***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Introduction Fresh frozen plasma ( FFP ) is widely used , but few studies have described patterns of plasma use in critical care . We carried out a multicentre study of coagulopathy in intensive care units ( ICUs ) and here describe overall FFP utilisation in adult critical care , the indications for transfusions , factors indicating the doses used and the effects of FFP use on coagulation . Methods We conducted a prospect i ve , multicentre , observational study of all patients sequentially admitted to 29 adult UK general ICUs over 8 weeks . Daily data throughout ICU admission were collected concerning coagulation , relevant clinical outcomes ( including bleeding ) , coagulopathy ( defined as international normalised ratio ( INR ) > 1.5 , or equivalent prothrombin time ( PT ) ) , FFP and cryoprecipitate use and indications for transfusion .  Results Of 1,923 admissions , 12.7 % received FFP in the ICU during 404 FFP treatment episodes ( 1,212 FFP units ) . Overall , 0.63 FFP units/ICU admission were transfused ( 0.11 units/ICU day ) . Reasons for FFP transfusion were bleeding ( 48 % ) , preprocedural prophylaxis ( 15 % ) and prophylaxis without planned procedure ( 36 % ) . Overall , the median FFP dose was 10.8 ml kg-1 , but doses varied widely ( first to third quartile , 7.2 to 14.4 ml kg-1 ) . Thirty-one percent of FFP treatments were to patients without PT prolongation , and 41 % were to patients without recorded bleeding and only mildly deranged INR ( < 2.5 ) . Higher volumes of FFP were administered when the indication was bleeding ( median doses : bleeding 11.1 ml kg-1 , preprocedural prophylaxis 9.8 ml kg-1 , prophylaxis without procedure 8.9 ml kg-1 ; P = 0.009 across groups ) and when the pretransfusion INR was higher ( ranging from median dose 8.9 ml kg-1 at INR ≤1.5 to 15.7 ml kg-1 at INR > 3 ; P < 0.001 across ranges ) . Regression analyses suggested bleeding was the strongest predictor of higher FFP dose . Pretransfusion INR was more frequently normal when the transfusion indication was bleeding . Overall , posttransfusion corrections of INR were consistently small unless the pretransfusion INR was > 2.5 , but administration during bleeding was associated with greater INR corrections . Conclusions There is wide variation in FFP use by ICU clinicians , and a high proportion of current FFP transfusions are of unproven clinical benefit . Better evidence from clinical trials could significantly alter patterns of use and modify current treatment costs Early changes in coagulation were found in patients following a paracetamol overdose . Low levels of clotting factors II , V and VII were present within 24 hours of the overdose . As the levels of factor II correlated with plasma fibrinogen values at this time , it is possible that they were consumed in the process of intravascular coagulation , although this was not supported by the presence of raised titres of fibrin degradation products . The prothrombin time ratio was greater than 2 - 2 within 30 hours of ingestion of the overdose in all patients who eventually died , whereas it was less than this in those developing only moderate liver damage . The administration of fresh frozen plasma to patients did appear to reduce the maximum abnormality of the prothrombin time ratio , which was significantly less three days after the overdose in the group receiving fresh frozen plasma . However , the coagulation disturbance was of short duration , and the prothrombin time ratio had also returned to normal within one week of the overdose in the control patients , and the administration of fresh frozen plasma did not appear to reduce the morbidity or mortality in the treated patients OBJECTIVES To assess the benefits of withdrawn autologous plasma , the objective of this study was to investigate whether withdrawal of acutely performed platelet-rich or platelet-poor plasmapheresis allays changes in the protein C-thrombomodulin and fibrinolytic systems after retransfusion secondary to cardiopulmonary bypass ( CPB ) . In addition , the study attempted to determine the influence of acute plasmapheresis ( APP ) on the protein C-thrombomodulin and fibrinolytic systems as well as on homologous blood consumption and perioperative blood loss in elective aortocoronary bypass patients . DESIGN The investigation was scheduled as a prospect i ve , r and omized , unblinded study . SETTING This single investigation was conducted in the Department of Anesthesiology and Intensive Care Medicine at a university in Germany . The study protocol was approved by the Ethics Committee of the hospital , and informed consent was obtained . PARTICIPANTS Sixty male patients scheduled for elective coronary artery bypass grafting with extracorporeal circulation were included in the study . INTERVENTIONS APP was performed between induction of anesthesia and incision , collecting either 10 mL/kg of autologous platelet-poor plasma ( PPP patients , group 1 ; n = 20 ) or the same amount of platelet-rich plasma ( PRP patients , group 2 ; n = 20 ) . Patients of group 3 ( n = 20 ) had no APP ( control group ) . All patients were maintained on their usual regimen of cardiac drugs until the morning of surgery . To preserve hemodynamic stability and restore the intravascular oncotic pressure , the separated plasma was replaced by infusion of an equal amount of hydroxyethyl starch solution ( HES ) ( 6 % HES , molecular weight 2 x 10(5 ) , substitution rate 0.5 % ) . In all operations , the same surgical procedure was chosen . For all patients , induction and maintenance of anesthesia were similar , consisting of weight-related doses of fentanyl ( 35 micrograms/kg ) , midazolam ( 0.65 mg/kg ) , and pancuronium bromide ( 0.15 mg/kg ) . The lungs of all patients were mechanically ventilated during the first 5 hours after the end of the operation . MEASUREMENTS AND MAIN RESULTS All patients had serial coagulation studies including antithrombin ( AT ) III-activity , prekallikrein , factor XII , and immunologic tests such as thrombin-antithrombin III ( TAT ) , fibrinopeptide A ( FPA ) , protein C and S ( PC and PS ) , thrombomodulin ( TM ) , tissue-plasminogen-activator ( t-PA ) , plasminogen-activator-inhibitor ( PAI 1 ) , fibrinopeptide B beta 15 - 42 ( FPB beta 15 - 42 ) , D-dimers , and hemoglobin and platelet counts determined intraoperatively and postoperatively . Chest tube drainage and transfusion requirements were recorded . APP had no negative effects on the quality of PPP and PRP plasma . The platelet count of the withdrawn plasma was 28 + /- 12 x 10(9)/L ( PPP group ) and 245 + /- 36 x 10(9)/L ( PRP group ) . At the end of the operation ( after retransfusion of autologous plasma ) and on the morning of the first postoperative day , platelet counts were significantly higher ( p > 0.05 ) in the PRP than in the PPP and control groups . Plasma concentrations of TAT and FPA increased ( ranging from + 185 % to + 340 % from baseline values ) and AT III-activity , PC , PS , and TM antigen decreased ( ranging from -8 % to -55 % from baseline values ) to a different extent for all three groups throughout CPB . t-PA-activity increased with a maximum at the end of CPB ( PPP group , 6.9 + /- 1.5 IU/mL : PRP group , 3.8 + /- 0.8 IU/mL ; control group , 10.9 + /- 2.8 IU/mL ) . Fibrin and fibrinogen degradation markers such as D-dimers and FPB beta 15 to 42 occurred in peak concentrations after neutralization of heparin by protamine . Only PRP patients showed baseline concentrations of coagulation parameters the next morning ( p < 0.05 ) . Total postoperative blood loss within the first 24 hours reached 482 + /- 273 mL ( PRP group ) , 775 + /- 256 mL ( PPP group ) , and 948 + /- 342 mL in the control group ( p < 0.05 ) . ( ABSTRACT TRUNCATED BACKGROUND Fresh frozen plasma ( FFP ) and prothrombin complex concentrates ( PCC ) reverse oral anticoagulants . We compared PCC and FFP intraoperative administration in patients undergoing heart surgery with cardiopulmonary bypass ( CPB ) . METHODS Forty patients [ with international normalized ratio (INR)≥ 2·1 ] assigned semi-urgent cardiac surgery were r and omized to receive either FFP ( n = 20 ) or PCC ( n = 20 ) . Prior to CPB , they received either 2 units of FFP or half of the PCC dose calculated according to body weight , initial INR and target INR ( ≤ 1·5 ) . After CPB and protamine administration , patients received either another 2 units of FFP or the other half PCC dose . Additional doses were administered if INR was still too high ( ≥ 1·5 ) . RESULTS Fifteen minutes after CPB , more patients reached INR target with PCC ( P = 0·007 ) : 7/16 patients vs. 0/15 patients with FFP ; there was no difference 1 h after CPB ( 6/15 patients with PCC vs. 4/15 patients with FFP reached target ) . Fifteen minutes after CPB , median INR ( range ) decreased to 1·6 ( 1·2 - 2·2 ) with PCC vs. 2·3 ( 1·5 - 3·5 ) with FFP ; 1 h after CPB both groups reached similar values [ 1·6 ( 1·3 - 2·2 ) with PCC and 1·7 ( 1·3 - 2·7 ) with FFP ] . With PCC , less patients needed additional dose ( 6/20 ) than with FFP ( 20/20 ) ( P < 0·001 ) . Both groups differed significantly on the course of factor II ( P = 0·0023 ) and factor X ( P = 0·008 ) over time . Dilution of coagulation factors was maximal at CPB onset . Safety was good for both groups , with only two related oozing cases with FFP . CONCLUSION PCC reverses anticoagulation safely , faster and with less bleeding than FFP Seventy three preterm infants weighing less than 1500 g or less than 32 weeks ' gestation , or both , were allocated r and omly to treatment ( fresh frozen plasma 10 ml/kg on admission and at 24 hours of age ) or control groups . Fifteen ( 41 % ) out of 37 control patients  sustained intraventricular haemorrhage compared with five ( 14 % ) of 36 patients receiving treatment ( X2 = 5.24 , P = 0.022 ) . No difference was found in coagulation factors measured at birth or at 48 hours of age in both groups . Fresh frozen plasma appears to have a beneficial effect in the prevention of intraventricular haemorrhage Objective To test the tolerability and safety of the universal plasma Uniplas [ solvent/detergent (SD)-treated plasma ] , infused regardless of the patient 's blood group . Design Prospect i ve , parallel group , controlled and observer-blinded study , r and omized with respect to patients requiring plasma transfusion .  Setting Cardiothoracic operating room and ICU in a university hospital . Patients Eighty-four patients undergoing open-heart surgery comparing three parallel treatment groups and one control group . Interventions The Uniplas treatment group was subdivided into patients with blood group A , B or AB , and group O. The treatment group receiving Octaplas of type AB , was not subdivided . Patients who did not require any plasma transfusion  served as control . Measurements Complement activation ( C3bc , TCC ) , direct antiglobulin test ( DAT ) and other immunohaematological tests , tests for haemolysis , and relevant clinical observations during treatment phase . Blood sample s were collected again after 6 months for evaluation of viral safety . Results Of the 84 patients , 29 served as control group . Uniplas was transfused in 36 of the patients ( 1–23 units ) . Octaplas was transfused in 19 patients ( 1–11 units ) . During the study no clinical adverse events related to plasma transfusion were observed . The degree of complement activation C3bc and TCC , a recommended test for biocompatibility , did not show any increased activation after Uniplas or Octaplas transfusion . No haemolytic reactions , positive DAT-tests or viral transmissions were observed after Uniplas transfusion . Conclusion In open-heart surgery , Uniplas , which can be transfused regardless of a patient 's blood group , was well-tolerated and gave no adverse drug reactions BACKGROUND Hepatic failure caused by severe hepatitis is a clinical syndrome where the major liver functions , particularly detoxification , synthetic functions , and metabolic regulation are impaired to different degrees , and may result in major life-threatening complications such as hepatic encephalopathy , ascites , jaundice , cholestasis , bleeding and hepatorenal synd 
    Output:
    
Overall , there was no significant benefit for FP use across all the clinical conditions .