The requirement for a safe diagnostic strategy of deep vein thrombosis(DVT) should be based on an overall objective post incidence of venous thromboembolism(VTE) of less than 1% during 3 mo fol low-up. Compression ult...
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The requirement for a safe diagnostic strategy of deep vein thrombosis(DVT) should be based on an overall objective post incidence of venous thromboembolism(VTE) of less than 1% during 3 mo fol low-up. Compression ultrasonography(CUS) of the leg veins has a negative predictive value(NPV) of 97%-98% indicating the need of repeated CUS testing within one week. A negative ELISA VIDAS safely excludes DVT and VTE with a NPV between 99% and 100% at a low clinical score of zero. The combination of low clinical score and a less sensitive D-dimer test(Simplify) is not sensitive enough to exclude DVT and VTE in routine daily practice. From prospective clinical research studies it may be concluded that complete recanalization within 3-6 mo and no reflux is associated with a low or no risk of PTS obviating the need of MECS 6 mo after DVT. Partial and complete recanalization after 6 to more than 12 mo is usually complicated by reflux due to valve destruction and symptomatic PTS. Reflux seems to be a main determinant for PTS and DVT recurrence, the latter as a main contributing factor in worsening PTS. This hypothesis is supported by the relation between the persistent residual vein thrombosis(RVT = partial recanalization) and the risk of VTE recurrence in prospective studies. Absence of RVT at 3 mo postDVT and no reflux is predicted to be associated with no recurrence of DVT(1.2%) during follow-up obviating the need of wearing medical elastic stockings and anticoagulation at 6 mo post-DVT. The presence or absence of RVT but with reflux at or after 6 mo postDVT is associated with both symptomatic PTS and an increased risk of VTE recurrence in about one third in the post-DVT period after regular discontinuation of anticoagulant treatment. To test this hypothesis we designed a prospective DVT and postthrombotic syndrome(PTS) Bridging the Gap Study by addressing at least four unanswered questions in the treatment ofDVT and *** DVT patient has a clear indication for long-term c
Background:It is unknown whether lung-protective ventilation is applied in burn patients and whether they benefit from *** study aimed to determine ventilation practices in burn intensive care units(ICUs)and investiga...
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Background:It is unknown whether lung-protective ventilation is applied in burn patients and whether they benefit from *** study aimed to determine ventilation practices in burn intensive care units(ICUs)and investigate the association between lung-protective ventilation and the number of ventilator-free days and alive at day 28(VFD-28).Methods:This is an international prospective observational cohort study including adult burn patients requiring mechanical *** tidal volume(V_(T))was defined as V_(T)≤8 mL/kg predicted body weight(PBW).Levels of positive end-expiratory pressure(PEEP)and maximum airway pressures were *** association between V_(T) and VFD-28 was analyzed using a competing risk *** settings were presented for all patients,focusing on the first day of *** also compared ventilation settings between patients with and without inhalation ***:A total of 160 patients from 28 ICUs in 16 countries were *** V_(T) was used in 74%of patients,median V_(T) size was 7.3[interquartile range(IQR)6.2–8.3]mL/kg PBW and did not differ between patients with and without inhalation trauma(p=0.58).Median VFD-28 was 17(IQR 0–26),without a difference between ventilation with low or high V_(T)(p=0.98).All patients were ventilated with PEEP levels≥5 cmH_(2)O;80%of patients had maximum airway pressures<30 cmH_(2)***:In this international cohort study we found that lung-protective ventilation is used in the majority of burn patients,irrespective of the presence of inhalation *** of low V_(T) was not associated with a reduction in *** registration:*** *** of registration:9 December 2014.
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