China
Africa
Explore chapters and articles related to this topic
Pharmacologic alternatives to blood
Published in Jennifer Duguid, Lawrence Tim Goodnough, Michael J. Desmond, Transfusion Medicine in Practice, 2020
The two principal indications for the red cell substitutes currently under clinical investigation are in patients with acute trauma and patients who are undergoing surgery, with or without acute normovolemic hemodilution. The rationale for the use of red cell substitutes with hemodilution is several-fold: (i) the cellular hemoglobin collected during hemodilution would be used to replace the hemoglobin solution or other synthetic oxygen carrier as it is eliminated; (ii) the use of a red cell substitute would permit more aggressive hemodilution with lower targeted cellular hemoglobin levels than would otherwise be tolerated; and (iii) a red cell substitute could serve as a replacement fluid during blood loss.87 However, patients with pre-existing anemia can be expected to derive only limited benefit from this approach, because the amount of autologous cellular hemoglobin is low to begin with.87 A multinational prospective, randomized study88 evaluated the use of perflubron, a perflurocarbon solution, to augment acute normovolemic hemodilution during orthopedic surgery. The investigators found that perflubron combined with 100% oxygen was more effective than autologous blood in reversing physiological transfusion triggers in patients undergoing orthopedic surgery. They concluded that this blood-conservation technique may represent a safe, temporary alternative to conventional blood transfusion. Because of the small sample size of the study, the efficacy of perflubron in eliminating allogeneic blood exposure was not demonstrated, and additional large clinical trials will be needed to evaluate its efficacy. At present, several of these ‘blood substitute’ products are in various stages of clinical development. If approved by the FDA, they would most likely be used in military and trauma patients and massive surgical blood loss settings. The role of these substances in other arenas will, most likely, be determined by issues related to blood inventory and costs, rather than the safety of the blood supply.
The role of precision medicine in bronchiectasis: emerging data and clinical implications
Published in Expert Review of Respiratory Medicine, 2023
Grace Oscullo, David de la Rosa, Marta Garcia Clemente, Rosa Giron, Rafael Golpe, Luis Máiz, Miguel Angel Martinez-Garcia
Treatments that enhance mucociliary function and mucus hydration also play a fundamental part in individualized treatment. The effectiveness of current therapies (hypertonic or isotonic saline, cysteine derivatives) is only sparsely supported by data, so studies are being carried out with both currently used and new mucoactive drugs. Various inhaled treatments are being studied, including hypertonic saline with carbocysteine [132], ARINA-1 (consisting of glutathione, ascorbate and sodium bicarbonate) [133] and S-1226, a biophysical agent that combines carbon dioxide and enriched air with nebulized perflubron (a synthetic surfactant) [134]. The possible beneficial effect of increased long-term humidification therapy with the myAIRVO2 system, which delivers high-flow warm and humidified gases through a nasal cannula, is also being evaluated [135].
Pediatric bronchoscopy: recent advances and clinical challenges
Published in Expert Review of Respiratory Medicine, 2021
P Goussard, P Pohunek, E Eber, F Midulla, G Di Mattia, M Merven, JT Janson
WLL is performed under general anesthesia and usually muscle relaxation, with extensive monitoring including ECG, blood pressure, pulse oximetry, and capnography. In adults, the procedure is considered safe and effective, but has not yet been standardized [172]. In children aged eight years and above, the technique is the same as in adults, with airway management by a double lumen endotracheal tube (ETT) [173]. As the smallest double-lumen ETT is 26 Fr (approx. 8.7 mm), alternative techniques have to be used in infants and small children. Several alternative techniques have been proposed [174]. (1) WLL may be performed through an elongated cuffed ETT [174] or through a balloon catheter. (2) Alternatively, two ETTs may be used, a bronchial tube for the lavage and a tracheal tube for ventilation [174]. (3) WLL may also be performed via the working channel of a flexible bronchoscope with an external diameter of 2.8, 3.5, or 4.9 mm according to the age and the size of the patient. Two techniques may be used: With one, the bronchoscope is inserted along a narrow ETT; with the other, the bronchoscope is inserted through a large ETT [174,175]. These techniques allow direct visualization and thus more selective lobar lavages. (4) In critically ill children, WLL may be performed under extracorporeal membrane oxygenation (ECMO) [176] or liquid ventilation using polyurethane perflubron [177].