[Gastrointestinal stress ulcer: still a typical intensive care complication or a vanishing disease?]. / Gastrointestinale Stressläsionen: Noch eine typische intensiv-medizinische Komplikation oder eine verschwundene Erkrankung?

Stress-induced hemorrhage from gastroduodenal lesions is a serious complication in critically ill patients. An analysis of the studies published in recent years shows, that the incidence of "clinically relevant bleedings" decreased over the past 15 years. Beside a medicinal prophylaxis of stress lesions, the general improvements in critical care, like all measures to prevent stress, the early treatment of shock states, sufficient oxygenation and early enteral nutrition as well as the improvements in nursing care are responsible for the reduction of the incidence. Those in danger of "clinically relevant bleedings" are as a rule patients with one or more predisposing factors. These factors are conditions of hypotension, various forms of shock, hypoxia, respiratory failure, hepatic and renal failure, coagulopathies and the treatment with steroids and nonsteroidal antiinflammatory drugs. Only for these critically ill patients a medicinal prophylaxis of stress lesions in justified and sensible.

Plateletapheresis with the new cell separator AS-104.

Summarizing several studies, it can be shown that the new cell separator AS-104 (Fresenius), in comparison to the older systems, provides a real advantage concerning the separation efficiency, the purity of the platelet concentrates (PC), the platelet function and the donor safety. The results of 5 different separation protocols demonstrate the technical flexibility and developmental potential of this system. From the experience of 580 plateletapheresis runs the successful improvement of the cell separator, and the disposables can be documented as the frequency of disturbances and discontinuations are reduced considerably. The preliminary results of an uncontrolled, not randomized transfusion study of 244 transfusions in 49 patients show comparable posttransfusion increments as obtained with PC of the CS-3000 (Baxter).

Biocompatibility and safety of cytapheresis.

Cytaphereses are safe and can be used routinely like whole blood donations on the premise that standard techniques based on appropriate guidelines and regulations are performed. Before the introduction of a new cell or plasma separator, a thorough clinical investigation is always recommended in order to demonstrate biocompatibility and safety features. In this context cell loss and damage as well as activation of coagulation and complement should be tested primarily. The examination should consist of a direct comparison with an approved system. In addition, it is necessary to repeat periodically on multicenter studies adverse donor reactions such as those already described so that it is possible to recognize even rare side effects. Of special importance are long-term studies of donors undergoing frequent cytaphereses for many years in order to detect relevant immunological changes. On the other hand, harm caused by the plasticizer or cancer due to cancerogenicity of the plastics are only speculative at the moment.