RESUMEN
BACKGROUND: Preinjury antiplatelet agent (APA) use in trauma patients can increase traumatic hemorrhage and worsen outcomes. Thromboelastography with platelet mapping (TEGPM) has characterized platelet function via arachidonic acid (AA) and adenosine diphosphate (ADP) inhibition in nontrauma settings, but limited data exist in the acute trauma population. METHODS: A prospective observational study of adult trauma patients with suspected preinjury APA use who received TEGPM testing from 2017 to 2020 was performed. Patients on anticoagulants were excluded. Patients were grouped according to preinjury APA regimen: 81 mg or 325 mg of aspirin daily, 81 mg of aspirin and 75 mg of clopidrogrel daily, 75 mg of clopidrogrel daily, or no antiplatelet. Ability of TEGPM to detect APA use was assessed using predictive statistics and area under receiver operating characteristic curves (AUROCs). RESULTS: A total of 824 patients were included with most patients taking 81 mg of aspirin (n = 558). Patients on no antiplatelet were younger and had higher baseline platelet counts, while patients on 75 mg of clopidrogrel were more likely to be admitted after ground level fall. All other baseline characteristics were balanced. Admission TEG values were similar between groups. Median AA inhibition was higher in patients on aspirin containing regimens (p < 0.0001). Median ADP inhibition was higher in patients on clopidogrel containing regimens and those taking 325 mg of aspirin (p < 0.0001). Arachidonic acid inhibition accurately detected preinjury APA use and aspirin use (AUROC, 0.89 and 0.84, respectively); however, ADP inhibition performed poorly (AUROC, 0.58). Neither AA nor ADP inhibition was able to discern specific APA regimens or rule out APA use entirely. CONCLUSION: High AA inhibition accurately detects preinjury APA use in trauma patients. High ADP inhibition after trauma is common, limiting its utility to accurately identify preinjury APA use. Further study is needed to identify assays that can reliably detect and further characterize preinjury APA use in trauma populations. LEVEL OF EVIDENCE: Diagnostic test, level II.
Asunto(s)
Hemorragia/prevención & control , Conciliación de Medicamentos/métodos , Inhibidores de Agregación Plaquetaria/efectos adversos , Tromboelastografía/estadística & datos numéricos , Heridas y Lesiones/complicaciones , Anciano , Anciano de 80 o más Años , Ácido Araquidónico/análisis , Ácido Araquidónico/antagonistas & inhibidores , Ácido Araquidónico/metabolismo , Aspirina/administración & dosificación , Aspirina/efectos adversos , Plaquetas/efectos de los fármacos , Plaquetas/metabolismo , Domperidona/administración & dosificación , Domperidona/efectos adversos , Domperidona/análogos & derivados , Femenino , Hemorragia/sangre , Hemorragia/etiología , Humanos , Masculino , Agregación Plaquetaria/efectos de los fármacos , Inhibidores de Agregación Plaquetaria/administración & dosificación , Valor Predictivo de las Pruebas , Estudios Prospectivos , Curva ROC , Heridas y Lesiones/sangre , Heridas y Lesiones/terapiaRESUMEN
BACKGROUND: Parenteral nutrition (PN) is a complex and costly therapy that places significant demands on healthcare resources. Commercially manufactured 3-chamber bags (3CBs) offer potential time and cost advantages compared with hospital pharmacy-compounded bags (HCBs); however, no data are yet available from studies comparing these delivery systems in US hospitals. The primary aim of this study was to evaluate the PN preparation time and resource utilization required for 3CBs compared with HCBs in US hospitals. METHODS: A prospective, multicenter, time and motion study was performed to evaluate the time from transcription to completion of PN preparation and costs for 3CBs compared with HCBs. The cost per bag included labor, PN products, medical consumables, and equipment. RESULTS: One hundred thirty-six PN prescriptions were prepared during the study (66 prescriptions for 3CBs and 70 prescriptions for HCBs). The mean ± standard deviation total time required for transcription, review, validation, and preparation of PN was 5.5 ± 1.3 minutes for 3CBs vs 14.3 ± 6.2 minutes for HCBs (P < .001). The mean total cost per PN bag was $81.60 for 3CBs and $131.17 for HCBs (mean difference, -$49.57). CONCLUSION: Commercial 3CBs reduced staff time by 62% and direct costs by 37% compared with HCBs. The results demonstrate that 3CBs offer potential cost-savings for hospitalized patients who require PN in US hospitals.
Asunto(s)
Servicio de Farmacia en Hospital , Costos y Análisis de Costo , Humanos , Nutrición Parenteral , Soluciones para Nutrición Parenteral , Nutrición Parenteral TotalRESUMEN
Parenteral nutrition (PN), including lipids, in high-risk or poorly nourished critically ill patients is indicated when enteral nutrition is contraindicated; however, soybean oil-based PN can stimulate proinflammatory processes. Fish oil (FO) is generally less inflammatory and has recently been shown to be active in the resolution of inflammatory processes. In this study, we look at whether the use of a blended intravenous fat emulsion that includes soybean, medium-chain triglycerides, olive oil, and FO confers clinical benefits in critically ill patients.