tailieunhanh - Critical Care Obstetrics part 16

Critical Care Obstetrics part 16 provides expert clinical guidance throughout on how you can maximize the chances of your patient and her baby surviving trauma. In this stimulating text, internationally recognized experts guide you through the most challenging situations you as an obstetrician are likely to face, enabling you to skillfully:Recognize conditions early-on which might prove life threatening, Implement immediate life-saving treatments in emergency situations, Maximize the survival prospects of both the mother and her fetus | Ventilator Management in Critical Illness However the precise risk of deep vein thrombosis in patients with acute respiratory failure is not known. Another source of pulmonary emboli in critically ill patients can be thrombosis associated with intravenous catheters 98 . One study found that 66 of 33 consecutive patients monitored for a mean of 3 days with a pulmonary artery catheter had internal jugular thrombosis as detected venographically or on autopsy 103 . Autopsy data suggest that pulmonary emboli are present in patients with catheter- associated thrombosis 104 . However the relationship of pulmonary emboli to catheter-associated thrombosis is not clear. Venous thromboembolism is both more common and more complex to diagnose in patients who are pregnant than in those who are not pregnant. The incidence of venous thromboembolism is estimated at to per 1000 pregnancies which is four times as great as the risk in the nonpregnant meta-analysis showed that two thirds of cases of deep-vein thrombosis occurred in the antepartum period and were distributed relatively equally among all three trimesters 105 . Needless to say deep venous thrombosis prophylaxis is of paramount importance in the critically ill pregnant patient. Critically ill patients at very high risk for bleeding should receive mechanical prophylaxis . graduated compression stockings and or intermittent pneumatic compression devices until the bleeding risk decreases 106 . When the bleeding risk is moderate . postoperative patients or medically ill either low-dose unfractionated heparin UFH or low-molecular-weight heparin LMWH may be used. In conditions associated with the highest risk of thromboembolic complications such as following major trauma and acute spinal cord injury prophylaxis with LMWH is considered first-line therapy 106 . During pregnancy if UFH is to be used we recommend doses of 5000 U subcutaneously every 8 hours or 10 000 units every 12 hours for .