Abstract:
OBJECTIVE:To date, no study has systematically investigated the impact of drowning-induced asphyxia on hemostasis. Our objective was to test the hypothesis that asphyxia induces bleeding by hyperfibrinolytic disseminated intravascular coagulation. DESIGN:Observational study. SETTING:A 2,100-bed tertiary care facility in Vienna, Austria, Europe. PATIENTS:All cases of drowning-induced asphyxia (n=49) were compared with other patients with cardiopulmonary resuscitation (n=116) and to patients with acute promyelocytic leukemia (n=83). Six drowning victims were investigated prospectively. To study the mechanism, a forearm-ischemia model was used in 20 volunteers to investigate whether hypoxia releases tissue plasminogen activator. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:Eighty percent of patients with drowning-induced asphyxia developed overt disseminated intravascular coagulation within 24 hours. When compared with nondrowning cardiac arrest patients, drowning patients had a 13 times higher prevalence of overt disseminated intravascular coagulation at admission (55% vs 4%; p<0.001). Despite comparable disseminated intravascular coagulation scores, acute promyelocytic leukemia patients had higher fibrinogen but lower d-dimer levels and platelet counts than drowning patients (p<0.001). Drowning victims had a three-fold longer activated partial thromboplastin time (124 s; p<0.001) than both nondrowning cardiac arrest and acute promyelocytic leukemia patients. Hyperfibrinolysis was reflected by up to 1,000-fold increased d-dimer levels, greater than 5-fold elevated plasmin antiplasmin levels, and a complete absence of thrombelastometric clotting patterns, which was reversed by antifibrinolytics and heparinase. Thirty minutes of forearm-ischemia increased tissue plasminogen activator 31-fold (p<0.001). CONCLUSIONS:The vast majority of drowning patients develops overt hyperfibrinolytic disseminated intravascular coagulation, partly caused by hypoxia induced tissue plasminogen activator release. Antifibrinolytics and heparinase partially reverse the abnormal clotting patterns. Severe activated partial thromboplastin time prolongation may be a marker of combined hyperfibrinolytic afibrinogenemia and autoheparinization in drowning-related asphyxia.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Schwameis M,Schober A,Schörgenhofer C,Sperr WR,Schöchl H,Janata-Schwatczek K,Kürkciyan EI,Sterz F,Jilma Bdoi
10.1097/CCM.0000000000001273subject
Has Abstractpub_date
2015-11-01 00:00:00pages
2394-402issue
11eissn
0090-3493issn
1530-0293journal_volume
43pub_type
杂志文章abstract::Several variables may account for the response of electrochemical skin surface PO2 sensors to anesthetic gases: cathode material and size, pH of the electrolyte and membrane material. These variables cannot be chosen arbitrarily and their influence has been tested with two types of sensors. In one type (LSC), a large ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198110000-00010
更新日期:1981-10-01 00:00:00
abstract::One hundred patients were ventilated with high-frequency jet ventilation (HFJV) during the initial 24-h postoperative period in the surgical and neurosurgical ICUs. Eighty-three were successfully weaned, 2 could not be ventilated adequately with HFJV, and 15 with criteria of acute respiratory failure received HFJV for...
journal_title:Critical care medicine
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doi:10.1097/00003246-198409000-00022
更新日期:1984-09-01 00:00:00
abstract:OBJECTIVE:To investigate the association of collaboration between intensive care unit (ICU) physicians and nurses and patient outcome. DESIGN:Prospective, descriptive, correlational study using self-report instruments. SETTINGS:A community teaching hospital medical ICU, a university teaching hospital surgical ICU, an...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/00003246-199909000-00045
更新日期:1999-09-01 00:00:00
abstract:OBJECTIVE:The clinical value of stroke volume variations to assess intravascular fluid status in critically ill patients is well known. Electrical impedance tomography is a noninvasive monitoring technology that has been primarily used to assess ventilation. We investigated the potential of electrical impedance tomogra...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3182227e65
更新日期:2011-09-01 00:00:00
abstract::One hundred six early features were retrospectively collected on 44 patients with acute pancreatitis and stored in a database programmed on a microcomputer. Intraoperative/autopsy findings or clinical course categorized patients as having severe (n = 16) or mild (n = 28) pancreatitis. The frequency of 88 early availab...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198904000-00004
更新日期:1989-04-01 00:00:00
abstract:OBJECTIVE:Recent studies have demonstrated the therapeutic effectiveness and pharmacologic mechanisms of hyperbaric oxygen therapy (HBOT) in the treatment of a systemic shock state. To elucidate the in vivo role of HBOT during sepsis, we evaluated the effects of HBOT on intestinal mucosal injury and bacterial transloca...
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更新日期:2004-08-01 00:00:00
abstract::The objectives of this article were to review the causes and extent of hospital-associated infectious diarrhea and associated risks in the general hospital ward and intensive care unit (ICU), to compare microorganisms with similar symptoms to aid in recognition that will lead to timely and appropriate treatment and co...
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journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199109000-00004
更新日期:1991-09-01 00:00:00
abstract:OBJECTIVE:Intravesical pressure measurement is considered to be the gold standard for the assessment of intra-abdominal pressure. However, this method is indirect and depends on a physiologic bladder function. We evaluated a modified piezoresistive technique and a water-capsule technique for direct and continuous intra...
journal_title:Critical care medicine
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doi:10.1097/01.CCM.0000198526.04530.36
更新日期:2006-03-01 00:00:00
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journal_title:Critical care medicine
pub_type: 杂志文章,随机对照试验
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更新日期:2007-11-01 00:00:00
abstract:OBJECTIVES:To evaluate knowledge translation after publication of the target temperature management 33°C versus 36°C after out-of-hospital cardiac arrest trial and associated patient outcomes. Our primary hypothesis was that target temperature management at 36°C was rapidly adopted in Australian and New Zealand ICUs. S...
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doi:10.1097/CCM.0000000000003339
更新日期:2018-11-01 00:00:00
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pub_type: 杂志文章,评审
doi:10.1097/00003246-200301001-00001
更新日期:2003-01-01 00:00:00
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doi:10.1097/01.CCM.0000104950.52577.97
更新日期:2004-02-01 00:00:00
abstract:OBJECTIVE:To elucidate sources of variability in the estimate of treatment effects in a successful phase 3 trial in severe sepsis and to assess their implications on the design of future clinical trials. DESIGN:Retrospective evaluation of prospectively defined subgroups from a large phase 3, placebo-controlled clinica...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1097/01.ccm.0000147440.71142.ac
更新日期:2004-12-01 00:00:00
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pub_type: 杂志文章,评审
doi:10.1097/ccm.0b013e3181b9e8b3
更新日期:2010-02-01 00:00:00
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doi:10.1097/00003246-199606000-00025
更新日期:1996-06-01 00:00:00
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doi:10.1097/CCM.0b013e31824e6750
更新日期:2012-07-01 00:00:00
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doi:10.1097/CCM.0b013e31828a6688
更新日期:2013-11-01 00:00:00
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journal_title:Critical care medicine
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doi:10.1097/00003246-198612000-00001
更新日期:1986-12-01 00:00:00
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doi:10.1097/00003246-198712000-00009
更新日期:1987-12-01 00:00:00
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journal_title:Critical care medicine
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doi:10.1097/00003246-198507000-00001
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更新日期:2015-11-01 00:00:00
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更新日期:2015-01-01 00:00:00
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journal_title:Critical care medicine
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doi:10.1097/00003246-199604000-00009
更新日期:1996-04-01 00:00:00
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doi:10.1097/00003246-200111000-00022
更新日期:2001-11-01 00:00:00
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pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:2004-04-01 00:00:00
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journal_title:Critical care medicine
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更新日期:1977-01-01 00:00:00
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journal_title:Critical care medicine
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更新日期:2001-03-01 00:00:00
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更新日期:1999-01-01 00:00:00
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更新日期:2007-03-01 00:00:00