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Țichil I, Rus IC, Cenariu D, Fodor L, Mitre I. Blood transfusions in non-major burns patients. Burns 2023; 49:1808-1815. [PMID: 37867053 DOI: 10.1016/j.burns.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/07/2023] [Accepted: 09/26/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Blood transfusions are essential to treating anaemia of burn injuries. It has recently been observed that patients with non-major burns < 20%TBSA may also develop anaemia requiring transfusion of blood products. Due to the morbidity and mortality rate associated with blood transfusions better understanding of risk factors may guide clinical practices to improve patient care. OBJECTIVE To determine risk factors for transfusion of blood products in patients with non-major burn injuries and assess transfusion practices to establish impact on patient outcome. METHOD Our study included 182 adult patients with non-major burn injuries, < 20%TBSA admitted over a 3-year period at the Department of Plastic Surgery and Burns Unit of the Emergency County Hospital Cluj-Napoca. We analysed patient and injury characteristics: age, gender, %TBSA burn, %FT burn, burn site, mechanism of injury, inhalation injury, Hb lab determinations throughout admission and surgical management. Charlson comorbidities index has been determined based on cardiovascular, neurological, gastrointestinal and renal comorbidities as well as diabetes mellitus. We selected blood transfusions, wound infections and length of hospital stay as outcome for our analysis. RESULTS 37.9% of patients included in our study developed anaemia throughout admission and 7.7% underwent blood transfusions. Mean Hb levels triggering blood transfusions have been recorded at 7.4 (IQR=8.8-9.9) g/dL. Patients who received transfusions were older, presented with higher %TBSA and associated a higher comorbidity index. They also tended to develop coagulopathy and underwent more surgical procedures to achieve wound closure. In transfused patients who associate comorbidities we observed a higher rate of wound infections and longer hospital stay. CONCLUSIONS Patient related comorbidities correlate with higher transfusion rates in non-major burn injuries. Due to the risk associated with the use of blood products decision to transfuse should adhere to current guideline practices and be tailored to specific patient requirements.
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Affiliation(s)
- Ioana Țichil
- University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj Napoca, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania; Emergency County Hospital, 3-5 Clinicilor Street, 400006 Cluj-Napoca, Romania; Department of Haematology "Ion Chiricuta" Institute of Oncology, 34-36 Republicii Street, Cluj-Napoca 400015, Romania.
| | - Ioana Codruta Rus
- Department of Haematology "Ion Chiricuta" Institute of Oncology, 34-36 Republicii Street, Cluj-Napoca 400015, Romania
| | - Diana Cenariu
- University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj Napoca, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania; MEDFUTURE - Research Centre for Advanced Medicine, 8 Louis Pasteur Street, 400347 Cluj-Napoca, Romania
| | - Lucian Fodor
- Emergency County Hospital, 3-5 Clinicilor Street, 400006 Cluj-Napoca, Romania
| | - Ileana Mitre
- University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj Napoca, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania; Emergency County Hospital, 3-5 Clinicilor Street, 400006 Cluj-Napoca, Romania
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Roggan CLM, Akbas S, Arvanitakis M, Mannil L, Spahn DR, Plock JA, Kaserer A. Changes in coagulation and temperature management in burn patients - A survey of burn centers in Switzerland, Austria and Germany. Burns 2023; 49:1566-1573. [PMID: 36914441 DOI: 10.1016/j.burns.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/13/2023] [Accepted: 02/19/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Severely burned patients suffer from both coagulopathy and hypothermia, with a lack of international consensus and appropriate treatment guidelines. This study examines recent developments and trends in coagulation and temperature management in European burn centers. METHODS A survey was sent to burn centers in Switzerland, Austria and Germany in 2016 and again in 2021. The analysis was performed using descriptive statistics, with categorical data reported in absolute numbers (n) and percentages (%) and numerical data reported as mean and standard deviation. RESULTS The rate of completed questionnaires was 84 % (16 of 19 questionnaires) in 2016 and 91 % (21 of 22 questionnaires) in 2021. The number of global coagulation tests performed has decreased over the observation period in favor of single factor determination and bed-side point-of-care coagulation tests. This has also led to increased administration of single factor concentrates in therapy. Although many centers had a defined treatment protocol for hypothermia in 2016, coverage increased such that in 2021 all centers surveyed had such a protocol. The body temperature was measured more consistently in 2021; thus, hypothermia was more actively sought, detected and treated. CONCLUSION A point-of-care guided, factor-based coagulation management and the maintenance of normothermia have gained importance in the care of burn patients in recent years.
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Affiliation(s)
- Celine L M Roggan
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Samira Akbas
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Michael Arvanitakis
- University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Plastic Surgery and Hand Surgery, Burn Center, University of Zurich, Zurich, Switzerland
| | - Lijo Mannil
- University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Plastic Surgery and Hand Surgery, Burn Center, University of Zurich, Zurich, Switzerland
| | - Donat R Spahn
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Jan A Plock
- University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Plastic Surgery and Hand Surgery, Burn Center, University of Zurich, Zurich, Switzerland; Department of Plastic Surgery and Hand Surgery; Cantonal Hospital Aarau; Aarau, Switzerland
| | - Alexander Kaserer
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland.
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Haase DR, Haase LR, Moon TJ, Dallman J, Vance D, Benedick A, Ochenjele G, Napora JK, Wise BT. Perioperative allogenic blood transfusions are associated with increased fracture related infection rates, but not nonunion in operatively treated distal femur fractures. Injury 2023:S0020-1383(23)00383-2. [PMID: 37188588 DOI: 10.1016/j.injury.2023.04.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 04/11/2023] [Accepted: 04/23/2023] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Distal femur fractures are common injuries that remain difficult for orthopedic surgeons to treat. High complication rates, including nonunion rates as high as 24% and infection rates of 8%, can lead to increased morbidity for these patients. Allogenic blood transfusions have previously been identified as risk factors for infection in total joint arthroplasty and spinal fusion surgeries. No studies have explored the relationship between blood transfusions and fracture related infection (FRI) or nonunion in distal femur fractures. METHODS 418 patients with operatively treated distal femur fractures at two level I trauma centers were retrospectively reviewed. Patient demographics were collected including age, gender, BMI, medical comorbidities, and smoking. Injury and treatment information was also collected including open fracture, polytrauma status, implant, perioperative transfusions, FRI, and nonunion. Patients with less than three months of follow up were excluded. RESULTS 366 patients were included in final analysis. One hundred thirty-nine (38%) patients received a perioperative blood transfusion. Forty-seven (13%) nonunions and 30 (8%) FRI were identified. Allogenic blood transfusion was not associated with nonunion (13% vs 12%, P = 0.87), but was associated with FRI (15% vs 4%, P<0.001). Binary logistic regression analysis identified a dose dependent relationship between number of perioperative blood transfusions and FRI: total transfusion ≥2 U PRBC RR= 3.47(1.29, 8.10, P = 0.02), ≥3 RR= 6.99 (3.01, 12.40, P<0.001), and ≥4 RR= 8.94 (4.03, 14.42, P<0.001). DISCUSSION In patients undergoing operative treatment of distal femur fractures, perioperative blood transfusions are associated with increased risk of fracture related infection, but not the development of a nonunion. This risk association increases in a dose-dependent relationship with increasing total blood transfusions received.
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Souto J, Rodrigues AG. Reducing Blood Loss in a Burn Care Unit: A Review of Its Key Determinants. J Burn Care Res 2023; 44:459-466. [PMID: 36106386 DOI: 10.1093/jbcr/irac114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patients with a major burn injury differ considerably from the typical critical ill and trauma population. Very often, burn patients suffer from anemia throughout their hospital stay. This is caused both by combination of persistent blood loss with decreased erythropoiesis. Therefore, burn patients do have major transfusion requirements. However, transfusion is not devoid of risks or costs. We hereby review the best surgical techniques and medical approaches, aiming to reduce blood loss in a burn patient and optimize red cell production, so that we can reduce the need of RBC transfusion. The implementation of a combination of surgical techniques aiming to reduce blood loss and medical care approaches to prevent anemia, rather than single attitudes, should be adopted in burn care. There is an urgent need for clear guidelines that can easily be accepted, applied, and spread across different burn units to methodically implement measures to reduce blood loss and transfusion needs, and ultimately improve burn patients' outcome and the health care financial status.
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Affiliation(s)
- João Souto
- Faculty of Medicine, University of Porto, Portugal
| | - Acacio Goncalves Rodrigues
- Burn Unit and Department of Plastic and Reconstructive Surgery, Faculty of Medicine, S. João University Hospital Center, Porto, Portugal.,CINTESIS@RISE, Faculty of Medicine, University of Porto, Portugal
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Gigengack RK, Taha D, Martijn Kuijper T, Roukema GR, Dokter J, Koopman SSHA, Van der Vlies CH. Predicting blood loss in burn excisional surgery. Burns 2023; 49:566-572. [PMID: 36732103 DOI: 10.1016/j.burns.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 01/11/2023] [Indexed: 01/18/2023]
Abstract
BACKGROUND Blood loss during burn excisional surgery remains an important factor as it is associated with significant comorbidity, mortality and longer length of stay. Blood loss is, among others, influenced by length of surgery, burn size, excision size and age. Most literature available is aimed at large burns and little research is available for small burns. Therefore, the goal of this study is to investigate blood loss and develop a prediction model to identify patient at risk for blood loss during burn excisional surgery ≤ 10% body surface area. STUDY DESIGN AND METHODS This retrospective study included adult patients who underwent burn excisional surgery of ≤ 10% body surface area in the period 2013-2018. Duplicates, patients with missing data and delayed surgeries were excluded. Primary outcome was blood loss. A prediction model for per-operative blood loss (>250 ml) was built using a multivariable logistic regression analysis with stepwise backward elimination. Discriminative ability was assessed by the area under the ROC-curve in conjunction with optimism and calibration. RESULTS In total 269 patients were included for analysis. Median blood loss was 50 ml (0-150) / % body surface area (BSA) excised and 0.28 (0-0.81) ml / cm2. Median burn size was 4% BSA and median excision size was 2% BSA. Blood loss of> 250 ml was present in 39% of patients. The model can predict blood loss> 250 ml based on %BSA excised, length of surgery and ASA-score with an AUC of 0.922 (95% CI 0.883 - 0.949) and an AUC after optimism correction of 0.915. The calibration curve showed an intercept of 0.0 (95% CI -0.36 to 0.36) with a slope of 1.0 (95% CI 0.78-1.22). CONCLUSION Median blood loss during burn excisional surgery of ≤ 10% BSA is 50 ml / % BSA excised and 0.28 ml / cm2 excised. However, a substantial part of patients is at risk for higher blood loss. The prediction model can predict P(blood loss>250 ml) with an AUC of 0.922, based on expected length of surgery, ASA-score and size of excision. The model can be used to identify patients at risk for significant blood loss (>250 ml).
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Affiliation(s)
- Rolf K Gigengack
- Departments of Trauma and Burn surgery, Maasstad Hospital, Rotterdam, the Netherlands; Amsterdam UMC location Vrije Universiteit, Amsterdam, Department of Intensive Care, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam UMC location Vrije Universiteit, Amsterdam, Department of Anesthesiology, De Boelelaan 1117, Amsterdam, the Netherlands.
| | - Diman Taha
- Department of Anesthesiology, Maasstad Hospital, Rotterdam, the Netherlands; Department of Anesthesiology, Erasmus MC, Rotterdam, the Netherlands
| | | | - Gert R Roukema
- Departments of Trauma and Burn surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | - Jan Dokter
- Departments of Trauma and Burn surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | | | - Cornelis H Van der Vlies
- Departments of Trauma and Burn surgery, Maasstad Hospital, Rotterdam, the Netherlands; Trauma Research unit Department of surgery, Erasmus MC, Rotterdam, the Netherlands
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Sahli SD, Pedrazzi N, Braun J, Spahn DR, Kaserer A, Plock JA. Effect of a factor-based coagulation management on blood product use after major burn injury: A retrospective cohort study. Burns 2021; 47:1486-1494. [PMID: 34465509 DOI: 10.1016/j.burns.2021.08.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/16/2021] [Accepted: 08/18/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Transfusion of allogenic blood products was shown to be associated with more adverse events and a higher mortality in severely burned patients. This study investigated the impact of a goal-directed and factor-based coagulation algorithm on blood product use and clinical outcomes in severely burned patients. METHODS This retrospective cohort study included adult patients admitted to the burn center of the University Hospital Zurich with major burn injuries compromising 20-80% of total body surface area. We compared two 3-year periods, one before the introduction of a goal-directed coagulation and transfusion algorithm (period 1: 2009-2011) and one after (period 2: 2016-2018). We applied linear and logistic regression models adjusted for confounders. RESULTS We analyzed 36 patients (27.8% female) versus 42 patients (14.3% female) in period 1 and 2, respectively. Comorbidities and burn types were comparable between both collectives. Treatment according to the coagulation algorithm resulted in an overall reduction of 33 units of red blood cells (95% CI -52.8 to -12.9, p = 0.002), 9 units fresh frozen plasma (95% CI -14.7 to -2.6, p = 0.006) and 1.4g fibrinogen (95% CI -2.2 to -0.5, p = 0.001) per patient. We observed less infections (61.8% vs. 41.5%, p = 0.11) and a reduced mortality (38.9% vs. 26.8%, p = 0.33) during the algorithm treated period, although not significant. CONCLUSION Treatment of severely burned patients with a goal-directed coagulation algorithm reduced blood product use and resulted in target-oriented administration of coagulation factors to improve outcomes.
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Affiliation(s)
- Sebastian D Sahli
- Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland.
| | - Nadine Pedrazzi
- Department of Plastic and Hand Surgery, Lausanne University Hospital, Lausanne, Switzerland.
| | - Julia Braun
- Departments of Epidemiology and Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
| | - Donat R Spahn
- Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland.
| | - Alexander Kaserer
- Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland.
| | - Jan A Plock
- Department of Plastic Surgery and Hand Surgery, Burn Center, University and University Hospital Zurich, Switzerland; Department of Plastic Surgery and Hand Surgery, Cantonal Hospital Aarau, Aarau, Switzerland.
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Yuan Y, Zhang Y, Shen L, Xu L, Huang Y. Perioperative Allogeneic Red Blood Cell Transfusion and Wound Infections: An Observational Study. Anesth Analg 2020; 131:1573-1581. [PMID: 33079881 DOI: 10.1213/ane.0000000000005122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND It remains unclear whether the benefits of performing perioperative allogeneic red blood cell (RBC) transfusion outweigh the risks of postoperative wound infection. The aim of this study was to assess the impact of perioperative RBC transfusion as well as dose-response relationship on wound infections in surgical patients in a large cohort. METHODS As a retrospective observational study, the national Hospital Quality Monitoring System database was used to retrieve information about in-hospital surgical patients without limitations on surgical types in the People's Republic of China between 2013 and 2018. Patients were divided into the perioperative RBC transfusion and non-RBC transfusion groups, and wound infection rates (the primary end point) were compared. Secondary end points included in-hospital mortality, nosocomial infections, and length of hospital stay. Furthermore, patients who underwent RBC transfusion were subdivided into 6 groups based on the volume of transfused RBCs to investigate the dose-response relationship between RBC transfusions and wound infections. The association between RBC transfusion and patient outcomes were analyzed using multivariable logistic regression models adjusted for potential confounders. RESULTS A total of 1,896,584 patients from 29 provinces were included, among whom 76,078 (4.0%) underwent RBC transfusions; the overall wound infection rate was 0.7%. After adjusting for confounding factors, perioperative RBC transfusion was associated with higher odds of wound infection (odds ratio [OR] = 2.24, 95% confidence interval [CI], 2.09-2.40; P < .001). As the volume of transfused RBCs increased, so did the odds of wound infection with a clear dose-response relationship (OR of >0 and ≤1 U, >1 and ≤2 U, >2 and ≤4 U, >4 and ≤8 U, >8 U transfusion compared with no RBC transfusion were 1.20, 95% CI, 0.76-1.91; 1.27, 95% CI, 1.10-1.47; 1.70, 95% CI, 1.49-1.93; 2.12, 95% CI, 1.83-2.45 and 3.65, 95% CI, 3.13-4.25, respectively). RBC transfusion was also found to be associated with higher odds of in-hospital mortality, nosocomial infection, and longer hospital stay. CONCLUSIONS RBC transfusion was associated with an increased odd of postoperative wound infection in surgical patients, and a significant dose-related relationship was also observed. While there are still essential confounders not adjusted for and the results do not necessarily indicate a causal relationship, we still recommend to lessen perioperative blood loss and optimize blood conservation strategies.
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Affiliation(s)
| | - Yuelun Zhang
- Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Le Shen
- From the Department of Anesthesiology and
| | - Li Xu
- From the Department of Anesthesiology and
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Kelemen JA, Kaserer A, Jensen KO, Stein P, Seifert B, Simmen HP, Spahn DR, Pape HC, Neuhaus V. Prevalence and outcome of contrast-induced nephropathy in major trauma patients. Eur J Trauma Emerg Surg 2020; 48:907-913. [PMID: 32948886 PMCID: PMC7500990 DOI: 10.1007/s00068-020-01496-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/04/2020] [Indexed: 11/29/2022]
Abstract
Background Contrast-induced nephropathy (CIN) has been well investigated in patients undergoing coronary angiography, but not in trauma patients. The main aim of this study was to determine the prevalence and to investigate independent risk factors for the development of CIN. Methods Between 2008 and 2014, all pre-hospital intubated major trauma patients with documented serum creatinine levels (SCr) undergoing a contrast-enhanced whole-body CT at admission were retrospectively analyzed. CIN was defined as a relative increase in SCr > 25% over the baseline value or an absolute SCr increase of > 44 µmol/l within 72 h. Univariate and multivariable regression analyses were performed to identify significant risk factors. A p value of < 0.01 was considered statistically significant and a p value of 0.01–0.049 suggested evidence. Results Of 284 analyzed patients, 41 (14%) met the criteria for CIN. There is suggestive evidence that age and lactate level influenced the development of CIN. Six patients (15%) had hemodialysis in the CIN-group and eight (3.3%) in the group without CIN. Complication and mortality rate was higher in patients with CIN (71% vs. 56% and 32% vs. 23%, respectively). CIN was not an independent risk factor for complications or mortality while controlling for age, gender, injury severity score, and lactate level. The length of stay was not affected by CIN. Conclusion CIN occurs frequently in trauma patients, but is not an independent risk factor for complications or mortality. Therefore, contrast enhanced whole-body CT can safely be performed in trauma patients.
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Affiliation(s)
- Julian Alexander Kelemen
- Division of Trauma Surgery, Department of Surgery, University Hospital Zurich, University of Zurich, Raemistrasse. 100, 8091 Zurich, Switzerland
| | - Alexander Kaserer
- Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Kai Oliver Jensen
- Division of Trauma Surgery, Department of Surgery, University Hospital Zurich, University of Zurich, Raemistrasse. 100, 8091 Zurich, Switzerland
| | - Philipp Stein
- Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
- Institute of Anesthesiology, Cantonal Hospital Winterthur, Brauerstrasse 15, 8400 Winterthur, Switzerland
| | - Burkhardt Seifert
- Institute of Epidemiology, Biostatistics and Prevention, University of Zurich, Zurich, Switzerland
- Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland
| | - Hans-Peter Simmen
- Division of Trauma Surgery, Department of Surgery, University Hospital Zurich, University of Zurich, Raemistrasse. 100, 8091 Zurich, Switzerland
| | - Donat R. Spahn
- Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Hans-Christoph Pape
- Division of Trauma Surgery, Department of Surgery, University Hospital Zurich, University of Zurich, Raemistrasse. 100, 8091 Zurich, Switzerland
| | - Valentin Neuhaus
- Division of Trauma Surgery, Department of Surgery, University Hospital Zurich, University of Zurich, Raemistrasse. 100, 8091 Zurich, Switzerland
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Abstract
Background: Blood product transfusion has historically been utilized after major burn injury in the resuscitative as well as the acute phase. Transfusion has been implicated in infection and immunosuppression in many disease states. Recommendations for blood product transfusion has varied, but several landmark studies have helped define optimal burn transfusion strategies with respect to infection. The purpose of this article is to review the evidence describing the relation between transfusion and infection in burn injury during different phases of burn treatment to identify optimal transfusion strategies and suggest future targets for transfusion research in burns. Methods: This article presents the history, current status, and future research directions related to blood and blood product transfusion in burn injury. Results: Patients with burns are subject to infectious complications resulting from the loss of skin and burn-related immunosuppression. The use of blood in burn treatment has varied during both the resuscitative phase and the acute treatment phase. Whole-blood use in resuscitation was replaced with crystalloid infusion. Future trials are examining the role of plasma and albumin in burn resuscitation. A randomized prospective multicenter transfusion trial was able to decrease transfusion by 50% with no change in infection. Further examination of the role of hemostatic resuscitation in burn excision may help to better define transfusion goals. Conclusions: Blood product transfusion in burn injury has varied throughout the last century. Although advances in the understanding of blood transfusion in burn injury have occurred, initiatives to define optimal care better are required.
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Affiliation(s)
- Tina L Palmieri
- Department of Surgery, University of California, Davis, Sacramento, California, USA
- Shriners Hospital for Children Northern California, Sacramento, California, USA
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