Author/Editor		Borovšak, Zvonko
Title		Zdravljenje s krvnimi pripravki pri kritično bolnih gastroenteroloških bolnikih
Type		članek
Source		In: Bricl I, Lampreht N, editors. Zdravljenje s krvjo v gastroenterologiji in hepatologiji. Zbornik strokovnih prispevkov 7. podiplomski seminar Zdravljenje s krvjo; 2005 dec 9-10; Portorož. Ljubljana: Klinični center Ljubljana,
Publication year		2005
Volume		str. 65-77
Language		slo
Abstract		Introduction. Immediately after patients with severe head injury, critically ill gastroterological patients (CIGP) represent the second largest group of patients in the ICU. Treatment of CIGP with blood preparations is an everyday challenge since their use in these patients is most often unjustified and pointless. Patients. CIGP are those with gastroenterological diseases that fulfill the criteria for critical diseases as evaluated by one of the point systems for disease evaluation (APACHE II). They differ from other critically ill patients by their greater susceptibility to inflammation, which mostly leads to sepsis and multiorgan failure. The cause lies in the affection of the intestinal mucosa and the transition of bacteria from the intestinal lumen to the lymph nodes. The ensuing inflammation stimulates disturbances in coagulation stimulation. Conclusions. The course of treatment for CIGP is the same as in other critical cases in the ICU. The guidelines for thrombocyte replacement are established and no major deviations occur during the replacement. The use of fresh frozen plasma is increasing regardless of clear indications and of the fact that in at least one third of cases its use is unjustified. Studies have caused some confusion in the field of albumin replacement, so the decisions regarding replacement are left entirely to the judgment of the physician. Fibrinogen is replaced only rarely, and in agreement with a transfusiologist. The use of antithrombin III is decreasing in accordance with guidelines and is strictly monitored. Activated recombinant factor VIIa is used in cases of uncontrollable hemorrhage and according to protocol. In CIGP the consideration of guidelines for treatment with blood preparations decreases the possibility of misuse of a biological remedy. The decisions regarding the justification - usefulness of applying plasma components are made by the physician at the patients bedside.
Descriptors		GASTROINTESTINAL DISEASES CRITICAL ILLNESS BLOOD COMPONENT TRANSFUSION INTENSIVE CARE UNITS THROMBOCYTOPENIA PLATELET TRANSFUSION PLASMA ALBUMINS FACTOR VII ANTITHROMBIN III