Hospital Universitario La Paz

About: Hospital Universitario La Paz is a healthcare organization based out in Madrid, Spain. It is known for research contribution in the topics: Population & Medicine. The organization has 8960 authors who have published 11499 publications receiving 191509 citations.

Bleeding risk of surgery and its prevention in patients with inherited platelet disorders

Abstract: Excessive bleeding at surgery is a feared complication in patients with inherited platelet disorders. However, very few studies have evaluated the frequency of surgical bleeding in these hemorrhagic disorders. We performed a worldwide, multicentric, retrospective study to assess the bleeding complications of surgery, the preventive and therapeutic approaches adopted, and their efficacy in patients with inherited platelet disorders: the Surgery in Platelet disorders And Therapeutic Approach (SPATA) study. We rated the outcome of 829 surgical procedures carried out in 423 patients with well-defined forms of inherited platelet disorders: 238 inherited platelet function disorders and 185 inherited platelet number disorders. Frequency of surgical bleeding was high in patients with inherited platelet disorders (19.7%), with a significantly higher bleeding incidence in inherited platelet function disorders (24.8%) than in inherited platelet number disorders (13.4%). The frequency of bleeding varied according to the type of inherited platelet disorder, with biallelic Bernard Soulier syndrome having the highest occurrence (44.4%). Frequency of bleeding was predicted by a pre-operative World Health Organization bleeding score of 2 or higher. Some types of surgery were associated with a higher bleeding incidence, like cardiovascular and urological surgery. The use of pre-operative pro-hemostatic treatments was associated with a lower bleeding frequency in patients with inherited platelet function disorders but not in inherited platelet number disorders. Desmopressin, alone or with antifibrinolytic agents, was the preventive treatment associated with the lowest bleedings. Platelet transfusions were used more frequently in patients at higher bleeding risk. Surgical bleeding risk in inherited platelet disorders is substantial, especially in inherited platelet function disorders, and bleeding history, type of disorder, type of surgery and female sex are associated with higher bleeding frequency. Prophylactic pre-operative pro-hemostatic treatments appear to be required and are associated with a lower bleeding incidence.

Noninvasive continuous monitoring of the effects of head position on brain hemodynamics in ventilated infants.

Abstract: Hypothesis. Laying supine with the head in midline position improves cerebral venous return by preventing functional occlusion of the vessels of the neck. Objectives. To assess changes in cerebral blood volume (ΔCBV) and cerebral blood flow (CBF) with the position of the head in ventilated patients using a noninvasive method. The influence of the type of ventilation and birth weight was evaluated. Methods. Thirteen conventionally ventilated and 8 high-frequency oscillatory ventilated infants, with mean gestational ages and birth weights of 31 ± 5 weeks (24–38) and 1575 ± 803 g (560–3000), respectively, were studied 5.8 ± 7.8 days (1–33) after birth. ΔCBV (mL/100 g) and CBF (mL/100 g/min) were measured by near-infrared spectroscopy with the head in supine midline position (ΔCBVs, CBFs) and rotated 90° to one side (ΔCBVlat, CBFlat). Heart rate, peripheral saturation, transcutaneous Pco2, and blood pressure were monitored continuously. Ventilatory settings remained constant throughout the study period. Results. Mean ΔCBVs was lower than mean ΔCBVlat, although no changes in blood pressure, transcutaneous Pco2, oxygenation, or heart rate occurred. This change in ΔCBV was not associated with the type of ventilation or birth weight, but the differences tended to be greater (dΔCBV = ΔCBVlat−ΔCBVs) in the smallest infants ( Conclusion. The supine midline position of the head favors cerebral venous drainage and helps to prevent elevation of CBV. Speculation. This finding may be important in the first days of life, particularly in tiny preterm infants recovering from lung disease with improving lung compliance, in which functional obstruction of cerebral venous drainage should be avoided.