surgical critical care philip goodney, md october 26th, 2005
TRANSCRIPT
![Page 1: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/1.jpg)
Surgical Critical Care
Philip Goodney, MD
October 26th, 2005
![Page 2: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/2.jpg)
Format
• Question and Answer (multiple choice)
• Review of reading in Sabiston and Greenfield Chapter
![Page 3: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/3.jpg)
Neurologic dysfunction
• Which criteria is NOT necessary to declare brain death? – A: absence of cerebral function
– B: absence of pupillary light reflex
– C: absence of corneal reflex
– D: absence of vestibulo-ocular reflex
– E: absence of radio-isotope uptake on brain scan
– F: absence of oropharyngeal reflex
– G: apnea in the presence of “adequate stimulation” (PaCO2
> 60 mm Hg for 30 seconds).
![Page 4: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/4.jpg)
Neurologic dysfunction
• Which criteria is NOT necessary to declare brain death? – A: absence of cerebral function – B: absence of pupillary light reflex – C: absence of corneal reflex – D: absence of vestibulo-ocular reflex – E: absence of radio-isotope uptake on brain scan– F: absence of oropharyngeal reflex – G: apnea in the presence of “adequate stimulation” (PaCO2
> 60 mm Hg for 30 seconds). – Provides supportive evidence only.
![Page 5: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/5.jpg)
Neurologic dysfunction
– Damage to the midbrain affects level of consciousness via the
a) the reticular activating system
b) Cerebral cortex
c) Uncus
d) Internal capsule
![Page 6: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/6.jpg)
Neurologic dysfunction
– Damage to the midbrain affects level of consciousness via the
a) the reticular activating system
b) Cerebral cortex
c) Uncus
d) Internal capsule
![Page 7: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/7.jpg)
Neurologic dysfunction
– Depolarizing neuromuscular blockers mimic
a) Vecuronium
b) Cisatricurium
c) Acetylcholine
d) Pseudocholineserase
![Page 8: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/8.jpg)
Neurologic dysfunction
– Depolarizing neuromuscular blockers mimic
a) Vecuronium
b) Cisatricurium
c) Acetylcholine
d) Pseudocholineserase
Succinylcholine, the only available depolarizing NMB, works by binding the acetylcholine receptors and causing depolarization (clinically seen as muscle fasciculations). Succinylcholine is characterized by a rapid onset and short half-life; it is most useful for short invasive procedures
![Page 9: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/9.jpg)
Neurologic dysfunction
• A dose of vecuronium lasts for ___ minutes, and is cleared by the _____.
a) 15 / liver
b) 90 / kidneys
c) 10 / plasma ester hydrolysis
d) 30 / liver and kidneys
![Page 10: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/10.jpg)
Neurologic dysfunction
• A dose of vecuronium lasts for ___ minutes, and is cleared by the _____.
a) 15 / liver
b) 90 / kidneys
c) 10 / plasma ester hydrolysis
d) 30 / liver and kidneysVec – 30 minutes, longer in px with hepatic/renal dysfunc
Panc: 90 min, don’t use in px with cardiac dx b/c vagolytic
Atricur/cistatricur: eliminated by plasma ester hydrolysis, so useful in patients with liver/kidney dysfunction
![Page 11: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/11.jpg)
Cardiovascular dysfunction
• Patients who require afterload reduction with nitroprusside warrant observation for cyanide toxicity, as cyanide is a breakdown product of nitroprusside. How is it detected?
![Page 12: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/12.jpg)
Cardiovascular dysfunction
• Patients who require afterload reduction with nitroprusside warrant observation for cyanide toxicity, as cyanide is a breakdown product of nitroprusside. How is it detected?– Elevated mixed venous oxygen saturation
![Page 13: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/13.jpg)
Cardiovascular dysfunction
• Treatment of cyanide toxicity is:
![Page 14: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/14.jpg)
Cardiovascular dysfunction
• Treatment of cyanide toxicity is:– Sodium nitrite (10 ml)– Followed by 1mg/kg methelyne blue– HD
![Page 15: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/15.jpg)
Cardiovascular dysfunction
• Acts primarily on the heart, increasing heart rate, contractility, and atrioventricular conduction– Alpha 1 – Beta 1– Beta 2– Dopamine1– Dopamine2
![Page 16: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/16.jpg)
Cardiovascular dysfunction
• Acts primarily on the heart, increasing heart rate, contractility, and atrioventricular conduction– Alpha 1 – Beta 1– Beta 2– Dopamine1– Dopamine2
![Page 17: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/17.jpg)
Cardiovascular dysfunction
• Decreases heart rate– Alpha 1 – Beta 1– Beta 2– Dopamine1– Dopamine2
![Page 18: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/18.jpg)
Cardiovascular dysfunction
• Decreases heart rate– Alpha 1 – Beta 1– Beta 2– Dopamine1– Dopamine2
![Page 19: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/19.jpg)
Cardiovascular dysfunction
• Causes arterial vasodilation– Alpha 1 – Beta 1– Beta 2– Dopamine1– Dopamine2
![Page 20: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/20.jpg)
Cardiovascular dysfunction
• Causes arterial vasodilation– Alpha 1 – Beta 1– Beta 2– Dopamine1– Dopamine2
![Page 21: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/21.jpg)
Pulmonary dysfunction
• At which part of the hemoglobin – O2 dissociation curve do continued increases in PaO2 result in very little increase in SaO2 ?
![Page 22: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/22.jpg)
Pulmonary dysfunction
• At which part of the hemoglobin – O2 dissociation curve do continued increases in PaO2 result in very little increase in SaO2 ?
– Upper part of the curve
![Page 23: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/23.jpg)
Pulmonary dysfunction
The pathogenesis of ARDS involves three stages.1. First (exudative) phase2. Second (fibroproliferative) phase3. Third (resolution) phaseWhat kind of cells are destroyed in Stg 1?a) macrophagesb) type II pneumocytesc) alveolar epitheliumd) mesenchymal cells
![Page 24: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/24.jpg)
Pulmonary dysfunction
The pathogenesis of ARDS involves three stages.
1. First (exudative) phase
2. Second (fibroproliferative) phase
3. Third (resolution) phase
What kind of cells are destroyed in Stg 1?
a) macrophages (cause the damage)
b) type II pneumocytes
c) alveolar epithelium (disrupted, not destroyed)
d) mesenchymal cells (fill the space and initiate fibrosis)
![Page 25: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/25.jpg)
Pulmonary dysfunction
• Low tidal volume ventilation translates into how many ml/kg tidal volumes?– 3– 6– 9– 12
![Page 26: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/26.jpg)
Pulmonary dysfunction
• Low tidal volume ventilation translates into how many ml/kg tidal volumes?– 3
– 6
– 9
– 12
NEJM: In 861 patients, trial stopped because in-hospital mortality was 31% with Tv = 6 ml/kg, and 40% in TV 12 ml/kg
![Page 27: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/27.jpg)
GI dysfunction
• Grade 2 abdominal compartment syndrome should be treated with:– IVF– Observation– Paralytics– Decompression
![Page 28: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/28.jpg)
GI dysfunction
• Grade 2 abdominal compartment syndrome should be treated with:– IVF– Observation– Paralytics– Decompression
![Page 29: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/29.jpg)
GI dysfunction
Grade IAP Rx
I 10-14 IVF
II 15-24 Supranormal IVF
III 25-35 Decompression
IV >35 Emergent decompression
![Page 30: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/30.jpg)
GI dysfunction
• The average nutritional requirement for a patient is calculated by the Harris-Benedict equation. However, a reasonable estimate for patients of normal body habitus is ___ kcal/kg/day– 15– 30– 45– 60
![Page 31: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/31.jpg)
GI dysfunction
• The average nutritional requirement for a patient is calculated by the Harris-Benedict equation. However, a reasonable estimate for patients of normal body habitus is ___ kcal/kg/day– 15
– 30
– 45
– 60• 35 kcal/kg/day for underweight px, 25 kcal/kg/day for overwieght
patients
![Page 32: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/32.jpg)
GI dysfunction
• Patients with severe stress should receive ___ g/kg/day of protein in their TPN– 0.5– 1.5– 2.5– 3.5
![Page 33: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/33.jpg)
GI dysfunction
• Patients with severe stress should receive ___ g/kg/day of protein in their TPN– 0.5– 1.5– 2.5– 3.5
– Normal – 2.0g/kg/day of protein in tpn
![Page 34: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/34.jpg)
GI dysfunction
• Arginine.
• Glutamine
• The ω-3 fatty acids
• Nucleotides
•oxidative fuel for enterocytes and other rapidly replicating cells.
•promotes normal T-cell distribution and function and aids in wound healing.
•enhance the replication of rapidly dividing cells as well as immune responsiveness.
•compete with arachidonic acid in cyclooxygenase metabolism, resulting in production of prostaglandins of the three series and leukotrienes of the five series.
Match the nutrient with the beneficial effect
![Page 35: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/35.jpg)
GI dysfunction
• Arginine.
• Glutamine
• The ω-3 fatty acids
• Nucleotides
•oxidative fuel for enterocytes and other rapidly replicating cells.
•promotes normal T-cell distribution and function and aids in wound healing.
•enhance the replication of rapidly dividing cells as well as immune responsiveness.
•compete with arachidonic acid in cyclooxygenase metabolism, resulting in production of prostaglandins of the three series and leukotrienes of the five series.
Match the nutrient with the beneficial effect
![Page 36: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/36.jpg)
Renal dysfunction
• True or false: – Continuous renal replacement therapy has been
proven to be safer in the ICU patient than intermittent HD
![Page 37: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/37.jpg)
Renal dysfunction
• True or false: – Continuous renal replacement therapy has been
proven to be safer in the ICU patient than intermittent HD
– False: While Continuous RRT techniques offer the advantage of improved hemodynamic stability and relatively less resource utilization, but they require some anticoagulation and have not been proven superior to hemodialysis in improving outcomes.
![Page 38: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/38.jpg)
Hepatic dysfunction
• Which of these clinical entities does not exist in hepatorenal syndrome:– Decreased activity of the renin-angiotensin-
aldosterone system– Systemic vasodilation– Azotemia– High urine sodium– High urine osmolality
![Page 39: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/39.jpg)
Hepatic dysfunction
• Which of these clinical entities does not exist in hepatorenal syndrome:– Decreased activity of the renin-angiotensin-
aldosterone system (should be increased)– Systemic vasodilation– Azotemia– High urine sodium (Una should be <10)– High urine osmolality
![Page 40: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/40.jpg)
Hematologic dysfunction
• Heparin induced thrombocytopenia typically occurs how long after a patient is exposed to heparin?– 2 days– 4 days– 6 days– 8 days
![Page 41: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/41.jpg)
Hematologic dysfunction
• Heparin induced thrombocytopenia typically occurs how long after a patient is exposed to heparin?– 2 days– 4 days– 6 days– 8 days (5 days if the patient has been sensitized
before)
![Page 42: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/42.jpg)
Sepsis
• APC is an endogenous protein that
(Choose all that apply)a) Promotes fibrinolysis
b) inhibits thrombosis
c) Inhibits inflammation
d) Modulates of the coagulation cascade
e) Limits cell apoptosis
![Page 43: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/43.jpg)
Sepsis
• APC is an endogenous protein that
(Choose all that apply)a) Promotes fibrinolysis
b) inhibits thrombosis
c) Inhibits inflammation
d) Modulates of the coagulation cascade
e) Limits cell apoptosis
![Page 44: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/44.jpg)
Sepsis
Complications of therapy with APC, in a large RCT of 1690 patients with sepsis, was limited to
a) infection
b) seizures
c) somnolence
d) bleeding
![Page 45: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/45.jpg)
Sepsis
Complications of therapy with APC, in a large RCT of 1690 patients with sepsis, was limited to
a) infection
b) seizures
c) somnolence
d) bleeding
![Page 46: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/46.jpg)
Coagulopathy
Recombinant factor VIIa …
a) is contraindicated in trauma
b) induces a thrombin burst with formation of fibrin clots
c) Has no effect on measured prothrombin time
d) Activates the intrinsic coagulation cascade
e) Combines with platelets to enhance platelet plug formation
![Page 47: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/47.jpg)
Coagulopathy
Recombinant factor VIIa …
a) is contraindicated in trauma
b) induces a thrombin burst with formation of fibrin clots
c) Has no effect on measured prothrombin time
d) Activates the intrinsic coagulation cascade
e) Combines with platelets to enhance platelet plug formation
![Page 48: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/48.jpg)
Inflammation
All of the following cytokines or proteins are pro-inflammatory and procoagulant except:
a) tumor necrosis factora, b) interleukin-1bc) interleukin-6d) Thrombine) Activated Protein C
![Page 49: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/49.jpg)
Inflammation
All of the following cytokines or proteins are pro-inflammatory and procoagulant except:
a) tumor necrosis factora, b) interleukin-1bc) interleukin-6d) Thrombine) Activated Protein C
![Page 50: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/50.jpg)
PROWESS Study
• Activated protein C, endogenous protein promotes fibrinolysis inhibits thrombosis inhibits inflammation is an important modulator of the
coagulation and inflammation associated with severe sepsis
• Reduced levels correlated with increased risk of death in patients with severe sepsis
![Page 51: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/51.jpg)
PROWESS Study
![Page 52: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/52.jpg)
PROWESS Study
• We therefore evaluated whether the administration of drotrecogin alfa activated would reduce the rate of death from all causes at 28 days in patients with severe sepsis and have an acceptable safety profile.
![Page 53: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/53.jpg)
PROWESS Study: Eligibility
• Known or suspected infection on the basis of
• Three or more signs of systemic inflammation • sepsis-induced dysfunction of at least one
organ or system that lasted no longer than 24 hours.
• Patients had to begin treatment within 24 hours after they met the inclusion criteria.
![Page 54: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/54.jpg)
PROWESS Study: Treatment
• Randomized to saline or DrAA
• Dose = 24ug per kg infused over 96 hours
• Evaluation:– D-dimer (marker of coagulopathy)– IL-6 (marker of inflammation)– Mortality
![Page 55: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/55.jpg)
PROWESS Study: Results
• Trial stopped at second interim analysis (1520 patients analyzed)
• 1728 patients randomized, 1690 received DrAA or placebo• Twenty-eight days after the start of the
infusion, 259 of 840 patients in the placebo group (30.8
percent) and 210 of 850 (24.7 percent) of the patients in the drotrecogin alfa activated group had died.
Absolute reduction = 6.1 % (p<0.005)Relative risk reduction = 19.5%
![Page 56: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/56.jpg)
PROWESS Study: Results (Survival)
![Page 57: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/57.jpg)
PROWESS Study: Results (IL-6)
![Page 58: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/58.jpg)
PROWESS Study: Complications
![Page 59: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/59.jpg)
PROWESS Study:
• Discussion points:– Was the effect of DrAA dependant upon the type
or location of the infection?– What kind of patients underwent bleeding
complications?
![Page 60: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/60.jpg)
ADDRESS Study
• Similar study, required as part of the FDA approval of DrAA
• PROWESS: high risk patients
• ADDRESS: examine the response in patients of lower risk
![Page 61: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/61.jpg)
ADDRESS Study
• Methods: excluded patients with high risk.
• After 1500 patients enrolled, trial was stopped because of <5% chance of effect
![Page 62: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/62.jpg)
ADDRESS Study (results)
![Page 63: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/63.jpg)
ADDRESS Study
• No survival effect
• Complications:– Bleeding, both during the infusion period and
subsequently thereafter in the 28 day study period.
![Page 64: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/64.jpg)
ADDRESS Study
![Page 65: Surgical Critical Care Philip Goodney, MD October 26th, 2005](https://reader035.vdocuments.mx/reader035/viewer/2022062314/56649e445503460f94b38a25/html5/thumbnails/65.jpg)
ADDRESS Study
• Study halted given the lack of effect, and the increased complication
• Discussion: “inexperienced sites”, “APACHE… good for populations, less useful in predicting the outcome of individual patients”
• Conclusion: No role for DrAA in low risk patients.