451
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Schotola H, Wetz AJ, Popov AF, Bergmann I, Danner BC, Schöndube FA, Bauer M, Bräuer A. The Effects of Residual Pump Blood on Patient Plasma Free Haemoglobin Levels Post Cardiac Surgery. Anaesth Intensive Care 2016; 44:587-92. [DOI: 10.1177/0310057x1604400519] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
At the end of cardiopulmonary bypass, there are invariably several hundred millilitres of residual pump blood in the reservoir, which can either be re-transfused or discarded. The objective of this prospective observational study was to investigate the quality of the residual pump blood, focusing on plasma free haemoglobin (pfHb) and blood cell counts. Fifty-one consecutive patients were included in the study. Forty-nine units of residual pump blood and 58 units of transfused red blood cell (RBC) concentrates were analysed. The mean preoperative pfHb of the patients was 0.057 ± 0.062 g/l, which increased gradually to 0.55 ± 0.36 g/l on arrival in the intensive care unit postoperatively. On the first postoperative day, the mean pfHb had returned to within the normal range. Our data showed that haemoglobin, haematocrit, and erythrocyte counts of residual pump blood were approximately 40% of the values in standardised RBC concentrates. Plasma free haemoglobin was significantly higher in residual pump blood compared to RBC concentrates, and nearly twice as high as the pfHb in patient blood samples taken contemporaneously. Our findings indicate that residual pump blood pfHb levels are markedly higher compared to patients' blood and RBC concentrates, but that its administration does not significantly increase patients' pfHb levels.
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Affiliation(s)
- H. Schotola
- Department of Anaesthesiology, Georg-August-University Goettingen, Goettingen, Germany
| | - A. J. Wetz
- Department of Anaesthesiology, Georg-August-University Goettingen, Goettingen, Germany
| | - A. F. Popov
- Department of Cardiothoracic Transplantation and Mechanical Support, Brompton and Harefield Hospital, London, United Kingdom
| | - I. Bergmann
- Department of Anaesthesiology, Georg-August-University Goettingen, Goettingen, Germany
| | - B. C. Danner
- Department of Thoracic and Cardiovascular Surgery, Georg-August-University Goettingen, Goettingen, Germany
| | - F. A. Schöndube
- Department of Thoracic and Cardiovascular Surgery, Georg-August-University Goettingen, Goettingen, Germany
| | - M. Bauer
- Department of Anaesthesiology, Georg-August-University Goettingen, Goettingen, Germany
| | - A. Bräuer
- Department of Anaesthesiology, Georg-August-University Goettingen, Goettingen, Germany
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452
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453
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Crippa IA, Lelubre C, Lozano-Roig A, Taccone FS. Optimizing Blood Transfusion Practices in Traumatic Brain Injury and Subarachnoid Hemorrhage. CURRENT ANESTHESIOLOGY REPORTS 2016. [DOI: 10.1007/s40140-016-0169-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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454
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Transfusion thresholds and beyond. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2016; 14:123-5. [PMID: 26950940 DOI: 10.2450/2016.0008-16] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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455
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Romagnoli S, Rizza A, Ricci Z. Fluid Status Assessment and Management During the Perioperative Phase in Adult Cardiac Surgery Patients. J Cardiothorac Vasc Anesth 2016; 30:1076-84. [DOI: 10.1053/j.jvca.2015.11.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Indexed: 01/25/2023]
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456
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Hallward G, Balani N, McCorkell S, Roxburgh J, Cornelius V. The Relationship Between Preoperative Hemoglobin Concentration, Use of Hospital Resources, and Outcomes in Cardiac Surgery. J Cardiothorac Vasc Anesth 2016; 30:901-8. [DOI: 10.1053/j.jvca.2016.02.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Indexed: 02/01/2023]
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457
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Capdevila A, Navarro M, Bori G, Tornero E, Camacho P, Bosch J, García S, Mensa J, Soriano A. Incidence and Risk Factors for Infection When Teicoplanin Is Included for Prophylaxis in Patients with Hip Fracture. Surg Infect (Larchmt) 2016; 17:381-4. [DOI: 10.1089/sur.2015.173] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Aina Capdevila
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Margarita Navarro
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Guillem Bori
- Department of Orthopedic Surgery and Traumatology, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Eduard Tornero
- Department of Orthopedic Surgery and Traumatology, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Pilar Camacho
- Department of Orthopedic Surgery and Traumatology, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Jordi Bosch
- Department of Microbiology, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Sebastián García
- Department of Internal Medicine, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Josep Mensa
- Department of Infectious Diseases, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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458
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Stokes EA, Wordsworth S, Bargo D, Pike K, Rogers CA, Brierley RCM, Angelini GD, Murphy GJ, Reeves BC. Are lower levels of red blood cell transfusion more cost-effective than liberal levels after cardiac surgery? Findings from the TITRe2 randomised controlled trial. BMJ Open 2016; 6:e011311. [PMID: 27481621 PMCID: PMC4985876 DOI: 10.1136/bmjopen-2016-011311] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To assess the incremental cost and cost-effectiveness of a restrictive versus a liberal red blood cell transfusion threshold after cardiac surgery. DESIGN A within-trial cost-effectiveness analysis with a 3-month time horizon, based on a multicentre superiority randomised controlled trial from the perspective of the National Health Service (NHS) and personal social services in the UK. SETTING 17 specialist cardiac surgery centres in UK NHS hospitals. PARTICIPANTS 2003 patients aged >16 years undergoing non-emergency cardiac surgery with a postoperative haemoglobin of <9 g/dL. INTERVENTIONS Restrictive (transfuse if haemoglobin <7.5 g/dL) or liberal (transfuse if haemoglobin <9 g/dL) threshold during hospitalisation after surgery. MAIN OUTCOME MEASURES Health-related quality of life measured using the EQ-5D-3L to calculate quality-adjusted life years (QALYs). RESULTS The total costs from surgery up to 3 months were £17 945 and £18 127 in the restrictive and liberal groups (mean difference is -£182, 95% CI -£1108 to £744). The cost difference was largely attributable to the difference in the cost of red blood cells. Mean QALYs to 3 months were 0.18 in both groups (restrictive minus liberal difference is 0.0004, 95% CI -0.0037 to 0.0045). The point estimate for the base-case cost-effectiveness analysis suggested that the restrictive group was slightly more effective and slightly less costly than the liberal group and, therefore, cost-effective. However, there is great uncertainty around these results partly due to the negligible differences in QALYs gained. CONCLUSIONS We conclude that there is no clear difference in the cost-effectiveness of restrictive and liberal thresholds for red blood cell transfusion after cardiac surgery. TRIAL REGISTRATION NUMBER ISRCTN70923932; Results.
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Affiliation(s)
- E A Stokes
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK
| | - S Wordsworth
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK
| | - D Bargo
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK Eli Lilly and Company Limited, Lilly House, Basingstoke, Hampshire, UK
| | - K Pike
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - C A Rogers
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - R C M Brierley
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - G D Angelini
- Bristol Heart Institute, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - G J Murphy
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Leicester, UK
| | - B C Reeves
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
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459
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Spradbrow J, Cohen R, Lin Y, Armali C, Collins A, Cserti-Gazdewich C, Lieberman L, Pavenski K, Pendergrast J, Webert K, Callum J. Evaluating appropriate red blood cell transfusions: a quality audit at 10 Ontario hospitals to determine the optimal measure for assessing appropriateness. Transfusion 2016; 56:2466-2476. [DOI: 10.1111/trf.13737] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 06/07/2016] [Accepted: 06/10/2016] [Indexed: 01/28/2023]
Affiliation(s)
- Jordan Spradbrow
- Department of Clinical Pathology; Sunnybrook Health Sciences Centre; the; Toronto Ontario Canada
| | - Robert Cohen
- Department of Clinical Pathology; Sunnybrook Health Sciences Centre; the; Toronto Ontario Canada
| | - Yulia Lin
- Department of Clinical Pathology; Sunnybrook Health Sciences Centre; the; Toronto Ontario Canada
- Department of Laboratory Medicine and Pathobiology; University of Toronto; and the; Toronto Ontario Canada
- Quality, Utilization, Efficacy; and Safety of Transfusion (QUEST) Research Collaborative; Toronto Ontario Canada
| | - Chantal Armali
- Department of Clinical Pathology; Sunnybrook Health Sciences Centre; the; Toronto Ontario Canada
| | - Allison Collins
- Department of Clinical Pathology; Northumberland Hills Hospital; Cobourg Ontario Canada
| | - Christine Cserti-Gazdewich
- Department of Laboratory Medicine and Pathobiology; University of Toronto; and the; Toronto Ontario Canada
- Quality, Utilization, Efficacy; and Safety of Transfusion (QUEST) Research Collaborative; Toronto Ontario Canada
- Department of Clinical Pathology; University Health Network, and the; Toronto Ontario Canada
| | - Lani Lieberman
- Department of Laboratory Medicine and Pathobiology; University of Toronto; and the; Toronto Ontario Canada
- Quality, Utilization, Efficacy; and Safety of Transfusion (QUEST) Research Collaborative; Toronto Ontario Canada
- Department of Clinical Pathology; University Health Network, and the; Toronto Ontario Canada
| | - Katerina Pavenski
- Department of Laboratory Medicine and Pathobiology; University of Toronto; and the; Toronto Ontario Canada
- Department of Laboratory Medicine; St. Michael's Hospital; Toronto Ontario Canada
| | - Jacob Pendergrast
- Department of Laboratory Medicine and Pathobiology; University of Toronto; and the; Toronto Ontario Canada
- Quality, Utilization, Efficacy; and Safety of Transfusion (QUEST) Research Collaborative; Toronto Ontario Canada
- Department of Clinical Pathology; University Health Network, and the; Toronto Ontario Canada
| | - Kathryn Webert
- Medical Services and Innovation; Canadian Blood Services; Ancaster Ontario Canada
- Department of Pathology and Molecular Medicine; McMaster University; Hamilton Ontario Canada
| | - Jeannie Callum
- Department of Clinical Pathology; Sunnybrook Health Sciences Centre; the; Toronto Ontario Canada
- Department of Laboratory Medicine and Pathobiology; University of Toronto; and the; Toronto Ontario Canada
- Quality, Utilization, Efficacy; and Safety of Transfusion (QUEST) Research Collaborative; Toronto Ontario Canada
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460
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Thakkar RN, Lee KK, Ness PM, Wintermeyer TL, Johnson DJ, Liu E, Rajprasad A, Knight AM, Wachter PA, Demski R, Frank SM. Relative impact of a patient blood management program on utilization of all three major blood components. Transfusion 2016; 56:2212-20. [DOI: 10.1111/trf.13718] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 05/07/2016] [Accepted: 05/19/2016] [Indexed: 12/23/2022]
Affiliation(s)
- Rajiv N. Thakkar
- Department of MedicineThe Johns Hopkins Medical InstitutionsBaltimore Maryland
| | - K.H. Ken Lee
- Armstrong Institute of Patient Safety and QualityThe Johns Hopkins Medical InstitutionsBaltimore Maryland
| | - Paul M. Ness
- Department of Pathology (Transfusion Medicine)The Johns Hopkins Medical InstitutionsBaltimore Maryland
| | - Tyler L. Wintermeyer
- Department of Clinical AnalyticsThe Johns Hopkins Medical InstitutionsBaltimore Maryland
| | - Daniel J. Johnson
- Department of Anesthesiology/Critical Care MedicineThe Johns Hopkins Medical InstitutionsBaltimore Maryland
| | - Emily Liu
- Department of Pathology (Transfusion Medicine)The Johns Hopkins Medical InstitutionsBaltimore Maryland
| | - Anjuli Rajprasad
- Armstrong Institute of Patient Safety and QualityThe Johns Hopkins Medical InstitutionsBaltimore Maryland
| | - Amy M. Knight
- Department of MedicineThe Johns Hopkins Medical InstitutionsBaltimore Maryland
| | - Pat A. Wachter
- Armstrong Institute of Patient Safety and QualityThe Johns Hopkins Medical InstitutionsBaltimore Maryland
| | - Renee Demski
- Armstrong Institute of Patient Safety and QualityThe Johns Hopkins Medical InstitutionsBaltimore Maryland
| | - Steven M. Frank
- Department of Anesthesiology/Critical Care MedicineThe Johns Hopkins Medical InstitutionsBaltimore Maryland
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461
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Pike K, Maishman RL, Brierley RCM, Rogers CA, Murphy GJ, Reeves BC. Adherence to transfusion strategies in a randomized controlled trial: experiences from the TITRe2 trial. Br J Haematol 2016; 179:346-349. [PMID: 27378402 PMCID: PMC5655708 DOI: 10.1111/bjh.14220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Katie Pike
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, BS2 8HW, UK
| | - Rachel L Maishman
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, BS2 8HW, UK
| | - Rachel C M Brierley
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, BS2 8HW, UK
| | - Chris A Rogers
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, BS2 8HW, UK
| | - Gavin J Murphy
- Department of Cardiovascular Sciences, University of Leicester, Clinical Sciences Wing, Glenfield General Hospital, Leicester, LE3 9QP, UK
| | - Barnaby C Reeves
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, BS2 8HW, UK
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462
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Restrictive versus Liberal Transfusion Strategy in the Perioperative and Acute Care Settings. Anesthesiology 2016; 125:46-61. [DOI: 10.1097/aln.0000000000001162] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Abstract
Background
Blood transfusions are associated with morbidity and mortality. However, restrictive thresholds could harm patients less able to tolerate anemia. Using a context-specific approach (according to patient characteristics and clinical settings), the authors conducted a systematic review to quantify the effects of transfusion strategies.
Methods
The authors searched MEDLINE, EMBASE, CENTRAL, and grey literature sources to November 2015 for randomized controlled trials comparing restrictive versus liberal transfusion strategies applied more than 24 h in adult surgical or critically ill patients. Data were independently extracted. Risk ratios were calculated for 30-day complications, defined as inadequate oxygen supply (myocardial, cerebral, renal, mesenteric, and peripheral ischemic injury; arrhythmia; and unstable angina), mortality, composite of both, and infections. Statistical combination followed a context-specific approach. Additional analyses explored transfusion protocol heterogeneity and cointerventions effects.
Results
Thirty-one trials were regrouped into five context-specific risk strata. In patients undergoing cardiac/vascular procedures, restrictive strategies seemed to increase the risk of events reflecting inadequate oxygen supply (risk ratio [RR], 1.09; 95% CI, 0.97 to 1.22), mortality (RR, 1.39; 95% CI, 0.95 to 2.04), and composite events (RR, 1.12; 95% CI, 1.01 to 1.24—3322, 3245, and 3322 patients, respectively). Similar results were found in elderly orthopedic patients (inadequate oxygen supply: RR, 1.41; 95% CI, 1.03 to 1.92; mortality: RR, 1.09; 95% CI, 0.80 to 1.49; composite outcome: RR, 1.24; 95% CI, 1.00 to 1.54—3465, 3546, and 3749 patients, respectively), but not in critically ill patients. No difference was found for infections, although a protective effect may exist. Risk estimates varied with successful/unsuccessful transfusion protocol implementation.
Conclusions
Restrictive transfusion strategies should be applied with caution in high-risk patients undergoing major surgery.
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463
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Bjursten H, Dardashti A, Björk J, Wierup P, Algotsson L, Ederoth P. Transfusion of sex-mismatched and non–leukocyte-depleted red blood cells in cardiac surgery increases mortality. J Thorac Cardiovasc Surg 2016; 152:223-232.e1. [DOI: 10.1016/j.jtcvs.2015.12.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 12/11/2015] [Accepted: 12/14/2015] [Indexed: 11/30/2022]
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464
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Folléa G. Rethinking blood components and patients: Patient blood management. Possible ways for development in France. Presse Med 2016; 45:e273-80. [DOI: 10.1016/j.lpm.2016.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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465
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Calcaterra D, Renfro LA, Shander A. Navigating the Fine Line Between the Bad and Worse: The Issue Is Not the Number, and the Message Is Not "All or Nothing". J Cardiothorac Vasc Anesth 2016; 30:1159-62. [PMID: 27640892 DOI: 10.1053/j.jvca.2016.06.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Indexed: 01/02/2023]
Affiliation(s)
- Domenico Calcaterra
- Division of Cardiac Surgery, Hennepin County Medical Center and Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN
| | - Leslie A Renfro
- Department of Anesthesiology, University of Minnesota, Minneapolis, MN
| | - Aryeh Shander
- Department of Anesthesiology, Englewood Hospital & Medical Center, Englewood, NJ
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466
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Cleland S, Corredor C, Ye JJ, Srinivas C, McCluskey SA. Massive haemorrhage in liver transplantation: Consequences, prediction and management. World J Transplant 2016; 6:291-305. [PMID: 27358774 PMCID: PMC4919733 DOI: 10.5500/wjt.v6.i2.291] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 03/16/2016] [Accepted: 04/11/2016] [Indexed: 02/05/2023] Open
Abstract
From its inception the success of liver transplantation has been associated with massive blood loss. Massive transfusion is classically defined as > 10 units of red blood cells within 24 h, but describing transfusion rates over a shorter period of time may reduce the potential for survival bias. Both massive haemorrhage and transfusion are associated with increased risk of mortality and morbidity (need for dialysis/surgical site infection) following liver transplantation although causality is difficult to prove due to the observational design of most trials. The blood loss associated with liver transplantation is multifactorial. Portal hypertension secondary to cirrhosis results in extensive collateral circulation, which can bleed during hepatectomy particular if portal pressures are increased. Avoiding volume loading and maintenance of a low central venous pressure together with the use of vasopressors have been shown to reduce blood loss and transfusion during liver transplantation, but may increase the risk of renal impairment post-operatively. Coagulation defects may be present pre-transplant, but haemostasis is often re-balanced due to a deficit in both pro- and anti-coagulation factors. Further derangement of haemostasis may develop in the anhepatic and neohepatic phases due to absent hepatic metabolic function, hyperfibrinolysis and platelet sequestration in the donor liver. Point-of-care tests of coagulation such as the viscoelastic tests rotation thromboelastometry/thromboelastometry allow and more accurate and rapid assessment of these derangements in coagulation and guide the use of factor replacement and antifibrinolytics. Transfusion protocols guided by these tests have been shown to reduce transfusion rates compared with conventional coagulation tests, but have not shown improvements in mortality or morbidity. Pre-operative factors associated with massive transfusion include previous surgery, re-do transplantation, the aetiology and severity of liver disease. Intra-operatively the use of piggy-back technique and avoiding veno-veno bypass has been shown to reduced blood loss.
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467
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Patient blood management equals patient safety. Best Pract Res Clin Anaesthesiol 2016; 30:159-69. [DOI: 10.1016/j.bpa.2016.04.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 04/29/2016] [Indexed: 01/28/2023]
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468
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Roubinian N, Carson JL. Red Blood Cell Transfusion Strategies in Adult and Pediatric Patients with Malignancy. Hematol Oncol Clin North Am 2016; 30:529-40. [DOI: 10.1016/j.hoc.2016.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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469
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Kassakian SZ, Yackel TR, Deloughery T, Dorr DA. Clinical Decision Support Reduces Overuse of Red Blood Cell Transfusions: Interrupted Time Series Analysis. Am J Med 2016; 129:636.e13-20. [PMID: 26873112 DOI: 10.1016/j.amjmed.2016.01.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 01/13/2016] [Accepted: 01/15/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Red blood cell transfusion is the most common procedure in hospitalized patients in the US. Growing evidence suggests that a sizeable percentage of these transfusions are inappropriate, putting patients at significant risk and increasing costs to the health care system. METHODS We performed a retrospective quasi-experimental study from November 2008 until November 2014 in a 576-bed tertiary care hospital. The intervention consisted of an interruptive clinical decision support alert shown to a provider when a red blood cell transfusion was ordered in a patient whose most recent hematocrit was ≥21%. We used interrupted time series analysis to determine whether our primary outcome of interest, rate of red blood cell transfusion in patients with hematocrit ≥21% per 100 patient (pt) days, was reduced by the implementation of the clinical decision support tool. The rate of platelet transfusions was used as a nonequivalent dependent control variable. RESULTS A total of 143,000 hospital admissions were included in our analysis. Red blood cell transfusions decreased from 9.4 to 7.8 per 100 pt days after the clinical decision support intervention was implemented. Interrupted time series analysis showed that significant decline of 0.05 (95% confidence interval [CI], 0.03-0.07; P < .001) units of red blood cells transfused per 100 pt days per month was already underway in the preintervention period. This trend accelerated to 0.1 (95% CI, 0.09-0.12; P < .001) units of red blood cells transfused per 100 pt days per month following the implementation of the clinical decision support tool. There was no statistical change in the rate of platelet transfusion resulting from the intervention. CONCLUSIONS The implementation of an evidence-based clinical decision support tool was associated with a significant decline in the overuse of red blood cell transfusion. We believe this intervention could be easily replicated in other hospitals using commercial electronic health records and a similar reduction in overuse of red blood cell transfusions achieved.
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Affiliation(s)
- Steven Z Kassakian
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Sciences University, Portland.
| | - Thomas R Yackel
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Sciences University, Portland
| | - Thomas Deloughery
- Division of Hematology/Medical Oncology, Oregon Health and Sciences University, Portland
| | - David A Dorr
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Sciences University, Portland
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470
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Vasques F, Kinnunen EM, Pol M, Mariscalco G, Onorati F, Biancari F. Outcome of Jehovah's Witnesses after adult cardiac surgery: systematic review and meta-analysis of comparative studies. Transfusion 2016; 56:2146-53. [DOI: 10.1111/trf.13657] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 04/04/2016] [Accepted: 04/04/2016] [Indexed: 02/01/2023]
Affiliation(s)
- Francesco Vasques
- Department of Medicine; Anesthesia and Intensive Care Unit, Padua University Hospital; Padua Italy
| | | | - Marek Pol
- Institute of Anatomy, First Faculty of Medicine, Charles University in Prague; Prague Czech Republic
| | - Giovanni Mariscalco
- Department of Cardiovascular Sciences; University of Leicester, Glenfield Hospital; Leicester UK
| | - Francesco Onorati
- Division of Cardiac Surgery; University of Verona Medical School; Verona Italy
| | - Fausto Biancari
- Department of Surgery; Oulu University Hospital; Oulu Finland
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471
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Motivating Factors and Potential Deterrents to Blood Donation in High School Aged Blood Donors. JOURNAL OF BLOOD TRANSFUSION 2016; 2016:8624230. [PMID: 27293985 PMCID: PMC4884579 DOI: 10.1155/2016/8624230] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 04/21/2016] [Accepted: 04/24/2016] [Indexed: 12/26/2022]
Abstract
Background. To ensure an adequate supply of blood, collection centers must design campaigns that successfully recruit and maintain an active donor pool. Understanding factors that motivate and deter individuals from donating may help centers develop targeted recruitment campaigns. These factors among high school aged blood donors have not yet been fully investigated. Study Design and Methods. A voluntary, anonymous survey was administered to student donors at high school mobile blood drives. The survey instrument asked the students to rate several potential motivating factors in their importance in the decision to donate blood and several potential deterring factors in their future decision whether or not to donate blood again. The survey also asked the students to rate the desirability of several potential incentives. Results. Motivating factors that reflected prosocial, empathetic, and altruistic thoughts and beliefs were rated highly by students. Pain from phlebotomy was most commonly chosen as potential deterrent. Movie tickets and cookies/snacks at the drive were rated as the most attractive incentives. Conclusion. High school aged blood donors are similar to other donor groups in their expressed motives for donating blood. This group may be unique in the factors that deter them from donating and in their preferences for different incentives.
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472
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Seiffert M, Conradi L, Gutwein A, Schön G, Deuschl F, Schofer N, Becker N, Schirmer J, Reichenspurner H, Blankenberg S, Treede H, Schäfer U. Baseline anemia and its impact on midterm outcome after transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2016; 89:E44-E52. [DOI: 10.1002/ccd.26563] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 02/15/2016] [Accepted: 03/28/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Moritz Seiffert
- Department of General and Interventional Cardiology; University Heart Center Hamburg; Hamburg Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery; University Heart Center Hamburg; Hamburg Germany
| | - Andreas Gutwein
- Department of General and Interventional Cardiology; University Heart Center Hamburg; Hamburg Germany
| | - Gerhard Schön
- Department of Medical Biometry and Epidemiology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Florian Deuschl
- Department of General and Interventional Cardiology; University Heart Center Hamburg; Hamburg Germany
| | - Niklas Schofer
- Department of General and Interventional Cardiology; University Heart Center Hamburg; Hamburg Germany
| | - Nina Becker
- Department of General and Interventional Cardiology; University Heart Center Hamburg; Hamburg Germany
| | - Johannes Schirmer
- Department of Cardiovascular Surgery; University Heart Center Hamburg; Hamburg Germany
| | | | - Stefan Blankenberg
- Department of General and Interventional Cardiology; University Heart Center Hamburg; Hamburg Germany
| | - Hendrik Treede
- Department of Cardiovascular Surgery; University Heart Center Hamburg; Hamburg Germany
| | - Ulrich Schäfer
- Department of General and Interventional Cardiology; University Heart Center Hamburg; Hamburg Germany
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473
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The Case for a Conservative Approach to Blood Transfusion Management in Cardiac Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016; 11:157-64. [DOI: 10.1097/imi.0000000000000280] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Limiting blood transfusion in cardiac operations is a well-meaning goal of perioperative care. Potential benefits include decreasing morbidity and limiting procedural costs. It is difficult to identify transfusion as the cause of adverse outcomes. The need for transfusion may identify a sicker patient population at greater risk for a worse outcome that may or may not be related to the transfusion. We reviewed the indications for and adverse effects of blood transfusion in patients undergoing cardiac procedures to provide a balanced approach to management of blood resources in this population. We reviewed current literature, including systematic reviews and practice guidelines, to synthesize a practice management plan in patients having cardiac operations. Several prospective randomized studies and large population cohort studies compared a postoperative restrictive transfusion policy to a more liberal policy and found very little difference in outcomes but decreased costs with a restrictive policy. Evidence-based practice guidelines and implementation standards provide robust intervention plans that can limit harmful effects of transfusion and provide safe and effective procedure outcomes. A restrictive transfusion policy seems to be safe and effective but does not necessarily provide better outcome in most patient cohorts. The implications of these findings suggest that many discretionary transfusions could be avoided. A subset of high-risk patients could undoubtedly benefit from a more liberal transfusion policy, but the definition of high risk is ill defined.
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474
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McSparron JI, Hayes MM, Poston JT, Thomson CC, Fessler HE, Stapleton RD, Carlos WG, Hinkle L, Liu K, Shieh S, Ali A, Rogers A, Shah NG, Slack D, Patel B, Wolfe K, Schweickert WD, Bakhru RN, Shin S, Sell RE, Luks AM. ATS Core Curriculum 2016: Part II. Adult Critical Care Medicine. Ann Am Thorac Soc 2016; 13:731-40. [PMID: 27144797 PMCID: PMC5461968 DOI: 10.1513/annalsats.201601-050cme] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 02/16/2016] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jakob I McSparron
- 1 Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Margaret M Hayes
- 1 Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Jason T Poston
- 2 Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Carey C Thomson
- 3 Division of Pulmonary and Critical Care, Mount Auburn Hospital, Harvard Medical School, Boston, Massachusetts
| | - Henry E Fessler
- 4 Division of Pulmonary and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Renee D Stapleton
- 5 Division of Pulmonary Disease and Critical Care Medicine, University of Vermont College of Medicine, Burlington, Vermont
| | - W Graham Carlos
- 6 Division of Pulmonary, Critical Care, Sleep, and Occupational Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Laura Hinkle
- 6 Division of Pulmonary, Critical Care, Sleep, and Occupational Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Kathleen Liu
- 7 Division of Nephrology, Department of Medicine, and
- 8 Division of Critical Care Medicine, Department of Anesthesia, University of California San Francisco, San Francisco, California
| | - Stephanie Shieh
- 9 Division of Nephrology, Department of Medicine, Saint Louis University, Saint Louis, Missouri
| | - Alyan Ali
- 10 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Angela Rogers
- 10 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Nirav G Shah
- 11 Division of Pulmonary and Critical Care Medicine, University of Maryland Medical Center, Baltimore, Maryland
| | - Donald Slack
- 11 Division of Pulmonary and Critical Care Medicine, University of Maryland Medical Center, Baltimore, Maryland
| | - Bhakti Patel
- 2 Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Krysta Wolfe
- 2 Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
| | - William D Schweickert
- 12 Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rita N Bakhru
- 13 Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases, Department of Internal Medicine, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Stephanie Shin
- 14 Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California San Diego, San Diego, California; and
| | - Rebecca E Sell
- 14 Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California San Diego, San Diego, California; and
| | - Andrew M Luks
- 15 Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington
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475
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Blood Transfusion Following Colorectal Resection: What Is the Real Story? Dis Colon Rectum 2016; 59:359-60. [PMID: 27050596 DOI: 10.1097/dcr.0000000000000587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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476
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Gunn T, Paone G, Emery RW, Ferraris VA. The Case for a Conservative Approach to Blood Transfusion Management in Cardiac Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016. [DOI: 10.1177/155698451601100302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Tyler Gunn
- Department of Surgery, University of Kentucky, Lexington, KY USA
| | - Gaetano Paone
- Cardiac Surgery, Henry Ford Hospital, Detroit, MI USA
| | | | - Victor A. Ferraris
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, KY USA
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477
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Nguyen TT, Donahue BS. Sex matching and red cell safety. J Thorac Cardiovasc Surg 2016; 152:233-4. [PMID: 27130299 DOI: 10.1016/j.jtcvs.2016.03.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 03/24/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Thanh T Nguyen
- Division of Pediatric Anesthesia, Department of Anesthesiology, Monroe Carell Jr Children's Hospital at Vanderbilt, Vanderbilt University, Nashville, Tenn
| | - Brian S Donahue
- Division of Pediatric Anesthesia, Department of Anesthesiology, Monroe Carell Jr Children's Hospital at Vanderbilt, Vanderbilt University, Nashville, Tenn.
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478
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Pocock SJ, Clayton TC, Stone GW. Design of Major Randomized Trials: Part 3 of a 4-Part Series on Statistics for Clinical Trials. J Am Coll Cardiol 2016; 66:2757-2766. [PMID: 26700838 DOI: 10.1016/j.jacc.2015.10.036] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 10/23/2015] [Accepted: 10/25/2015] [Indexed: 01/07/2023]
Abstract
This paper provides practical guidance on the fundamentals of design for major randomized controlled trials. Topics covered include the choice of patients, choice of treatment and control groups, choice of primary and secondary endpoints, methods of randomization, appropriate use of blinding, and determination of trial size. Insights are made with reference to contemporary major trials in cardiology.
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Affiliation(s)
- Stuart J Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Tim C Clayton
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Gregg W Stone
- Columbia University Medical Center, New York-Presbyterian Hospital, and the Cardiovascular Research Foundation, New York, New York
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479
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Transfusion Thresholds, Quality of Life, and Current Approaches in Myelodysplastic Syndromes. Anemia 2016; 2016:8494738. [PMID: 27195147 PMCID: PMC4853931 DOI: 10.1155/2016/8494738] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 04/04/2016] [Indexed: 11/17/2022] Open
Abstract
Hemoglobin thresholds and triggers for blood transfusions have changed over the years moving from a higher to a lower level. This review article summarizes the current evidence of transfusion thresholds in the hospitalized as well as in the outpatient setting and particularly in myelodysplasia. Fatigue is the main reported symptom in this group of patients and current clinical trials are looking for a more liberal approach of red cell transfusion and the effect on quality of life as opposed to the restrictive strategy used in the critical care setting. Practical considerations, the cost effectiveness of this strategy in addition to the possible complications, and the use of quality of life questionnaires have also been reviewed.
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480
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Balzer F, von Heymann C, Boyle EM, Wernecke KD, Grubitzsch H, Sander M. Impact of retained blood requiring reintervention on outcomes after cardiac surgery. J Thorac Cardiovasc Surg 2016; 152:595-601.e4. [PMID: 27210474 DOI: 10.1016/j.jtcvs.2016.03.086] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 03/06/2016] [Accepted: 03/18/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Evacuation of shed blood from around the heart and lungs is a critical requirement for patients in early recovery after cardiac surgery. Incomplete evacuation of shed blood can result in retained blood, which may require subsequent reinterventions to facilitate recovery. The purpose of this study was to determine the incidence of retained blood requiring reintervention and examine the impact on outcomes. METHODS We performed a cross-sectional, observational study of all adult patients undergoing cardiac surgery between 2006 and 2013. Subjects who required an intervention to remove blood, blood clot, or bloodily fluid were attributed to the retained blood group. These patients were compared with those not presenting with any of the defined criteria for retained blood. Multivariate regression was performed to account for confounders. RESULTS Of 6909 adult patients who underwent cardiac surgery, 1316 (19%) presented with a retained blood-related condition. Retained blood was associated with increased in-hospital mortality (odds ratio [OR], 4.041; 95% confidence interval [CI], 2.589-6.351, P < .001) and a length of stay more than 13 days in the hospital (OR, 3.853; 95% CI, 2.882-5.206; P < .001) and 5 days in the intensive care unit (OR, 4.602; 95% CI, 3.449-6.183; P < .001). The OR for a time of ventilation greater than 23 hours was 3.596 (95% CI, 2.690-4.851; P < .001) and for incidence of renal replacement therapy was 4.449 (95% CI, 3.188-6.226; P < .001). CONCLUSIONS Postoperative retained blood is a common outcome and associated with higher in-hospital mortality, longer intensive care unit and hospital stay, and higher incidence of renal replacement therapy. Further research is needed to validate these results and explore interventions to reduce these complications.
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Affiliation(s)
- Felix Balzer
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin, Berlin, Germany.
| | - Christian von Heymann
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin, Berlin, Germany; Department of Anesthesiology, Intensive Care Medicine, Emergency and Pain Medicine, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | | | - Klaus D Wernecke
- Charité - Universitätsmedizin Berlin and SOSTANA GmbH, Berlin, Germany
| | - Herko Grubitzsch
- Department of Cardiovascular Surgery, Campus Charité Mitte, Charité - Universitätsmedizin, Berlin, Germany
| | - Michael Sander
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin, Berlin, Germany; Department of Anesthesiology and Intensive Care Medicine, Universitätsklinikum Giessen und Marburg GmbH, Giessen, Germany
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481
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Rao SV, Vora AN. Transfusion in Ischemic Heart Disease: Correlation, Confounding, and Confusion. J Am Coll Cardiol 2016; 66:2519-21. [PMID: 26653626 DOI: 10.1016/j.jacc.2015.09.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 09/10/2015] [Accepted: 09/15/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Sunil V Rao
- Duke Clinical Research Institute, Durham, North Carolina.
| | - Amit N Vora
- Duke Clinical Research Institute, Durham, North Carolina
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482
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Abstract
The Centers for Disease Control and Prevention (CDC) released ventilator-associated event (VAE) definitions in 2013. The new definitions were designed to track episodes of sustained respiratory deterioration in mechanically ventilated patients after a period of stability or improvement. More than 2,000 U.S. hospitals have reported their VAE rates to the CDC, but there has been little guidance to date on how to prevent VAEs. Existing ventilator-associated pneumonia prevention bundles are unlikely to be optimal insofar as pneumonia accounts for only a minority of VAEs. This review proposes a framework and potential intervention set to prevent VAEs on the basis of studies of VAE epidemiology, risk factors, and prevention. Work to date suggests that the majority of VAEs are caused by four conditions: pneumonia, fluid overload, atelectasis, and acute respiratory distress syndrome. Interventions that minimize ventilator exposure and target one or more of these conditions may therefore prevent VAEs. Potential strategies include avoiding intubation, minimizing sedation, paired daily spontaneous awakening and breathing trials, early exercise and mobility, low tidal volume ventilation, conservative fluid management, and conservative blood transfusion thresholds. Interventional studies have thus far affirmed that minimized sedation, paired daily spontaneous awakening and breathing trials, and conservative fluid management can reduce VAE rates and improve patient-centered outcomes. Further studies are needed to evaluate the impact of the other proposed interventions, to identify additional modifiable risk factors for VAEs, and to measure whether combining strategies into VAE prevention bundles confers additional benefits over implementing one or more of these interventions in isolation.
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Affiliation(s)
- Michael Klompas
- 1 Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts; and.,2 Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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483
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Rossaint R, Bouillon B, Cerny V, Coats TJ, Duranteau J, Fernández-Mondéjar E, Filipescu D, Hunt BJ, Komadina R, Nardi G, Neugebauer EAM, Ozier Y, Riddez L, Schultz A, Vincent JL, Spahn DR. The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition. Crit Care 2016; 20:100. [PMID: 27072503 PMCID: PMC4828865 DOI: 10.1186/s13054-016-1265-x] [Citation(s) in RCA: 597] [Impact Index Per Article: 74.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 03/11/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Severe trauma continues to represent a global public health issue and mortality and morbidity in trauma patients remains substantial. A number of initiatives have aimed to provide guidance on the management of trauma patients. This document focuses on the management of major bleeding and coagulopathy following trauma and encourages adaptation of the guiding principles to each local situation and implementation within each institution. METHODS The pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma was founded in 2004 and included representatives of six relevant European professional societies. The group used a structured, evidence-based consensus approach to address scientific queries that served as the basis for each recommendation and supporting rationale. Expert opinion and current clinical practice were also considered, particularly in areas in which randomised clinical trials have not or cannot be performed. Existing recommendations were reconsidered and revised based on new scientific evidence and observed shifts in clinical practice; new recommendations were formulated to reflect current clinical concerns and areas in which new research data have been generated. This guideline represents the fourth edition of a document first published in 2007 and updated in 2010 and 2013. RESULTS The guideline now recommends that patients be transferred directly to an appropriate trauma treatment centre and encourages use of a restricted volume replacement strategy during initial resuscitation. Best-practice use of blood products during further resuscitation continues to evolve and should be guided by a goal-directed strategy. The identification and management of patients pre-treated with anticoagulant agents continues to pose a real challenge, despite accumulating experience and awareness. The present guideline should be viewed as an educational aid to improve and standardise the care of the bleeding trauma patients across Europe and beyond. This document may also serve as a basis for local implementation. Furthermore, local quality and safety management systems need to be established to specifically assess key measures of bleeding control and outcome. CONCLUSIONS A multidisciplinary approach and adherence to evidence-based guidance are key to improving patient outcomes. The implementation of locally adapted treatment algorithms should strive to achieve measureable improvements in patient outcome.
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Affiliation(s)
- Rolf Rossaint
- />Department of Anaesthesiology, University Hospital Aachen, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Bertil Bouillon
- />Department of Trauma and Orthopaedic Surgery, Witten/Herdecke University, Cologne-Merheim Medical Centre, Ostmerheimer Strasse 200, 51109 Cologne, Germany
| | - Vladimir Cerny
- />Department of Anaesthesiology, Perioperative Medicine and Intensive Care, J.E. Purkinje University, Masaryk Hospital, Usti nad Labem, Socialni pece 3316/12A, 40113 Usti nad Labem, Czech Republic
- />Department of Research and Development, Charles University in Prague, Faculty of Medicine in Hradec Kralove, Sokolska 581, 50005 Hradec Kralove, Czech Republic
- />Department of Anaesthesiology and Intensive Care, Charles University in Prague, Faculty of Medicine in Hradec Kralove, Sokolska 581, 50005 Hradec Kralove, Czech Republic
- />Department of Anaesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, QE II Health Sciences Centre, 10 West Victoria, 1276 South Park St., Halifax, NS B3H 2Y9 Canada
| | - Timothy J. Coats
- />Emergency Medicine Academic Group, University of Leicester, University Road, Leicester, LE1 7RH UK
| | - Jacques Duranteau
- />Department of Anaesthesia and Intensive Care, Hôpitaux Universitaires Paris Sud, University of Paris XI, Faculté de Médecine Paris-Sud, 78 rue du Général Leclerc, 94275 Le Kremlin-Bicêtre, Cedex France
| | - Enrique Fernández-Mondéjar
- />Servicio de Medicina Intensiva, Complejo Hospitalario Universitario de Granada, ctra de Jaén s/n, 18013 Granada, Spain
| | - Daniela Filipescu
- />Department of Cardiac Anaesthesia and Intensive Care, C. C. Iliescu Emergency Institute of Cardiovascular Diseases, Sos Fundeni 256-258, 022328 Bucharest, Romania
| | - Beverley J. Hunt
- />King’s College, Departments of Haematology, Pathology and Lupus, Guy’s and St Thomas’ NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH UK
| | - Radko Komadina
- />Department of Traumatology, General and Teaching Hospital Celje, Oblakova 5, 3000 Celje, Slovenia
| | - Giuseppe Nardi
- />Shock and Trauma Centre, S. Camillo Hospital, Viale Gianicolense 87, 00152 Rome, Italy
| | - Edmund A. M. Neugebauer
- />Faculty of Health - School of Medicine, Witten/Herdecke University, Ostmerheimer Strasse 200, Building 38, 51109 Cologne, Germany
| | - Yves Ozier
- />Division of Anaesthesia, Intensive Care and Emergency Medicine, Brest University Hospital, Boulevard Tanguy Prigent, 29200 Brest, France
| | - Louis Riddez
- />Department of Surgery and Trauma, Karolinska University Hospital, 171 76 Solna, Sweden
| | - Arthur Schultz
- />Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Lorenz Boehler Trauma Centre, Donaueschingenstrasse 13, 1200 Vienna, Austria
| | - Jean-Louis Vincent
- />Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium
| | - Donat R. Spahn
- />Institute of Anaesthesiology, University of Zurich and University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
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484
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Banayan JM, Chaney MA. Blood: Can't live with it, can't live without it. J Thorac Cardiovasc Surg 2016; 152:18-9. [PMID: 27112711 DOI: 10.1016/j.jtcvs.2016.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 04/01/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Jennifer M Banayan
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, Ill
| | - Mark A Chaney
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, Ill.
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485
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Goel R, Johnson DJ, Scott AV, Tobian AA, Ness PM, Nagababu E, Frank SM. Red blood cells stored 35 days or more are associated with adverse outcomes in high-risk patients. Transfusion 2016; 56:1690-8. [DOI: 10.1111/trf.13559] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 01/24/2016] [Accepted: 02/05/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Ruchika Goel
- Departments of Pathology and Pediatric Hematology/Oncology; New York Presbyterian Hospital, Weill Cornell Medical College, and The New York Blood Center; New York New York
| | - Daniel J. Johnson
- Department of Anesthesiology/Critical Care Medicine; The Johns Hopkins Medical Institutions; Baltimore Maryland
| | - Andrew V. Scott
- Department of Anesthesiology/Critical Care Medicine; The Johns Hopkins Medical Institutions; Baltimore Maryland
| | - Aaron A.R. Tobian
- Department of Pathology (Transfusion Medicine); The Johns Hopkins Medical Institutions; Baltimore Maryland
| | - Paul M. Ness
- Department of Pathology (Transfusion Medicine); The Johns Hopkins Medical Institutions; Baltimore Maryland
| | - Enika Nagababu
- Department of Anesthesiology/Critical Care Medicine; The Johns Hopkins Medical Institutions; Baltimore Maryland
| | - Steven M. Frank
- Department of Anesthesiology/Critical Care Medicine; The Johns Hopkins Medical Institutions; Baltimore Maryland
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486
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Klein AA, Arnold P, Bingham RM, Brohi K, Clark R, Collis R, Gill R, McSporran W, Moor P, Rao Baikady R, Richards T, Shinde S, Stanworth S, Walsh TS. AAGBI guidelines: the use of blood components and their alternatives 2016. Anaesthesia 2016; 71:829-42. [PMID: 27062274 DOI: 10.1111/anae.13489] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2016] [Indexed: 12/13/2022]
Abstract
Blood transfusion can be life-saving. Anaesthetists regularly request and administer blood components to their patients. All anaesthetists must be familiar with indications and appropriate use of blood and blood components and their alternatives, but close liaison with haematology specialists and their local blood sciences laboratory is encouraged. Considerable changes in approaches to optimal use of blood components, together with the use of alternative products, have become apparent over the past decade, leading to a need to update previous guidelines and adapt them for the use of anaesthetists working throughout the hospital system.
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Affiliation(s)
- A A Klein
- Department of Anaesthesia and Intensive Care, Papworth Hospital, Cambridge, UK
| | - P Arnold
- Department of Paediatric Anaesthesia, Alder Hey Children's Hospital, University of Liverpool, Liverpool, UK
| | - R M Bingham
- Department of Paediatric Anaesthesia, Great Ormond Street Hospital for Children, London, UK
| | - K Brohi
- Centre for Trauma Sciences, Barts Health NHS Trust and Queen Mary University of London, London, UK
| | - R Clark
- Department of Anaesthesia, Glasgow Royal Infirmary, Glasgow, UK
| | - R Collis
- Department of Anaesthesia, University Hospital of Wales, Cardiff, UK
| | - R Gill
- Department of Anaesthesia, University Hospital Southampton, UK
| | | | - P Moor
- Department of Anaesthesia, Derriford Hospital, Plymouth, UK
| | - R Rao Baikady
- Department of Anaesthesia, The Royal Marsden Hospital, London, UK
| | - T Richards
- Division of Surgery and Interventional Science, University College Hospital, London, UK
| | - S Shinde
- Department of Anaesthesia, Southmead Hospital, Bristol, UK
| | - S Stanworth
- Department of Haematology, Oxford Radcliffe Hospitals, Oxford, UK
| | - T S Walsh
- Department of Anaesthetics, Critical Care and Pain Medicine, Edinburgh University, Edinburgh, UK
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487
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Abstract
Transfusion-transmitted infections remain among the most-feared complications of allogeneic blood transfusion. Thanks to several strategies including donor screening and deferral, blood testing and pathogen inactivation, their risks have reached all-time low levels, particularly in developed nations. Nonetheless, new and emerging infections remain a threat that is likely to exacerbate in the coming years with continued globalization and climate change. More effective strategies of pathogen inactivation and more vigilant horizon screening are hoped to abate the risk. Additionally, allogeneic transfusion has repeatedly been shown to be associated with worsening of outcomes in patients, including the documented increased risk of infections (often nosocomial) in recipients of transfusions. The underlying mechanism is likely to be related to immunosuppressive effects of allogeneic blood, iron content, and bacterial contamination. This issue is best addressed by more judicious and evidence-based use of allogeneic blood components to ensure the potential benefits outweigh the risks.
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Affiliation(s)
- Aryeh Shander
- a Department of Anesthesiology and Critical Care Medicine , Englewood Hospital and Medical Center and TeamHealth Research Institute , Englewood , NJ , USA
| | - Gregg P Lobel
- a Department of Anesthesiology and Critical Care Medicine , Englewood Hospital and Medical Center and TeamHealth Research Institute , Englewood , NJ , USA
| | - Mazyar Javidroozi
- a Department of Anesthesiology and Critical Care Medicine , Englewood Hospital and Medical Center and TeamHealth Research Institute , Englewood , NJ , USA
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488
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Hogervorst EK, Rosseel PM, van de Watering LM, Brand A, Bentala M, van der Bom JG, van der Meer NJ. Intraoperative Anemia and Single Red Blood Cell Transfusion During Cardiac Surgery: An Assessment of Postoperative Outcome Including Patients Refusing Blood Transfusion. J Cardiothorac Vasc Anesth 2016; 30:363-72. [DOI: 10.1053/j.jvca.2015.10.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Indexed: 12/28/2022]
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489
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Docherty AB, O'Donnell R, Brunskill S, Trivella M, Doree C, Holst L, Parker M, Gregersen M, Pinheiro de Almeida J, Walsh TS, Stanworth SJ. Effect of restrictive versus liberal transfusion strategies on outcomes in patients with cardiovascular disease in a non-cardiac surgery setting: systematic review and meta-analysis. BMJ 2016; 352:i1351. [PMID: 27026510 PMCID: PMC4817242 DOI: 10.1136/bmj.i1351] [Citation(s) in RCA: 150] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To compare patient outcomes of restrictive versus liberal blood transfusion strategies in patients with cardiovascular disease not undergoing cardiac surgery. DESIGN Systematic review and meta-analysis. DATA SOURCES Randomised controlled trials involving a threshold for red blood cell transfusion in hospital. We searched (to 2 November 2015) CENTRAL, Medline, Embase, CINAHL, PubMed, LILACS, NHSBT Transfusion Evidence Library, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, ISRCTN Register, and EU Clinical Trials Register. Authors were contacted for data whenever possible. TRIAL SELECTION Published and unpublished randomised controlled trials comparing a restrictive with liberal transfusion threshold and that included patients with cardiovascular disease. DATA EXTRACTION AND SYNTHESIS Data extraction was completed in duplicate. Risk of bias was assessed using Cochrane methods. Relative risk ratios with 95% confidence intervals were presented in all meta-analyses. Mantel-Haenszel random effects models were used to pool risk ratios. MAIN OUTCOME MEASURES 30 day mortality, and cardiovascular events. RESULTS 41 trials were identified; of these, seven included data on patients with cardiovascular disease. Data from a further four trials enrolling patients with cardiovascular disease were obtained from the authors. In total, 11 trials enrolling patients with cardiovascular disease (n=3033) were included for meta-analysis (restrictive transfusion, n=1514 patients; liberal transfusion, n=1519). The pooled risk ratio for the association between transfusion thresholds and 30 day mortality was 1.15 (95% confidence interval 0.88 to 1.50, P=0.50), with little heterogeneity (I(2)=14%). The risk of acute coronary syndrome in patients managed with restrictive compared with liberal transfusion was increased (nine trials; risk ratio 1.78, 95% confidence interval 1.18 to 2.70, P=0.01, I(2)=0%). CONCLUSIONS The results show that it may not be safe to use a restrictive transfusion threshold of less than 80 g/L in patients with ongoing acute coronary syndrome or chronic cardiovascular disease. Effects on mortality and other outcomes are uncertain. These data support the use of a more liberal transfusion threshold (>80 g/L) for patients with both acute and chronic cardiovascular disease until adequately powered high quality randomised trials have been undertaken in patients with cardiovascular disease. REGISTRATION PROSPERO CRD42014014251.
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Affiliation(s)
- Annemarie B Docherty
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK Critical Care Department, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Rob O'Donnell
- Critical Care Department, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Susan Brunskill
- Systematic Review Initiative, NHS Blood and Transplant, John Radcliffe Hospital, Oxford, UK
| | - Marialena Trivella
- Systematic Review Initiative, NHS Blood and Transplant, John Radcliffe Hospital, Oxford, UK
| | - Carolyn Doree
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Lars Holst
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Martyn Parker
- Department of Orthopaedics, Peterborough and Stamford Hospitals NHS Trust, Peterborough, UK
| | | | - Juliano Pinheiro de Almeida
- Surgical Intensive Care Unit and Department of Anesthesiology, Cancer Institute, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Timothy S Walsh
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK Critical Care Department, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Simon J Stanworth
- Systematic Review Initiative, NHS Blood and Transplant, John Radcliffe Hospital, Oxford, UK Department of Haematology, NHS Blood and Transplant/Oxford University Hospitals NHS Trust, Oxford, UK
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490
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491
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Klein AA, Collier TJ, Brar MS, Evans C, Hallward G, Fletcher SN, Richards T. The incidence and importance of anaemia in patients undergoing cardiac surgery in the UK - the first Association of Cardiothoracic Anaesthetists national audit. Anaesthesia 2016; 71:627-35. [DOI: 10.1111/anae.13423] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2016] [Indexed: 12/20/2022]
Affiliation(s)
- A. A. Klein
- Department of Anaesthesia and Intensive Care; Papworth Hospital; Cambridge UK
| | - T. J. Collier
- Department of Medical Statistics; London School of Hygiene and Tropical Medicine; London UK
| | - M. S. Brar
- Department of Surgery; Cumming School of Medicine; University of Calgary; Calgary Alberta Canada
| | - C. Evans
- Department of Anaesthesia; University Hospital of Wales; Cardiff UK
| | - G. Hallward
- Department of Anaesthesia; Guy's and St Thomas' Hospitals; London UK
| | - S. N. Fletcher
- Department of Anaesthesia and Critical Care; St George's Hospital; London UK
| | - T. Richards
- Division of Surgery and Interventional Science; University College Hospital; London UK
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492
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Hemolysis following red cell concentrate transfusion in severe trauma patients. Med Intensiva 2016; 40:455-6. [PMID: 26947526 DOI: 10.1016/j.medin.2016.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 01/07/2016] [Accepted: 01/14/2016] [Indexed: 01/02/2023]
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493
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Murphy GJ, Verheyden V, Wozniak M, Sullo N, Dott W, Bhudia S, Bittar N, Morris T, Ring A, Tebbatt A, Kumar T. Trial protocol for a randomised controlled trial of red cell washing for the attenuation of transfusion-associated organ injury in cardiac surgery: the REDWASH trial. Open Heart 2016; 3:e000344. [PMID: 26977309 PMCID: PMC4785436 DOI: 10.1136/openhrt-2015-000344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 12/11/2015] [Accepted: 01/11/2016] [Indexed: 11/29/2022] Open
Abstract
Introduction It has been suggested that removal of proinflammatory substances that accumulate in stored donor red cells by mechanical cell washing may attenuate inflammation and organ injury in transfused cardiac surgery patients. This trial will test the hypotheses that the severity of the postoperative inflammatory response will be less and postoperative recovery faster if patients undergoing cardiac surgery receive washed red cells compared with standard care (unwashed red cells). Methods and analysis Adult (≥16 years) cardiac surgery patients identified at being at increased risk for receiving large volume red cell transfusions at 1 of 3 UK cardiac centres will be randomly allocated in a 1:1 ratio to either red cell washing or standard care. The primary outcome is serum interleukin-8 measured at 5 postsurgery time points up to 96 h. Secondary outcomes will include measures of inflammation, organ injury and volumes of blood transfused and cost-effectiveness. Allocation concealment, internet-based randomisation stratified by operation type and recruiting centre, and blinding of outcome assessors will reduce the risk of bias. The trial will test the superiority of red cell washing versus standard care. A sample size of 170 patients was chosen in order to detect a small-to-moderate target difference, with 80% power and 5% significance (2-tailed). Ethics and dissemination The trial protocol was approved by a UK ethics committee (reference 12/EM/0475). The trial findings will be disseminated in scientific journals and meetings. Trial registration number ISRCTN 27076315.
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Affiliation(s)
- G J Murphy
- Department of Cardiovascular Sciences and NIHR Cardiovascular Biomedical Research Unit , University of Leicester, Clinical Sciences Wing, Glenfield Hospital , Leicester , UK
| | - V Verheyden
- Department of Cardiovascular Sciences and NIHR Cardiovascular Biomedical Research Unit , University of Leicester, Clinical Sciences Wing, Glenfield Hospital , Leicester , UK
| | - M Wozniak
- Department of Cardiovascular Sciences and NIHR Cardiovascular Biomedical Research Unit , University of Leicester, Clinical Sciences Wing, Glenfield Hospital , Leicester , UK
| | - N Sullo
- Department of Cardiovascular Sciences and NIHR Cardiovascular Biomedical Research Unit , University of Leicester, Clinical Sciences Wing, Glenfield Hospital , Leicester , UK
| | - W Dott
- Department of Cardiovascular Sciences and NIHR Cardiovascular Biomedical Research Unit , University of Leicester, Clinical Sciences Wing, Glenfield Hospital , Leicester , UK
| | - S Bhudia
- University Hospitals Coventry and Warwickshire NHS Trust , Coventry , UK
| | - N Bittar
- Blackpool Victoria Hospital NHS Trust , Blackpool , UK
| | - T Morris
- Leicester Clinical Trials Unit , Leicester Diabetes Centre, Leicester General Hospital , Leicester , UK
| | - A Ring
- Leicester Clinical Trials Unit , Leicester Diabetes Centre, Leicester General Hospital , Leicester , UK
| | - A Tebbatt
- Department of Clinical Perfusion , University Hospital Leicester NHS Trust, Glenfield Hospital , Leicester , UK
| | - T Kumar
- Department of Cardiovascular Sciences and NIHR Cardiovascular Biomedical Research Unit , University of Leicester, Clinical Sciences Wing, Glenfield Hospital , Leicester , UK
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494
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Zwissler B. [Educating patients about blood transfusion risks : Do we have to rethink?]. Anaesthesist 2016; 65:165-8. [PMID: 26936276 DOI: 10.1007/s00101-016-0139-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- B Zwissler
- Klinik für Anaesthesiologie, LMU München, Marchioninistraße 15, 81377, München, Deutschland.
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495
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Ionized Calcium in the ICU. Chest 2016; 149:846-55. [DOI: 10.1016/j.chest.2015.12.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 11/25/2015] [Accepted: 12/02/2015] [Indexed: 02/07/2023] Open
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496
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Plumb JOM, Otto JM, Grocott MPW. 'Blood doping' from Armstrong to prehabilitation: manipulation of blood to improve performance in athletes and physiological reserve in patients. EXTREME PHYSIOLOGY & MEDICINE 2016; 5:5. [PMID: 26929820 PMCID: PMC4770708 DOI: 10.1186/s13728-016-0046-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 02/12/2016] [Indexed: 02/07/2023]
Abstract
Haemoglobin is the blood’s oxygen carrying pigment and is encapsulated in red blood corpuscles. The concentration of haemoglobin in blood is dependent on both its total mass in the circulation (tHb-mass) and the total plasma volume in which it is suspended. Aerobic capacity is defined as the maximum amount of oxygen that can be consumed by the body per unit time and is one measure of physical fitness. Observations in athletes who have undergone blood doping or manipulation have revealed a closer relationship between physical fitness (aerobic capacity) and total haemoglobin mass (tHb-mass) than with haemoglobin concentration ([Hb]). Anaemia is defined by the World Health Organisation (WHO) as a haemoglobin concentration of <130 g/L for men and <120 g/L for women. Perioperative anaemia is a common problem and is associated with increased mortality and morbidity following surgery. Aerobic capacity is also associated with outcome following major surgery, with less fit patients having a higher incidence of mortality and morbidity after surgery. Taken together, these observations suggest that targeted preoperative elevation of tHb-mass may raise aerobic capacity both directly and indirectly (by augmenting preoperative exercise initiatives- ‘prehabilitation’) and thus improve postoperative outcome. This notion in turn raises a number of questions. Which measure ([Hb] or tHb-mass) has the most value for the description of oxygen carrying capacity? Which measure has the most utility for targeting therapies to manipulate haemoglobin levels? Do the newer agents being used for blood manipulation (to increase tHb-mass) in elite sport have utility in the clinical environment? This review explores the literature relating to blood manipulation in elite sport as well as the relationship between perioperative anaemia, physical fitness and outcome following surgery, and suggests some avenues for exploring this area further.
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Affiliation(s)
- James O M Plumb
- Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK ; Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, University Road, Southampton, UK ; Critical Care Research Area, Southampton NIHR Respiratory Biomedical Research Unit, Southampton, UK ; Faculty of Medicine University of Southampton, Southampton General Hospital Mailpoint 801 South Academic Block, Tremona Road Southampton, Southampton, SO16 6YD UK
| | - James M Otto
- Division of Surgery and Interventional Science c/o, Institute of Sport, Exercise and Health (ISEH), 170 Tottenham Court Road, London, UK
| | - Michael P W Grocott
- Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK ; Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, University Road, Southampton, UK ; Critical Care Research Area, Southampton NIHR Respiratory Biomedical Research Unit, Southampton, UK ; Faculty of Medicine University of Southampton, Southampton General Hospital Mailpoint 801 South Academic Block, Tremona Road Southampton, Southampton, SO16 6YD UK
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497
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Verdecchia NM, Wisniewski MK, Waters JH, Triulzi DJ, Alarcon LH, Yazer MH. Changes in blood product utilization in a seven-hospital system after the implementation of a patient blood management program: A 9-year follow-up. Hematology 2016; 21:490-9. [DOI: 10.1080/10245332.2015.1112496] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
| | - Mary Kay Wisniewski
- The Donald D. Wolff Jr Center for Quality, Safety, and Innovation at UPMC, Pittsburgh, PA, USA
| | - Jonathan H. Waters
- Department of Anesthesiology, University of Pittsburgh, PA, USA
- Department of Bioengineering and the McGowan Institute for Regenerative Medicine, University of Pittsburgh, PA, USA
| | - Darrell J. Triulzi
- Department of Pathology, University of Pittsburgh, PA, USA
- The Institute for Transfusion Medicine, Pittsburgh, PA, USA
| | - Louis H. Alarcon
- Departments of Surgery and Critical Care Medicine, University of Pittsburgh, PA, USA
| | - Mark H. Yazer
- Department of Pathology, University of Pittsburgh, PA, USA
- The Institute for Transfusion Medicine, Pittsburgh, PA, USA
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498
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Grines CL, Harjai KJ, Schreiber TL. Percutaneous Coronary Intervention: 2015 in Review. J Interv Cardiol 2016; 29:11-26. [PMID: 26864949 DOI: 10.1111/joic.12272] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
| | - Kishore J. Harjai
- Geisinger Clinic; Pearsall Heart Hospital; Wilkes-Barre Pennsylvania
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499
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Chee Y, Liu S, Irwin M. Management of bleeding in vascular surgery. Br J Anaesth 2016; 117 Suppl 2:ii85-ii94. [DOI: 10.1093/bja/aew270] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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500
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Tempo JA, Englyst NA, Holloway JA, Smith DC. Platelet Microvesicles (Microparticles) in Cardiac Surgery. J Cardiothorac Vasc Anesth 2016; 30:222-8. [DOI: 10.1053/j.jvca.2015.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Indexed: 11/11/2022]
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