Perioperative clinical and economic outcomes associated with replacing first-generation high molecular weight hydroxyethyl starch (Hextend®) with low molecular weight hydroxyethyl starch (Voluven®) at a large medical center

4区 · 医学

ArticleOA

作者: Bartz, Raquel R ; Gan, Tong J ; White, William D

BACKGROUNDSeveral plasma volume expander alternatives exist to enhance intravascular volume status in patients undergoing surgery. The optimal intravascular volume expander in the perioperative setting is currently unknown. Low molecular weight hetastarch, Voluven® (130/0.4), may have a better safety profile than high molecular weight hetastarch, Hextend® (450/0.7). We examined the clinical and cost outcomes of converting from Hextend® to Voluven® in a large tertiary medical center.METHODSUsing a large electronic database, we retrospectively compared two different time periods (2009 and 2010) where the availability of semisynthetic colloids changed. Perioperative and postoperative outcomes including the use of red blood cells (RBC), platelets and coagulation factors, length of stay in the postoperative acute care unit (PACU), intensive care unit and hospital, as well as 30-day and 1-year mortality were compared. In addition, direct acquisition costs of all intraoperative and PACU colloids and crystalloid use were determined.RESULTSA total of 4,888 adult subjects were compared of which 1,878 received Hextend® (pre-conversion) and 2,759 received Voluven® (post-conversion) during two separate 7-month periods within 1 year apart, with the remainder receiving Plasmanate. The patients were similar in terms of patient demographics, preoperative comorbidities, ASA status, emergency surgery, types of surgery, intraoperative, and PACU times. In unadjusted outcomes, patients in the Hextend® group received more lactated Ringer's than in the Voluven® group (2,220 + 1,312 vs. 1,946 ± 1,097 ml; P < 0.0001). The use of albumin (Plasmanate) was reduced from 10.5% of patients to 1.1% when Voluven® was substituted for Hextend®. Unadjusted outcomes were similar in each group including hospital LOS, percent change from baseline creatinine and receipt of intraoperative and PACU blood product administration. However, overall unadjusted total fluid costs were greater in the Voluven® compared to Hextend® group ($116.7 compared to $59.3; P < 0.001).CONCLUSIONSConversion from Hextend® to Voluven® in the perioperative period resulted in decreased albumin use and was not associated with changes in clinical outcomes and short- and long-term mortality. The conversion was associated with decreases in crystalloid use and an increase in colloid use and hence IV fluid acquisition costs in the Voluven® group.

2006-06-01·Cell and Tissue Banking4区 · 工程技术

Cryopreservation of Human Ovarian Tissue

4区 · 工程技术

Article

作者: Barbara Di Tommaso ; Catia Orrico ; Raffaella Fabbri ; Gianandrea Pasquinelli ; Stefano Venturoli ; Graziella Bracone

New and often aggressive treatment schemes allow the successful healing of many young patients with cancer, but the price the young women have to pay is high: many of them lose ovarian function and fertility. Due to the improved long-term survival of adolescents and young women with malignancies undergoing gonadotoxic chemotherapy, preservation of future fertility has been the focus of recent ubiquitarian interest. A feasible solution is the cryopreservation of ovarian tissue. Ovarian tissue, after thawing, can be used in three different ways: 1. grafted into its normal site (orthotopic); 2. grafted into a site other than its normal position (heterotopic), necessitating recourse to in vitro fertilization (IVF); 3. grown and in vitro matured in order to obtain metaphase II oocytes for an IVF program. It is believed that protein supplementation, in cryopreservation solution, is essential for improving ovarian tissue cryopreservation. The aim of this study was to evaluate the ultrastructural appearance of human ovarian tissue cryopreserved in 1.5 M 1,2 propanediol (PROH), 0.2 M sucrose using different protein sources: fetal calf serum (FCS), plasmanate or syntetic serum substitute (SSS). Fresh and frozen/thawed ovarian tissues were compared by transmission electron microscope (TEM), to evaluate the appearance of stromal and follicle cells as affected by different protein sources. Our data indicate that FCS is a better protein support for ovarian tissue cryopreservation when compared to SSS or Plasmanate. In addition the follicles are more resistant to the cryopreservation with respect to stroma.

1998-02-01·Journal of Obstetrics and Gynaecology Research4区 · 医学

A Prospective Randomized Control Study to Compare the Effect of Serum and a Commercial Serum Substitute (Plasmanate) on the Outcome of Assisted Reproduction Program

4区 · 医学

Article

作者: William S. B. Yeung ; Tak‐Ming Cheung ; Estella Y. L. Lau ; Pak‐Chung Ho ; William W. K. So ; Victor K. H. Ng

AbstractObjectives: To compare the effect of supplementation of serum and Plasmanate, a commercial serum substitute, to culture medium on the IVF outcome.Methods: One hundred eighty‐nine subfertile couples were prospective randomized into the serum and the Plasmanate group during their IVF treatment. In vitro experiment was also performed to determine the fraction of Plasmanate that might affect embryo development.Results: The pregnancy rate were similar in both groups. The fertilization rate, the number of gestational sacs and good quality spare embryos suitable for cryopreservation were higher in the serum group than the Plasmanate group. However, these differences did not reach statistical significance. Significantly more embryos in the former cleaved to more than 4 cells at the time of transfer than the latter (p < 0.05). Ultrafiltration study showed that this inhibitory effect resided in the low molecular weight fraction (< 30‐kD) of Plasmanate.Conclusions: Serum is slightly better than Plasmanate as a protein supplement. However, Plasmanate may still be used for short term embryo culture in assisted reproduction.

100 项与 Plasma Protein Fraction (Human) (Grifols) 相关的药物交易

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