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Query: UMLS:C0085593 (chills)
 4,268 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Gram-negative septicemia presents a particular problem in the ICU. Septicemia is usually diagnosed by fever, chills, and shock. Results of blood cultures become available a few days later. Major surgery induced a marked decline in antithrombin III (AT III) and plasminogen (PLG) to a mean level of 0.60 U/ml (normal value: 0.80-1.40 U/ml) on the 2nd and 3rd postoperative days. Around the 5th postop day, these values again attained mean preoperative levels. Seventy-six surgical ICU patients were investigated preoperatively and for 10 days postoperatively to relate postop septicemia to changes in the hemostatic profile. In 15 patients with gram-negative septicemia verified by positive culture, AT III and PLG barely recovered from the postop decrease and remained significantly lower (p less than 0.05) after the 3rd postop day, compared to 61 surgical ICU patients without septicemia. The behavior of alpha 2antiplasmin (alpha 2AP) values was equal in both groups. This difference in hemostatic profile preceded the clinical manifestations of septicemia and the results of blood culture by several days. Leucocyte or platelet counts provided no reliable information on the early development of septicemia in these surgical patients. It is concluded that persistent low plasma AT III and PLG levels in the postop phase are early indicators of a developing gram-negative septicemia.
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PMID:Postoperative hemostatic profile in relation to gram-negative septicemia. 707 22

The purpose of this prospective study was to evaluate the safety of salvage and reinfusion of postoperative sanguineous wound drainage using the ConstaVac Blood Conservation System (Stryker, Kalamazoo, MI). A prospective analysis of 135 primary total hip and total knee arthroplasties was carried out. The collection time for reinfusion was limited to 6 hours, and suction pressure was kept to a minimum by using the lowest setting on the device. For all patients, no citrate-phosphate-dextrose anticoagulant was added to the reservoir. To evaluate the effect of reinfusion on hemostasis and the blood coagulation system, antithrombin III, fibrinogen, and D-dimer levels of 40 of 135 patients were measured before surgery and on the first and seventh days after the operation. The mean volume of reinfusion of postoperative drainage was 437 mL for the patients with total hip arthroplasties, 883 mL for those with total knee arthroplasties, and 1,713 mL for those with bilateral total knee arthroplasties. Ninety-nine of 135 patients underwent operations without homologous blood replacement. Transient chills with mild fever were seen in 2 patients during reinfusion. No complications related to air embolism, coagulopathy, renal failure, or sepsis were recognized in any of the patients. This study suggests that postoperative blood salvage and reinfusion appear to be safe and effective in patients undergoing primary total hip and knee arthroplasties.
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PMID:Postoperative blood salvage and reinfusion after total joint arthroplasty. 926 90