Blood transfusion in cardiac surgery is a risk factor for increased hospital length of stay in adult patients

Abstract Background Allogeneic red blood cell (RBC) transfusion has been proposed as a negative indicator of quality in cardiac surgery. Hospital length of stay (LOS) may be a surrogate of poor outcome in transfused patients. Methods Data from 502 patients included in Transfusion Requirements After Cardiac Surgery (TRACS) study were analyzed to assess the relationship between RBC transfusion and hospital LOS in patients undergoing cardiac surgery and enrolled in the TRACS study. Results According to the status of RBC transfusion, patients were categorized into the following three groups: 1) 199 patients (40%) who did not receive RBC, 2) 241 patients (48%) who received 3 RBC units or fewer (low transfusion requirement group), and 3) 62 patients (12%) who received more than 3 RBC units (high transfusion requirement group). In a multivariable Cox proportional hazards model, the following factors were predictive of a prolonged hospital length of stay: age higher than 65 years, EuroSCORE, valvular surgery, combined procedure, LVEF lower than 40% and RBC transfusion of > 3 units. Conclusion RBC transfusion is an independent risk factor for increased LOS in patients undergoing cardiac surgery. This finding highlights the adequacy of a restrictive transfusion therapy in patients undergoing cardiac surgery. Trial registration Clinicaltrials.gov identifier: http://NCT01021631.

A importância das áreas ripárias para a sustentabilidade hidrológica do uso da terra em microbacias hidrográficas

Zonas ripárias são áreas de saturação hídrica, permanente ou temporária, cuja principal função é a proteção dos recursos hídricos de uma microbacia. Essa pesquisa comparou a adequação do uso do solo de dois cenários de planejamento agrícola de uma microbacia: o cenário convencional, representando o método usualmente empregado, que apenas considera as classes de capacidade de uso da terra, e o cenário hidrológico, que inclui a delimitação e avaliação das zonas ripárias. Um estudo de caso foi realizado na Microbacia do Ribeirão São João (3.656 ha), no município de Mineiros do Tietê (São Paulo, Brasil). Mapas de Classe de Capacidade de Uso da Terra e de Adequação do Uso do Solo foram elaborados, utilizando o Sistema de Informação Geográfica (SIG), para a construção dos cenários convencional e do proposto. Excluindo a Área de Preservação Permanente (APP), o cenário convencional indicou que 59,0% da área destinada à agricultura está adequadamente utilizada, 28,2% está subutilizada e 2,6% está sobreutilizada. O cenário proposto ou hidrológico, com inclusão da identificação da zona ripária (24,9% da microbacia) mostrou que muitas áreas que, no cenário convencional, possuem pouca restrição para o cultivo intensivo, como as classes II e III, são zonas ripárias, de sensibilidade hidrológica. Existem dentro dos limites da zona ripária 38,9% de classe de capacidade de uso III e 49,5% de classe IV. O planejador, desconsiderando a zona ripária, pode colocar em risco áreas vitais que, se degradadas, representam danos para a saúde e resiliência da microbacia.

Validation of models for predicting milk urea nitrogen concentrations, estimating dry matter intake by the NRC (2001)

The objective of this study was to validate three different models for predicting milk urea nitrogen using field conditions, attempting to evaluate the nutritional adequacy diets for dairy cows and prediction of nitrogen excreted to the environment. Observations (4,749) from 855 cows were used. Milk yield, body weight (BW), days in milk and parity were recorded on the milk sampling days. Milk was sampled monthly, for analysis of milk urea nitrogen (MUN), fat, protein, lactose and total solids concentration and somatic cells count. Individual dry matter intake was estimated using the NRC (2001). The three models studied were derived from a first one to predict urinary nitrogen (UN). Model 1 was MUN = UN/12.54, model 2 was MUN = UN/17.6 and model 3 was MUN = UN/(0.0259 × BW), adjusted by body weight effect. To evaluate models, they were tested for accuracy, precision and robustness. Despite being more accurate (mean bias = 0.94 mg/dL), model 2 was less precise (residual error = 4.50 mg/dL) than model 3 (mean bias = 1.41 and residual error = 4.11 mg/dL), while model 1 was the least accurate (mean bias = 6.94 mg/dL) and the least precise (residual error = 5.40 mg/dL). They were not robust, because they were influenced by almost all the variables studied. The three models for predicting milk urea nitrogen were different with respect to accuracy, precision and robustness.

Facial lesions caused by renal osteodystrophy in a patient with chronic renal insufficiency: a case report

PURPOSE: Chronic renal insufficiency (CRI) is the last stage of a chronic renal condition in which the kidney loses its filtration and endocrine functions. Chronic endocrine hypofunction causes generalized damage to the body known as Uremic Syndrome, which affects the central nervous system as well as the cardiovascular, hematologic, dermatologic, ophthalmic, endocrine, respiratory, gastrointestinal and skeletal systems. The present study reports the case of a female patient with CRI who presented facial osteodystrophy of the osteitis fibrosa type, and highlights the main features of this condition. CASE DESCRIPTION: A 24-year old, female, Caucasian patient presented chronic glomerulonephritis recurrence and lost the transplanted kidney five years before, undergoing arteriovenous fistula hemodialysis three times a week. She presented swelling of the left masseter area with a hard consistency on palpation, covered by intact skin, swelling at the bottom of the left atrium, with a hard consistency on palpation, a mucosa-like color and absence of inflammation signs, suggesting expansive bone lesions on the face. These features were compatible with hyperparathyroidism brown tumor and/or osteodystrophy. The CT scan showed expansive bone lesions of heterogeneous appearance on the left jaw, maxilla/nasal floor, and right frontotemporal suture areas. The clinical and histopathological characteristics of the lesion, in association with PHT hormone high serum levels led to renal osteodystrophy diagnosis. The patient was referred to the nephrology services. CONCLUSION: Osteodystrophic bone alterations have a high prevalence in renal disease patients, and the dentist must take these alterations into consideration in bone lesion diagnosis for this specific group of patients.

Indenização arbitrada em parcela única – implicações materiais e processuais do art. 950, parágrafo único, do Código Civil

Ao disciplinar a reparação de dano do qual resulta incapacidade laboral, o Código Civil Brasileiro de 2002 trouxe, como alternativa à pensão vitalícia, a possibilidade de indenização paga de uma só vez. Diante disso, o primeiro impulso hermenêutico foi apurar tal montante multiplicando o valor da renda mensal do ofendido pela sua expectativa de sobrevida. o presente artigo busca, fundamentalmente, questionar a adequação epistemológica desta fórmula, bem como esquadrinhar as diretrizes processuais aplicáveis ao dispositivo. O fim colimado exigirá, inter alia, perscrutar o significado da expressão “arbitramento”, a extensão do conceito de “reparação integral” e as consequências jurídicas e econômicas do recebimento antecipado. Posteriormente, pretende-se minudenciar a titularidade, a efetiva existência e o momento da opção pelo prejudicado, à luz da cláusula do “devido processo”.

Los derechos de pesca, ¿una solución al estado de los caladeros de Gran Canaria (Islas Canarias, España)?

Máster en Gestión Sostenible de Recursos Pesqueros

Minori rumeni tra percorsi migratori e rappresentazioni. Nè soli, nè accompagnati a Bologna

The thesis deals with the heterogenous category of the “unaccompanied minors”, concentrating the scientific work on those who migrate from Romania to the Italian city of Bologna. Between different migratory routes that include Romanian minors, I chose to explore the ones linked with the underground and illegal contexts. In order to analyse the reasons and the morphology of their migratory career, I used the multisituated field research which allowed me to consider the social policies in both the Romanian and the Italian environment. The main debate on the situation of the “unaccompanied children” refers to the extent to which these minors leave their country of origin “accompanied” by different adult figures and it also involves the role played by these adults. The first chapter is dedicated to a brief theoretical and methodological introduction to the main arguments of the thesis such as Romanian migration to Italy, trafficking in human beings, transnationality of migrant’s migration and decentered cooperation as a means of contrasting illegal migration and trafficking. Each field of research is characterized by a specific methodological approach, but they are all linked by the anthropological perspective I adopted throughout the entire work. The Romanian context, analized from a diachronic and a synchronic perspective represents the object of the second chapter. Some aspects of the Regime policies and other characteristics of the Romanian poscomunist period of “transition” are useful frameworks that become a background of the migration flows outside the country. The third chapter focuses on the Romanian patterns of migration. The reconstruction of some past attitudes that Romanians adopted towards migration are relevant in order to reveal the continuity with the present migratory practices. A consistent part is dedicated to a concrete example based on a field research in Bologna on a group of Romanian roma migrating from the south of Romania. The contact with these persons opened a debate on the limits between legal and illegal migration practices among the Romanians. The conclusion is that minors’ migration to Italy follows the adult patterns and flows. The nucleus of the field researches is included in the fourth and the fifth chapter. Before presenting the settings and the itineraries of the field researches, some deconstructive reflections are made on the representations that common sense and social sciences create on concepts as “child”, “minor” and “childhood”. A first perspective on the Romanian migrant minors emerges from a research concentrated on a group of roma teenagers engaged in Bologna in activities like windscreen washing, pocket-picking, begging and street prostitution. The aim of the research was to gain access to their daily life, to observe their relationship with the adults who “accompany” them and the strategies they activate in order to take some material profit out of their migratory experience. A parallel field research focuses on the Romanian minors who are part of the roma group coming from the south of Romania. Most of them are reunited with their family in Bologna, but according to the Italian law, they are all living as illegal migrants. Others are only temporary sheltered by these families and they meanwhile dedicate to illegal survviving practices. An interesting point of my participant observation was to reveal the motivations that these minors give when asked about the refusal to start a legal career inside the local Centres dedicated to the “non accompanied minors”. Their autoreflexivity brings some light on the controversy regarding the adequacy of the local and national care system and the migratory projects the minors have. In this respect, a small part of the research is dedicated to the phenomena of minors’ street prostitution in Bologna, as a useful contribution to the fragmented vision researchers have on the “unaccompanied” or “separated” children. The last chapter focuses on a decentered cooperation project that emerged as an alternative response the local administration from Bologna had chosen for facing the presence of numerous migrants coming from the south of Romania. The group of Romanian roma who was also the object of my field research became the starting point for the cooperation proposals between the city of Bologna and the city of Craiova. Although there are three projects involving the two administrations, throughout a period of stage in the Romanian city of Craiova I chose to analyse, only the one dedicated to the “urgent measures” requested in order to contrast the illegal migration and the trafficking in minors. This final part of the thesis highlightens the possible contribution that such a project might bring to the study of a complex and in some parts contradictory phenomena as that of the “unaccompanied” migrant minors.

La Restless Legs Syndrome aumenta il rischio cardiovascolare e la mortalità a breve termine nei pazienti emodializzati

Abstract Restless legs syndrome (RLS) is a sensori-motor neurological disorder characterzed by paraesthesia, dysaesthesia and irresistibile urge to move the legs especially at night. Its prevalence is much higher among dialysis patients at 12 to 62% compared to 3 to 9% in the general population. In our study we investigated the association between RLS and cardiovascular events risk and laboratory parameters in End-stage kidney disease (ESKD) patients on dialysis. We studied 100 ESKD patients undergoing hemodialysis that were enrolled in an 18-months prospective observational study. The main outcomes were the association of RLS with new cardiovascular events and cardiovascular mortality. RLS affected 31% of the study population. It was associated with female gender, gradual reduction in residual dieresis, lower albumin (P=0.039) and inflammation, but not the dialysis parameters spKt/V and URR. During observation, 47% of patients experienced new cardiovascular events (64.5% with and 39.1% without RLS; P=0.019). Mortality was 20.0% in all patients, 32.3% in those with and 14.5% in patients without RLS (P=0.04). This study confirmed the high prevalence of RLS among dialysis patients and the associations between the severity of RLS and the risk of new cardiovascular events and higher short-term mortality. Abstract Restless legs syndrome (RLS) is a sensori-motor neurological disorder characterzed by paraesthesia, dysaesthesia and irresistibile urge to move the legs especially at night. Its prevalence is much higher among dialysis patients at 12 to 62% compared to 3 to 9% in the general population. In our study we investigated the association between RLS and cardiovascular events risk and laboratory parameters in End-stage kidney disease (ESKD) patients on dialysis. We studied 100 ESKD patients undergoing hemodialysis that were enrolled in an 18-months prospective observational study. The main outcomes were the association of RLS with new cardiovascular events and cardiovascular mortality. RLS affected 31% of the study population. It was associated with female gender, gradual reduction in residual dieresis, lower albumin (P=0.039) and inflammation, but not the dialysis parameters spKt/V and URR. During observation, 47% of patients experienced new cardiovascular events (64.5% with and 39.1% without RLS; P=0.019). Mortality was 20.0% in all patients, 32.3% in those with and 14.5% in patients without RLS (P=0.04). This study confirmed the high prevalence of RLS among dialysis patients and the associations between the severity of RLS and the risk of new cardiovascular events and higher short-term mortality.

Fistola Artero-venosa Radio-Cefalica Distale per Emodialisi nel paziente anziano: Valutazione dei risultati ottenuti con l'utilizzo della Tecnica Microchirurgica

PREMESSA: Le linee guida raccomandano la fistola AV radio-cefalica autogena (RCAVF)come prima scelta per l'emodialisi. Preoccupazione è stata sollevata che questo potrebbe non essere appropriato nei pazienti anziani. METODO: Noi abbiamo seguito in modo prospettico 126 pazienti per tre anni. Dopo sistematica valutazione clinica ed ecografica, la RCAVF è stata creata utilizzando un microscopio operatore. La pervietà è stata valutata subito, a 1 settimana, a 1 mese e a 1 anno. I risultati sono stati registrati e stratificati in 2 gruppi: <70a e > 70a. RISULTATI: La RCAVF è stata creata nel 75% dei <70a e nel 70% dei >70a. L'incidenza di insuccesso immediato è stata 11% (<70a) e 13% (>70a). La pervietà primaria e secondaria ad 1 anno è stata 67% e 84% (<70a), 63% e 80% (>70a). CONCLUSIONI: La microchirurgia ha permesso la creazione di RCVAF in >70a con un rischio accettabile di fallimento e lievi differenze rispetto a <70a. L'età non deve precludere una creazione di RCAVF.

A journey through the capital structure of the banking sector: Empirical evidence for Europe from 2008 to 2012

Systemic risk is the protagonist of the recent financial crisis. This thesis proposes a definition and a propagation mechanism for systemic risk. Risk management has a direct linkage with capital management, when addressing the question that the risk handled by a financial institution is compatible with the amount of equity available. This thesis proposes a risk management of liquid market variables, which compose the assets of a bank, based on the statistical tool of PCA. The principal component analysis will define the PCR, or Principal Components of Risk. Such definition of Risk will be adopted to test if the risk represented by PCR is explanatory of the movements of equity and/or debt for the banks included in the in the index Itraxx financial senior: the results of these regressions will be compared with a formal Capital Adequacy test in order to assess the financial soundness of the main financial European institutions.

La navigazione nella chirurgia oncologica ortopedica: Applicazione ed implementazione di nuove tecnologie per il trattamento chirurgico dei tumori dell'apparato muscolo-scheletrico, studio pilota

Nel presente progetto di ricerca, da novembre 2011 a novembre 2013 , sono stati trattati chirurgicamente, con l’assistenza del navigatore , pazienti con tumori ossei primitivi degli arti, del bacino e del sacro, analizzando i risultati degli esami istologici dei margini di resezione del tumore e i risultati clinici e radiografici. Materiali e metodi : Abbiamo analizzato 16 pazienti 9 maschi e 7 femmine , con un'età media di 31 anni (range 12-55 ). Di tutti i pazienti valutati 8 avevano una localizzazione agli arti inferiori , 4 al bacino e 4 all'osso sacro . Solo quelli con osteosarcoma parostale , Cordoma e Condrosarcoma non sono stati sottoposti a terapia antiblastica . Solo un paziente è stato sottoposto a radioterapia postoperatoria per una recidiva locale . Tutti gli altri pazienti non sono stati trattati con la radioterapia per l’ adeguatezza dei margini di resezione . Non ci sono state complicanze intraoperatorie . Nel periodo postoperatorio abbiamo osservato una vescica neurologica , una paresi sciatica, due casi di infezione di cui una superficiale e una profonda, tutti e quattro i pazienti con sarcoma sacrale sviluppati hanno avuto ritardato della guarigione della ferita e di questi tre hanno avuto incontinenza sfinterica. In tutti i casi si è ottenuta una eccellente risultato clinico e radiografico , con soddisfazione del paziente , corretto contatto tra l'osteotomia e l'impianto che apparivano stabili ai primi controlli ambulatoriali ( FU 19 mesi). Risultati: La chirurgia assistita da calcolatore ha permesso di migliorare l’esecuzione delle resezioni ossee prevista dal navigatore. Questa tecnologia è valida e utile per la cure dei tumori dell’apparato scheletrico, soprattutto nelle sedi anatomiche più complesse da trattare come la pelvi, il sacro e nelle resezioni intercalari difficoltose nell’ottenere un margine di resezione ampio e quindi di salvare l’articolazione e l’arto stesso.

Evaluation of slope stability under water and seismic load through the Minimum Lithostatic Deviation method

The main objective of this thesis is to obtain a better understanding of the methods to assess the stability of a slope. We have illustrated the principal variants of the Limit Equilibrium (LE) method found in literature, focalizing our attention on the Minimum Lithostatic Deviation (MLD) method, developed by Prof. Tinti and his collaborators (e.g. Tinti and Manucci, 2006, 2008). We had two main goals: the first was to test the MLD method on some real cases. We have selected the case of the Vajont landslide with the objective to reconstruct the conditions that caused the destabilization of Mount Toc, and two sites in the Norwegian margin, where failures has not occurred recently, with the aim to evaluate the present stability state and to assess under which conditions they might be mobilized. The second goal was to study the stability charts by Taylor and by Michalowski, and to use the MLD method to investigate the correctness and adequacy of this engineering tool.

Gesù continuatore di Giovanni. Studio storico-esegetico sulla relazione tra Gesù di Nazaret e Giovanni il Battista

L’enigma della relazione tra Gesù e Giovanni il Battista ha da sempre stimolato l’immaginazione storica degli studiosi, suscitando una varietà di ipotesi e valutazioni, spesso assai diverse. Ciò nonostante, tutti concordano su un punto: che, almeno nella sua fase maggiore in Galilea, il ministero di Gesù fosse una realtà essenzialmente autonoma, diversa, originale e irriducibile rispetto alla missione di Giovanni. In controtendenza con questa “impostazione predefinita”, il presente studio sostiene la tesi secondo cui Gesù portò avanti la sua missione come intenzionale e programmatica prosecuzione dell’opera prematuramente interrotta di Giovanni. Nella prima parte, si esamina approfonditamente quale memoria della relazione sia conservata nelle fonti più antiche, cioè Q (qui analizzata con particolare attenzione) e Marco – a cui si aggiunge Matteo, che, in ragione dello stretto legame storico-sociologico con Q, offre un esempio illuminante di rinarrazione della memoria altamente originale eppure profondamente fedele. La conclusione è che la memoria più antica della relazione Gesù-Giovanni è profondamente segnata da aspetti di accordo, conformità e allineamento. Nella seconda parte si esaminano una serie di tradizioni che attestano che Gesù era percepito pubblicamente in relazione al Battista e che egli stesso condivideva e alimentava tale percezione riallacciandosi a lui in polemica con i suoi avversari, e dipingendolo come una figura di capitale importanza nella predicazione e nell’insegnamento a seguaci e discepoli. Infine, si argomenta l’esistenza di ampie e sostanziali aree di accordo tra i due a livello di escatologia, istruzioni etiche e programma sociale, missione penitenziale verso i peccatori e attività battesimale. L’ipotesi che Gesù portasse avanti l’attività riformatrice di Giovanni, in termini di una campagna purificatoria “penitenziale-battesimale-esorcistica” in preparazione dell’avvento di Dio, consente infine di armonizzare in modo soddisfacente i due aspetti più caratteristici dell’attività di Gesù (normalmente giustapposti, quando non contrapposti): escatologia e miracoli, il Gesù profeta e il Gesù taumaturgo.

La funzione limitatrice dei principi - valori costituzionali nella giurisprudenza costituzionale. Riflessi ed implicazioni sulla legalità penale

La tesi di ricerca si propone di indagare il riflesso che i principi/valori producono sul parametro nel sindacato di legittimità costituzionale, al fine di verificarne le implicazioni sulla legalità, in termini di prevedibilità e certezza. In particolare, delineata la connessione tra principi e valori costituzionali e, ricostruito, secondo la teoria dell'ordinamento, il rapporto tra valori e normatività,si analizzano i riflessi prodotti, sul piano interpretativo, dall’apertura del parametro costituzionale alla logica dei valori, enfatizzandone le ricadute sul controllo di costituzionalità delle leggi. Identificato il nesso tra principi e valori nella capacità funzionale dei primi di realizzare i diritti fondamentali, si è inteso rimarcare come la più estesa realizzazione dei principi-valori costituzionali potrebbe compiersi a spese della legge e della certezza del diritto, in una relazione inversamente proporzionale. Ciò apparirebbe evidente dall’ottica privilegiata della materia penale, per cui una legalità materiale, letta alla luce di criteri di adeguatezza e di ragionevole proporzione, seppur vicina alle esigenze di giustizia del caso concreto, se spinta in eccessi interpretativi rischia di invadere il campo del legislatore, unico deputato a compiere scelte di valore.

Untersuchung der Pharmakokinetik von Ciprofloxacin und Piperacillin bei Intensivpatienten mit kontinuierlichen Hämodialyseverfahren

Infektionen zählen bei hämodialysepflichtigen Intensivpatienten zu den häufigsten Todesursachen. Um die Wirksamkeit und Sicherheit der Antibiotikatherapie zu verbessern, müssen verschiedene Faktoren, zum Beispiel die Pharmakodynamik und Pharmakokinetik des Antibiotikums, die Art des Hämodialyseverfahrens, die Art des Dialysefilters und der Zustand des Patienten berücksichtigt werden. Im Rahmen einer klinischen Studie wurde die antibiotische Wirkung von Piperacillin und Ciprofloxacin bei kontinuierlichen Hämodialyseverfahren mittels pharmakokinetischer Methoden bestimmt.Für die klinische Studie wurde eine HPLC-Methode mit kombinierter Festphasenextraktion (SPE) entwickelt und nach den Grenzwerten der EMA Guideline on Bioanalytical Method Validation validiert. Die Methode erwies sich für die gleichzeitige Bestimmung von Piperacillin und Ciprofloxacin in Plasma- und Dialysatproben als valide und zuverlässig. Die ermittelten Konzentrationen der beiden Antibiotika wurden für die Berechnung der pharmakokinetischen Parameter verwendet.In der klinischen Studie wurden bei 24 Intensivpatienten mit kontinuierlicher venovenöser Hämodialyse (CVVHD) bzw. kontinuierlicher venovenöser Hämodiafiltration (CVVHDF), bei denen Piperacillin/Tazobactam, Ciprofloxacin oder eine Kombination dieser Antibiotika indiziert war, die Antibiotikakonzentrationen im Plasma und Dialysat im Steady State gemessen. Unmittelbar vor einer Antibiotikainfusion (0 min) wurde ein Volumen von sechs Milliliter Blut entnommen. Weitere Blutentnahmen erfolgten 30 Minuten nach der Infusion sowie nach 1, 2, 3, 4, 8, 12 und 24 Stunden. Sobald ein Filtratbeutel ausgetauscht wurde, wurden parallel zu den Blutproben Dialysatproben entnommen. Die Konzentrationen von Piperacillin und Ciprofloxacin wurden nach der Festphasenextraktion aus den Plasmaproben mit der validierten HPLC-Methode innerhalb von 15 Minuten zuverlässig bestimmt. Neben den gemessenen Plasmakonzentrationen (Cmax, Cmin) wurden pharmakokinetische Parameter wie t0,5, VdSS, AUC, Cltot, ClCRRT und Clextrarenal berechnet. Für Piperacillin wurde untersucht, ob die Plasmaspiegel der Patienten für das gesamte Dosierungsintervall oberhalb der geforderten vierfachen MHK von 64 mg/l liegen. Für Ciprofloxacin wurde untersucht, ob die aus gemessenen Plasmaspiegeln berechnete AUC den Quotienten aus AUC und MHK (=AUIC) ≥ 125 h erfüllt.Bei zehn der 21 mit Piperacillin behandelten Patienten lagen die Plasmaspiegel unterhalb der angestrebten Konzentration von 64 mg/l für das gesamte Dosierungsintervall. Das Patientenkollektiv wies eine große interindividuelle Variabilität auf. Mit einer Wahrscheinlichkeit von 95 % waren 26 - 70 % der Patienten unterdosiert. In der Gruppe der mit Ciprofloxacin behandelten Patienten wurde die angestrebte AUIC von 125 h nur bei neun der 20 Patienten erreicht. Mit einer Wahrscheinlichkeit von 95 % waren 29 - 76 % der Patienten unterdosiert. Die kontinuierlichen Nierenersatzverfahren hatten nur einen geringen Anteil an der totalen Clearance der untersuchten Antibiotika. Während die Clearance des kontinuierlichen Nierenersatzverfahren bei Piperacillin für ein Drittel der Arzneistoffelimination verantwortlich war, trug diese im Fall von Ciprofloxacin lediglich zu 16 % zur Arzneistoffelimination bei.Die Dosierung von Piperacillin/Tazobactam bzw. Ciprofloxacin sollte bei kritisch kranken Intensivpatienten mit kontinuierlicher Hämodialyse mindestens 4 mal 4/0,5 g pro Tag bzw. 2 mal 400 mg pro Tag betragen. Diese Empfehlungen sind insbesondere für die verwendeten Dialyseverfahren und -bedingungen zutreffend. Zur weiteren Optimierung der Antibiotikatherapie ist ein Therapeutisches Drug Monitoring empfehlenswert.