Abstract:
OBJECTIVE:There are a number of potential etiologies of severe bleeding encountered in the intensive care unit. Although rare, acquired hemophilia is one such etiology that often presents with major bleeding requiring intensive care. Despite the introduction of effective treatments, the reported mortality rate of patients with acquired hemophilia ranges from 6 to 8% and is in part attributable to sequential delays in diagnosis and appropriate treatment. The purpose of this review is to familiarize the intensive care specialist with this underrecognized cause of bleeding, with an emphasis on diagnosis and treatment. METHODS:As the objective of this article was to provide a concise overview of the diagnosis and management of acquired hemophilia, a directed search of English-language literature was undertaken using the PubMed database, targeting such topics as the differential diagnosis of bleeding in the intensive care unit and the epidemiology, diagnosis, and treatment of acquired hemophilia. Clinical study findings pertaining to the efficacy of specific treatments for acquired hemophilia were summarized. RESULTS AND CONCLUSION:Recognition of acquired hemophilia presents a clinical challenge, given the rarity of this condition, a general lack of familiarity with acquired hemophilia, and the potential for confusion with other more common causes of bleeding in the intensive care unit. Nevertheless, there are sentinel clinical and laboratory findings that should raise suspicion of this diagnosis. The treatment of acquired hemophilia is a multi-step, physiologically focused process aimed at controlling both active and recurrent bleeding. Therefore, prompt diagnosis is central to prognosis. Consultation with a hematologist may facilitate efficient diagnosis and management.
journal_name
Intensive Care Medjournal_title
Intensive care medicineauthors
Shander A,Walsh CE,Cromwell Cdoi
10.1007/s00134-011-2258-5subject
Has Abstractpub_date
2011-08-01 00:00:00pages
1240-9issue
8eissn
0342-4642issn
1432-1238journal_volume
37pub_type
杂志文章,评审abstract::Intravenous bolus endotoxin elicits a marked but transient increase in plasma TxB2 and 6-keto-PGF1 alpha in a large number of species. A smaller, delayed and more prolonged increase in TxB2 and 6-keto-PGF1 alpha are reported in animals with septic shock, i.e., those with fecal peritonitis or cecal ligation. Thromboxan...
journal_title:Intensive care medicine
pub_type: 杂志文章,评审
doi:10.1007/BF00254925
更新日期:1986-01-01 00:00:00
abstract::During the last two decades, severe group A beta-haemolytic streptococcal infections have been defined as the "toxic strep syndrome", and have been reported not only in immunocompromised or elderly people, but also occasionally in previously healthy patients. We describe 4 patients presenting with the toxic strep synd...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01709279
更新日期:1993-01-01 00:00:00
abstract:PURPOSE:The aim of our study was to explore, using an innovative method, the effect of temporal changes in the mortality prediction performance of an existing model on the quality of care assessment. The prognostic model (rSAPS-II) was a recalibrated Simplified Acute Physiology Score-II model developed for very elderly...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-011-2390-2
更新日期:2012-01-01 00:00:00
abstract:: ...
journal_title:Intensive care medicine
pub_type: 评论,社论
doi:10.1007/s00134-018-5399-y
更新日期:2018-11-01 00:00:00
abstract:OBJECTIVE:To compare available instruments for assessing delirium in critically ill adults that have undergone validity testing and provide clinicians with strategies to incorporate these instruments into clinical practice. DESIGN:Medline (1966-September 2006) was searched using the key words: delirium, cognitive dysf...
journal_title:Intensive care medicine
pub_type: 杂志文章,评审
doi:10.1007/s00134-007-0603-5
更新日期:2007-06-01 00:00:00
abstract:OBJECTIVE:Inhalation of nitric oxide (NO) can improve oxygenation and decrease mean pulmonary artery pressure (MPAP) in patients with the acute respiratory distress syndrome (ARDS). It is not known whether inhaled NO exerts a similar effect in hypoxemic patients with chronic obstructive pulmonary disease (COPD). DESIG...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340050290
更新日期:1997-01-01 00:00:00
abstract::Knowledge translation is an important step for translational research. In this issue of Intensive Care Medicine, a new mini-series of basic research-related reviews is published. Three invited reviews focus on the role of extracellular matrix in ventilator-induced lung injury and mechanotransduction. The major challen...
journal_title:Intensive care medicine
pub_type: 评论,社论
doi:10.1007/s00134-007-0965-8
更新日期:2008-04-01 00:00:00
abstract::The pharmacokinetics of theophylline and ethylenediamine were examined in 6 patients with septicaemia and multiorgan failure (MOF). The patients received a bolus injection of 4 mg/kg aminophylline. Aminophylline is the ethylenediamine salt of theophylline. The clearance of theophylline was reduced in all our patients ...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01690768
更新日期:1991-01-01 00:00:00
abstract:OBJECTIVE:To assess the safety and efficacy of sustained inflations (SI) as lung recruitment maneuvers (RMs) in ventilated pediatric intensive care unit (PICU) patients. DESIGN:Observational, prospective data collection. SETTING:Tertiary-care PICU. PATIENTS AND PARTICIPANTS:Thirty-two consecutive ventilated pediatri...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-007-0764-2
更新日期:2007-10-01 00:00:00
abstract:OBJECTIVE:The most recent approach to estimate nursing resources consumption has led to the generation of the Nine Equivalents of Nursing Manpower use Score (NEMS). The objective of this prospective study was to establish a completely automatically generated calculation of the NEMS using a patient data management syste...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-004-2239-z
更新日期:2004-07-01 00:00:00
abstract::608 patients admitted to a general Intensive Care Unit (ICU) over a 30 month period were analyzed according to the Apache II Severity of Disease Classification System on day one of admission. Hospital outcome details were available on 583 patients in the series. The mean Apache II scores for survivors (396) and non-su...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF00263531
更新日期:1988-01-01 00:00:00
abstract:OBJECTIVE:To examine the attitudes of the general public regarding who should decide about the withdrawal of life support and to compare these attitudes with those of intensive care personnel. DESIGN:Nationwide postal questionnaire survey. SETTING:Sweden. PARTICIPANTS:One thousand one hundred ninety-six randomly sel...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340050987
更新日期:1999-09-01 00:00:00
abstract:PURPOSE:We examined whether influenza vaccination affects 1-year risk of myocardial infarction, stroke, heart failure, pneumonia, and death among intensive care unit (ICU) survivors aged ≥ 65 years. METHODS:Danish Intensive Care Database data on all elderly ( ≥ 65 years) patients hospitalized in Danish ICUs in the per...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-019-05648-4
更新日期:2019-07-01 00:00:00
abstract:OBJECTIVE:The Pediatric Index of Mortality 2 (PIM2), one of the key mortality prediction models for children in intensive care units, has not been validated in Japan. The purpose of this study was to validate the performance of PIM2 in a population of patients admitted to one pediatric intensive care unit (PICU) in Jap...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-011-2460-5
更新日期:2012-04-01 00:00:00
abstract:OBJECTIVES:Inhalation of nitric oxide (NO) selectively dilates pulmonary vessels in well-ventilated regions. Prostaglandin F2 alpha (PGF2 alpha) is a vasoconstrictor and is reported to enhance hypoxic pulmonary vasoconstriction. The objective of this study was to examine whether the combination of intravenous PGF2 alph...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01709742
更新日期:1996-07-01 00:00:00
abstract:OBJECTIVE:To evaluate the extent to which respiratory changes in inferior vena cava (IVC) diameter can be used to predict fluid responsiveness. DESIGN:Prospective clinical study. SETTING:Hospital intensive care unit. PATIENTS:Twenty-three patients with acute circulatory failure related to sepsis and mechanically ven...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章
doi:10.1007/s00134-004-2259-8
更新日期:2004-09-01 00:00:00
abstract:PURPOSE:Extracorporeal membrane oxygenation (ECMO) can support oxygenation and carbon dioxide elimination in severe lung failure. Usually it is accompanied by controlled mechanical ventilation. Neurally adjusted ventilatory assist (NAVA) is a new mode of ventilation triggered by the diaphragmatic electrical activity an...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-010-1982-6
更新日期:2010-12-01 00:00:00
abstract:BACKGROUND:Dislocation of the heart is a rare complication of thoracic blunt trauma. A high index of suspicion of pericardium rupture is necessary to formulate an early diagnosis to reduce morbidity and mortality. PATIENTS:A 23-year-old man suffered a blunt thoracoabdominal trauma and was admitted 3 days later to a un...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-002-1328-0
更新日期:2002-07-01 00:00:00
abstract:PURPOSE:During neurally adjusted ventilatory assist (NAVA) the ventilator is driven by the patients electrical activation of the diaphragm (EAdi), detected by a special esophageal catheter. A reliable positioning of the EAdi-catheter is mandatory to trace a representative EAdi signal. We aimed to determine whether a fo...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-009-1587-0
更新日期:2009-10-01 00:00:00
abstract::Several different epidemiological typing methods have been used in studies of coagulase-negative staphylococci; these include biotyping, antibiotic susceptibility pattern analysis, serological typing, phage typing, slime production detection, protein profile analysis, immunoblot fingerprinting and DNA typing. The most...
journal_title:Intensive care medicine
pub_type: 杂志文章,评审
doi:10.1007/BF01694703
更新日期:1993-01-01 00:00:00
abstract:PURPOSE:The aim of this study is to examine family members' experiences of end-of-life decision-making processes in Norwegian intensive care units (ICUs) to ascertain the degree to which they felt included in the decision-making process and whether they received necessary information. Were they asked about the patient'...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-011-2253-x
更新日期:2011-07-01 00:00:00
abstract::Hepatic encephalopathy is a complex neuropsychiatric syndrome associated with acute, subacute and chronic liver failure, involving increased neural inhibition by activation of the GABA/benzodiazepine inhibitory neurotransmitter system. Improvement by GABA and benzodiazepine receptor antagonists as well as by chloride ...
journal_title:Intensive care medicine
pub_type: 杂志文章,评审
doi:10.1007/BF01731153
更新日期:1991-01-01 00:00:00
abstract::In alcoholic patients, metabolic acidosis can be related to lactate acidosis associated with sepsis or thiamine deficiency, ketoacidosis, methanol or ethylene glycol poisoning. High resolution proton nuclear magnetic resonance (NMR) can be used to detect abnormal organic acid metabolites in urine or serum from patient...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340100892
更新日期:2001-04-01 00:00:00
abstract:OBJECTIVE:Interhospital transfers of critically ill pediatric patients in The Netherlands are accompanied by referring specialists or by specialist retrieval teams. We compared the interventions before and directly after transports and the complications and the equipment available during transports in the two groups. ...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-003-2066-7
更新日期:2004-02-01 00:00:00
abstract:OBJECTIVE:The study was undertaken to determine if critically ill patients under mechanical ventilation could reactivate latent cytomegalovirus (CMV) in either lung or blood. DESIGN:Prospective study in critically ill patients was performed in a multidisciplinary intensive care unit in a university hospital. PATIENTS...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01709343
更新日期:1996-11-01 00:00:00
abstract::In order to evaluate the in vitro activity of fleroxacin against nosocomial gram-negative organisms, 263 multiresistant gram-negative bacilli (203 Enterobacteriaceae and 60 non-fermenting gram-negative bacilli) were isolated from adult patients with nosocomial infections. The different patterns of resistance to eight ...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340050675
更新日期:1998-08-01 00:00:00
abstract:OBJECTIVE:To determine the diagnostic performance of a Bayesian Decision-Support System (BDSS) for ventilator-associated pneumonia (VAP). DESIGN:A previously developed BDSS, automatically obtaining patient data from patient information systems, provides likelihood predictions of VAP. In a prospectively studied cohort ...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-007-0728-6
更新日期:2007-08-01 00:00:00
abstract:OBJECTIVE:Biomarkers allowing accurate early staging of septic shock patients are lacking despite their obvious interest for patient management. Experimental models of septic shock in mouse previously noted a decrease in dendritic cell numbers. The aim of the study was to find a rapid reproducible biological test for a...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-006-0436-7
更新日期:2007-01-01 00:00:00
abstract:PURPOSE:To evaluate the diagnostic accuracy of ultrasonography of optic nerve sheath diameter (ONSD) for assessment of intracranial hypertension. METHODS:Systematic review without language restriction based on electronic databases, with manual review of literature and conference proceedings until July 2010. Studies we...
journal_title:Intensive care medicine
pub_type: 杂志文章,meta分析,评审
doi:10.1007/s00134-011-2224-2
更新日期:2011-07-01 00:00:00
abstract:OBJECTIVE:To define the mechanisms of the stable and prolonged post-operative plasma volume expansion observed with Hydroxyethyl Starches (HES) and to determine whether a partial intravascular hydrolysis of large molecules contribute to reinforce the colloid-osmotic effect. DESIGN:Prospective, pharmacologic study usin...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章
doi:10.1007/BF01700163
更新日期:1995-07-01 00:00:00