Efficacy of recombinant human erythropoietin in critically ill anaemic septic patients

To investigate the erythropoietic response to high dose of a weekly dosing schedule of recombinant human erythropoietin [rHuEPO] in critically ill anaemic septic patients, and to determine whether the administration of rHuEPO would reduce the number of red blood cell [RBC] transfusions required and whether would affect clinical course and final outcome or not. A prospective, randomized, controlled single center study. Critical Care Department [medical/surgical ICU], Cairo University Hospital. A total of 60 patients who were admitted to the intensive care unit [ICU] and met the eligibility criteria were enrolled into the study [30 into the rHuEPO group, 30 into the control group]. Patients were randomized to receive either rHuEPO or not. The study drug [40.000 units of rHuEPO] was administrated by subcutaneous injection beginning on ICU day 2 and continued once weekly for a minimum of 2 doses or until ICU discharge [for patients with ICU length of stay >2 weeks] up to a total of 4 doses. CBC, reticulocytic count, iron variables, APACHE II, SOFA scores were measured at baseline and subsequently thereafter every 3rd day until ICU discharge or death or up to a total of 28 days. The EPO treated group showed significant increases in reticulocytic count compared with baseline [P<0.001] as well as with the control group [P<0.006]. The EPO-treated group exhibited also significant increases in Hb concentration compared with baseline [P<0.001] as well as with the control group [P<0.03]. All patients in the control group received RBC transfusion [100%] while only [83.33%] of the patients who received rHuEPO were transfused. Concerning the in hospital clinical course, the EPO treated group showed significant decreases in their APACHE II score during the study period compared with baseline [P<0.001] as well as with the control group [P<0.05], the EPO treated group showed also no significant difference in their SOFA score during the study period compared with baseline [P=0.923], however, the control group exhibited continous and significant increase in their SOFA score throughout the study period compared with baseline [P<0.003]. There was no significant difference in the final outcome [i.e. recovery, mortality or morbidity] [P:0.337, P: 0.286 respectively]. The administration of rHuEPO to critically ill anaemic septic patients is effective in raising their reticulocytic counts, Hb concentrations and in reducing the total number of units of RBCs they require. In addition there was a trend toward better inhospital clinical course, increased recovery and decreased mortality in rHuEPO group

effects of different levels of auto-PEEP on hemodynamics in mechanically ventilated patients, correlation with lung mechanics and gas exchange in different ventilator settings

The goal of this study was to detect auto-PEEP in mechanically ventilated patients and monitor how its different levels may affect the patients hemodynamics, lung mechanics and gas exchange and trial of estimating an optimal PEEP level. Another goal was to monitor how the addition of external PEEP may affect the patient hemodynamics, lung mechanics and gas exchange and trial of estimating an optimal PEEP level. This study included 18 mechanically ventilated patients who were classified into three groups: COPD group [10 patients], restrictive group [4 patients] and normal group [4 patients]. Besides the routine clinical examination, ECG, chest X-ray, laboratory investigation and ABG, each individual patient was subjected to serial monitoring of hemodynamic parameters [SV, PCWP, LVSW, RVSW, PVR], lung mechanics parameters [auto-PEEP, external PEEP, total PEEP, P pressure, P mean, P total, Raw, C stat]. This is done for base line readings and after every change in ventilatory settings according to the study on different levels of auto-PEEP and on different levels of external PEEP. The results showed that auto-PEEP was detected in 13 out of 18 patients included in the study [72%] with mean of 6.8 cm H2O SD 5. On application of external PEEP, auto-PEEP had a significantly negative correlation with external PEEP in all groups