improved E. coli method for the measurement of cobalamin in serum: comparison with the E. gracilis assay results

Owing to the higher serum cobalamin results that are obtained by R-binder radioisotopic dilution assay compared to microbiological assays (E. gracilis and L. leichmannii) it was suggested that serum contained a cobamide(s) that could not be detected by the more specific microbiological assays and that a much less specific test organism, which responds to most naturally occurring cobamides, such as the cobamide-dependent E. coli mutant, might respond to these cobamide(s) in serum. In an attempt to investigate this possibility an improved and simplified E. coli assay for the measurement of cobamide in serum was developed. The method is described, and the results obtained in normal subjects, in patients with megaloblastic anemia, and in anaemic pregnant women not suffering from megaloblastic anaemia are reported and compared with E. gracilis assay results.     

Patients with new onset haematuria: assessing the discriminant value of clinical information in relation to urological malignancies.

BACKGROUND: There is little information available to assist general practitioners (GPs) in deciding which patients with haematuria are likely to have a malignancy. AIM: To derive discriminant functions for specific items or clusters of clinical history information in relation to the categorisation of patients presenting to the 'open access' haematuria clinic in Hull. DESIGN OF STUDY: Recruitment of patients via an 'open-access' haematuria clinic. SETTING: A consecutive series of 363 patients aged between 18 and 80 years who attended the clinic. METHOD: Between February 1999 and October 1999 clinical history information derived from the participating patients was compared with the patients' diagnoses. Diagnoses were established by a combination of cystoscopy and radiological assessments and rechecked against the patient records and the hospital patient administration system two to three months later. RESULTS: A number of individual variables seemed to be particularly helpful in discriminating malignancies. However, when indicants were combined using regression shrinkage techniques, only the following variables were preserved: age, sex, type of haematuria, number of episodes of haematuria, hesitancy, poor urinary stream, smoking history, and history of urinary tract infections. CONCLUSION: It is possible to generate helpful discriminant information to assist GPs in making more appropriate decisions in a difficult area of clinical practice. However, it remains a matter of judgement as to how representative the study population is likely to be compared with all haematuria patients encountered in primary care. We have reasonable confidence in the general applicability of the rules for macroscopic haematuria: however, it seems likely that the prediction rules outlined for microscopic haematuria have their greatest relevance once a patient has been referred by a GP. In developing the work further and testing out the discriminators identified in this study, we propose that a primary care-based project now needs to be undertaken focusing on microscopic haematuria with a particular emphasis on addressing selection biases. In addition, there is a more general need to assess the reliability of all the suggested items of clinical discriminant information.     

IL-15联合其他细胞因子对MDS患者CD34~+细胞体外增殖、分化的影响

为了探讨IL 1 5与其他细胞因子联合应用对体外培养的MDS患者CD34+ 细胞增殖和分化的影响。应用单克隆抗体(mAb )免疫磁珠系统分离CD34+ 细胞 ,实验分为IL 1 5加其他细胞因子的实验组和不加其他细胞因子的单独应用IL 1 5的对照组 ,用液体培养基和甲基纤维素半固体培养基培养 ,计数培养后细胞数和CFU E、BFU E、CFU GM、CFU GEMM的集落形成数。用流式细胞术检测上述培养细胞上各种表型分子CD33、CD1 3、CD71、CD1 9、CD3表达的变化和细胞周期的改变。结果显示IL 1 5与其他细胞因子联合应用的实验组作用于MDS患者CD34+ 细胞 ,培养 6d的细胞计数显示 ,细胞增殖倍数对照组为 4 0倍 ,实验组为 7 8倍 ;各祖细胞集落形成率实验组均明显多于对照组 ;培养细胞上各表型分子 (CD3除外 )的表达率实验组均明显高于对照组 ;IL 1 5加其他细胞因子联合应用后CD34+ 细胞的细胞周期G1 、S、G2 期的比率均有明显变化 ,与对照组相比较 ,差异显著。IL 1 5与其他细胞因子联合应用比单独应用IL 1 5对MDS患者CD34+ 细胞有明显地促增殖和诱导分化的效应。     

喹硫平与奥氮平治疗老年期痴呆伴行为和精神障碍的对照研究

目的 探讨喹硫平与奥氮平治疗老年期痴呆伴行为和精神障碍(BPSD)的疗效及不良反应.方法 将86例BPSD患者分为喹硫平组与奥氮平组,治疗8周.在治疗前、治疗2,4,8周末,采用痴呆病理行为评定量表(BEHAVE-AD)评定疗效,简易精神状况量表(MMSE)评定患者痴呆状况,日常生活能力量表(ADL)评定患者生活质量,...