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Utilizing Total Blood Volume and Red Cell Volume to Clarify Adverse Outcomes in Patients With High Hematocrit During Cardiac Surgery. Anesth Analg 2022; 135:e5-e6. [PMID: 35709459 DOI: 10.1213/ane.0000000000006023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Sun X, Xu Z, Feng Y, Yang Q, Xie Y, Wang D, Yu Y. RBC Inventory-Management System Based on XGBoost Model. Indian J Hematol Blood Transfus 2021; 37:126-133. [PMID: 33707845 DOI: 10.1007/s12288-020-01333-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 08/06/2020] [Indexed: 01/28/2023] Open
Abstract
It is difficult to predict RBC consumption accurately. This paper aims to use big data to establish a XGBoost Model to understand the trend of RBC accurately, and forecast the demand in time. XGBoost, which implements machine learning algorithms under the Gradient Boosting framework can provide a parallel tree boosting. The daily RBC usage and inventory (May 2014-September 2017) were investigated, and rules for RBC usage were analysed. All data were divided into training sets and testing sets. A XGBoost Model was established to predict the future RBC demand for durations ranging from a day to a week. In addition, the alert range was added to the predicted value to ensure RBC demand of emergency patients and surgical accidents. The gap between RBC usage and inventory was fluctuant, and had no obvious rule. The maximum residual inventory of a certain blood group was up to 700 units one day, while the minimum was nearly 0 units. Upon comparing MAE (mean absolute error):A:10.69, B:11.19, O:10.93, and AB:5.91, respectively, the XGBoost Model was found to have a predictive advantage over other state-of-the-art approaches. It showed the model could fit the trend of daily RBC usage. An alert range could manage the demand of emergency patients or surgical accidents. The model had been built to predict RBC demand, and the alert range of RBC inventory is designed to increase the safety of inventory management.
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Affiliation(s)
- Xiaolin Sun
- Department of Blood Transfusion, Chinese PLA General Hospital, No. 28, Fuxing Rd, Beijing, 100853 China
| | - Zhenhua Xu
- HealSci Technology Co., Ltd, 1606, Tower5, 2 Rong Hua South Road, BDA, Beijing, 100176 China
| | - Yannan Feng
- Department of Blood Transfusion, Chinese PLA General Hospital, No. 28, Fuxing Rd, Beijing, 100853 China
| | - Qingqing Yang
- HealSci Technology Co., Ltd, 1606, Tower5, 2 Rong Hua South Road, BDA, Beijing, 100176 China
| | - Yan Xie
- HealSci Technology Co., Ltd, 1606, Tower5, 2 Rong Hua South Road, BDA, Beijing, 100176 China
| | - Deqing Wang
- Department of Blood Transfusion, Chinese PLA General Hospital, No. 28, Fuxing Rd, Beijing, 100853 China
| | - Yang Yu
- Department of Blood Transfusion, Chinese PLA General Hospital, No. 28, Fuxing Rd, Beijing, 100853 China
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Furuta S, Inouye DS, Hayashi MS, Takanishi DM, Yu M. Blood volume measured by ultrasound and radioisotope dilution in critically ill subjects. J Surg Res 2017; 207:77-84. [DOI: 10.1016/j.jss.2016.08.077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 07/26/2016] [Accepted: 08/24/2016] [Indexed: 02/08/2023]
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Lobigs LM, Sottas PE, Bourdon PC, Nikolovski Z, El-Gingo M, Varamenti E, Peeling P, Dawson B, Schumacher YO. The use of biomarkers to describe plasma-, red cell-, and blood volume from a simple blood test. Am J Hematol 2017; 92:62-67. [PMID: 27737505 DOI: 10.1002/ajh.24577] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 10/06/2016] [Indexed: 12/13/2022]
Abstract
Plasma volume and red cell mass are key health markers used to monitor numerous disease states, such as heart failure, kidney disease, or sepsis. Nevertheless, there is currently no practically applicable method to easily measure absolute plasma or red cell volumes in a clinical setting. Here, a novel marker for plasma volume and red cell mass was developed through analysis of the observed variability caused by plasma volume shifts in common biochemical measures, selected based on their propensity to present with low variations over time. Once a month for 6 months, serum and whole blood samples were collected from 33 active males. Concurrently, the CO-rebreathing method was applied to determine target levels of hemoglobin mass (HbM) and blood volumes. The variability of 18 common chemistry markers and 27 Full Blood Count variables was investigated and matched to the observed plasma volume variation. After the removal of between-subject variations using a Bayesian model, multivariate analysis identified two sets of 8 and 15 biomarkers explaining 68% and 69% of plasma volume variance, respectively. The final multiparametric model contains a weighting function to allow for isolated abnormalities in single biomarkers. This proof-of-concept investigation describes a novel approach to estimate absolute vascular volumes, with a simple blood test. Despite the physiological instability of critically ill patients, it is hypothesized the model, with its multiparametric approach and weighting function, maintains the capacity to describe vascular volumes. This model has potential to transform volume management in clinical settings. Am. J. Hematol. 92:62-67, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Louisa Margit Lobigs
- School of Sport Science, Exercise and Health; University of Western Australia; Perth WA 6009
- Aspetar Orthopedic and Sports Medicine Hospital; Doha 29222 Qatar
| | | | - Pitre Collier Bourdon
- Sports Science Department; Aspire Academy; Doha 29222 Qatar
- School of Health Sciences; The University of South Australia; Adelaide SA 5000
| | | | | | | | - Peter Peeling
- School of Sport Science, Exercise and Health; University of Western Australia; Perth WA 6009
| | - Brian Dawson
- School of Sport Science, Exercise and Health; University of Western Australia; Perth WA 6009
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Vigué B, Leblanc PE, Moati F, Pussard E, Foufa H, Rodrigues A, Figueiredo S, Harrois A, Mazoit JX, Rafi H, Duranteau J. Mid-regional pro-adrenomedullin (MR-proADM), a marker of positive fluid balance in critically ill patients: results of the ENVOL study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:363. [PMID: 27825364 PMCID: PMC5101658 DOI: 10.1186/s13054-016-1540-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 10/20/2016] [Indexed: 12/14/2022]
Abstract
Background The optimal control of blood volume without fluid overload is a main challenge in the daily care of intensive care unit (ICU) patients. Accordingly this study focused on the identification of biomarkers to help characterize fluid overload status. Methods Sixty-seven patients were studied from ICU admission to day 7 (D7). Blood and urine samples were taken daily and sodium and water balance strictly calculated resulting in a total cumulative assessment of ∆Na+ and ∆H2O. Furthermore, plasmatic biomarkers (cortisol, epinephrine, norepinephrine, renin, angiotensin II, aldosterone, pro-endothelin, copeptine, atrial natriuretic peptide, erythropoietin, mid-regional pro-adrenomedullin (MR-proADM)) and Sequential Organ Failure Assessment (SOFA) scores were measured at D2, D5 and D7. Blood volumes were measured with 51Cr fixed on red blood cells at D2 and D7. Results The ∆Na+ or ∆H2O were increased in all patients but never related to blood volumes at D2 nor D7. Total blood volumes were at normal values with constantly low red blood cell volumes and normal or decreased plasmatic volume. Weight, plasmatic proteins, and hemoglobin were weakly related to ∆Na+ or ∆H2O. Amongst all tested biomarkers, only MR-proADM was related to sodium and fluid overload. This biomarker was also a predictor of SOFA scores. Conclusions Plasmatic concentration in MR-proADM seems to be a good surrogate for evaluation of ∆Na+ or ∆H2O and predicts sodium and extracellular fluid overload. Trial registration ClinicalTrials.gov: NCT01858675 in May 13, 2013. Electronic supplementary material The online version of this article (doi:10.1186/s13054-016-1540-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bernard Vigué
- Département d'Anesthésie-Réanimation, Hôpital de Bicêtre, Université Paris-Sud, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, Paris, France.
| | - Pierre-Etienne Leblanc
- Département d'Anesthésie-Réanimation, Hôpital de Bicêtre, Université Paris-Sud, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, Paris, France
| | - Frédérique Moati
- Service de biophysique et de médecine nucléaire, Centre Hospitalier Universitaire de Bicêtre, Assistance publique - Hôpitaux de Paris, Paris, France
| | - Eric Pussard
- Service de Génétique Moléculaire, Pharmacogénétique et Hormonologie, Inserm U1185, Centre Hospitalier Universitaire de Bicêtre, Assistance publique - Hôpitaux de Paris, Paris, France
| | - Hussam Foufa
- Département d'Anesthésie-Réanimation, Hôpital de Bicêtre, Université Paris-Sud, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, Paris, France
| | - Aurore Rodrigues
- Département d'Anesthésie-Réanimation, Hôpital de Bicêtre, Université Paris-Sud, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, Paris, France
| | - Samy Figueiredo
- Département d'Anesthésie-Réanimation, Hôpital de Bicêtre, Université Paris-Sud, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, Paris, France
| | - Anatole Harrois
- Département d'Anesthésie-Réanimation, Hôpital de Bicêtre, Université Paris-Sud, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, Paris, France
| | - Jean-Xavier Mazoit
- Département d'Anesthésie-Réanimation, Hôpital de Bicêtre, Université Paris-Sud, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, Paris, France
| | - Homa Rafi
- Thermo Fisher Scientific, Asnières sur Seine, France
| | - Jacques Duranteau
- Département d'Anesthésie-Réanimation, Hôpital de Bicêtre, Université Paris-Sud, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, Paris, France
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Oh WS, Chon SB. Calculation of the Residual Blood Volume after Acute, Non-Ongoing Hemorrhage Using Serial Hematocrit Measurements and the Volume of Isotonic Fluid Infused: Theoretical Hypothesis Generating Study. J Korean Med Sci 2016; 31:814-6. [PMID: 27134507 PMCID: PMC4835611 DOI: 10.3346/jkms.2016.31.5.814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 02/16/2016] [Indexed: 12/05/2022] Open
Abstract
Fluid resuscitation, hemostasis, and transfusion is essential in care of hemorrhagic shock. Although estimation of the residual blood volume is crucial, the standard measuring methods are impractical or unsafe. Vital signs, central venous or pulmonary artery pressures are inaccurate. We hypothesized that the residual blood volume for acute, non-ongoing hemorrhage was calculable using serial hematocrit measurements and the volume of isotonic solution infused. Blood volume is the sum of volumes of red blood cells and plasma. For acute, non-ongoing hemorrhage, red blood cell volume would not change. A certain portion of the isotonic fluid would increase plasma volume. Mathematically, we suggest that the residual blood volume after acute, non-ongoing hemorrhage might be calculated as 0·25N/[(Hct1/Hct2)-1], where Hct1 and Hct2 are the initial and subsequent hematocrits, respectively, and N is the volume of isotonic solution infused. In vivo validation and modification is needed before clinical application of this model.
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Affiliation(s)
- Won Sup Oh
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Sung-Bin Chon
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
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Gómez Perales JL. Blood volume analysis by radioisotopic dilution techniques: state of the art. Appl Radiat Isot 2014; 96:71-82. [PMID: 25479437 DOI: 10.1016/j.apradiso.2014.11.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 09/19/2014] [Accepted: 11/14/2014] [Indexed: 12/17/2022]
Abstract
In the last years, there has been a growing recognition of the importance of blood volume abnormalities in the pathophysiology of several conditions and, consequently, a growing interest of accurate and rapid volume status assessment. Accordingly, there has been a surge of interest in blood volume analysis by radioisotopic dilution technique. However, there are still some controversies about this technique, such as the use of the f-cell ratio, the errors associated with the method and the reference values. This review aims to revise and discuss the theoretical and methodological aspects of this technique and also to discuss their controversies. Furthermore, it is questioned whether red cell volume or plasma volume can be accurately estimated once the other quantity has been measured or should red cell volume and plasma volume be directly measured. As a conclusion, blood volume analysis by radioisotopic dilution technique is still valid and very useful.
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Affiliation(s)
- Jesús Luis Gómez Perales
- Nuclear Medicine Service, Puerta del Mar University Hospital, Avenida Ana de Viya 21, 11009 Cádiz, Spain.
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D'Angelo M, Hodgen RK, Wofford K, Vacchiano C. A Theoretical Mathematical Model to Estimate Blood Volume in Clinical Practice. Biol Res Nurs 2014; 17:478-86. [PMID: 25332464 DOI: 10.1177/1099800414555410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Perioperative intravenous (IV) fluid management is controversial. Fluid therapy is guided by inaccurate algorithms and changes in the patient's vital signs that are nonspecific for changes to the patient's blood volume (BV). Anesthetic agents, patient comorbidities, and surgical techniques interact and further confound clinical assessment of volume status. Through adaptation of existing acute normovolemic hemodilution algorithms, it may be possible to predict patient's BV by measuring hematocrit (HcT) before and after hemodilution. Our proposed mathematical model requires the following four data points to estimate a patient's total BV: ideal BV, baseline HcT, a known fluid bolus (FB), and a second HcT following the FB. To test our method, we obtained 10 ideal and 10 actual subject BV data measures from 9 unique subjects derived from a commercially used Food and Drug Administration-approved, semi-automated, BV analyzer. With these data, we calculated the theoretical BV change following a FB. Using the four required data points, we predicted BVs (BVp) and compared our predictions with the actual BV (BVa) measures provided by the data set. The BVp calculated using our model highly correlated with the BVa provided by the BV analyzer data set (df = 8, r = .99). Our calculations suggest that, with accurate HcT measurement, this method shows promise for the identification of abnormal BV states such as hyper- and hypovolemia and may prove to be a reliable method for titrating IV fluid.
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Affiliation(s)
- Matthew D'Angelo
- Uniformed Services University of the Health Sciences, Daniel K. Inouye Graduate School of Nursing, Bethesda, MD, USA
| | - R Kyle Hodgen
- Uniformed Services University of the Health Sciences, Daniel K. Inouye Graduate School of Nursing, Bethesda, MD, USA
| | - Kenneth Wofford
- Uniformed Services University of the Health Sciences, Daniel K. Inouye Graduate School of Nursing, Bethesda, MD, USA
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Brain-type natriuretic peptide and right ventricular end-diastolic volume index measurements are imprecise estimates of circulating blood volume in critically ill subjects. J Trauma Acute Care Surg 2014; 75:813-8. [PMID: 24158199 DOI: 10.1097/ta.0b013e3182a85f3a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Surrogate indicators have often been used to estimate intravascular volume to guide fluid management. Brain-type natriuretic peptide (BNP) has been used as a noninvasive adjunct in the diagnosis of fluid overload and as a marker of response to therapy, especially in individuals with congestive heart failure. Similarly, right ventricular end-diastolic volume index (RVEDVI) measurements represent another parameter used to guide fluid resuscitation. The aim of this study was to evaluate whether BNP and RVEDVI are clinically valuable parameters that can distinguish among hypovolemia, euvolemia, and hypervolemia, as measured by blood volume (BV) analysis in critically ill surgical subjects. METHODS This observational study was part of a prospective, randomized controlled trial. Subjects with pulmonary artery catheters for the treatment of traumatic injuries, severe sepsis/septic shock, cardiovascular collapse, adult respiratory distress syndrome, and postsurgical care were studied. Circulating BV was measured by a radioisotope dilution technique using the BVA-100 Analyzer (Daxor Corporation, New York, NY) within the first 24 hours of acute resuscitation. BV results were reported as percent deviation from the patient's ideal BV based on height and percent deviation from optimum weight. Hypovolemia was defined as less than 0%, euvolemia was defined as 0% to +16%, and hypervolemia was defined as greater than +16% deviation from ideal BV. RVEDVI was measured by continuous cardiac output pulmonary artery catheters (Edwards Lifesciences, Irvine, CA). BNP and RVEDVI measurements obtained with BV analysis were evaluated with Fisher's exact test and regression analysis. RESULTS In 81 subjects, there was no difference in BV status between those with BNP of 500 pg/mL or greater and BNP of less than 500 pg/mL (p = 0.82) or in those with RVEDVI of 140 mL/m or greater and RVEDVI of less than 140 mL/m (p = 0.43). No linear relationship existed between BV and these parameters. CONCLUSION In critically ill surgical patients, BNP and RVEDVI were not associated with intravascular volume status, although they may be useful as indices that reflect increased cardiac preload. LEVEL OF EVIDENCE Diagnostic study, level III.
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Isbister JP. The three-pillar matrix of patient blood management – An overview. Best Pract Res Clin Anaesthesiol 2013; 27:69-84. [DOI: 10.1016/j.bpa.2013.02.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 02/06/2013] [Indexed: 01/08/2023]
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Blood volume analysis can distinguish true anemia from hemodilution in critically ill patients. ACTA ACUST UNITED AC 2011; 70:646-51. [PMID: 21610355 DOI: 10.1097/ta.0b013e31820d5f48] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Peripheral hematocrit (pHct) is traditionally used as a marker for blood loss. In critically ill patients who are fluid resuscitated, pHct may not adequately represent red blood cell volume (RBCV). We hypothesize that the use of pHct alone may overestimate anemia, potentially leading to unnecessary interventions. METHODS Patients admitted to the intensive care unit underwent blood volume analysis. Serial blood samples were collected after injection of I-albumin. Samples were then processed by the Blood Volume Analyzer-100. RBCV and total blood volume (TBV) were calculated using the directly measured plasma volume (PV) and pHct. A computed normalized hematocrit (nHct) adjusts pHct to the patient's ideal blood volume. RESULTS Thirty-six patients (21 men), aged 49.8 years ± 18.4 years, Acute Physiology And Chronic Health Evaluation II score 14.9 ± 8.1, and injury severity score 29.4 ± 12.4 had 84 blood volume analyses performed on 3 consecutive days. Using ratios of TBV compared with ideal TBV, patients were stratified into three separate groups: hypovolemic (16 of 84), normovolemic (23 of 84), and hypervolemic (45 of 84). Mean differences between pHct and nHct in each group were 4.5% ± 3.1% (p≤0.01), 0.0% ± 1.2% (p=0.85), and -6.5% ± 4.1% (p≤0.01), respectively. pHct, when compared with nHct, diagnosed anemia (Hct <30) nearly equal within the hypovolemic and normovolemic groups. However, pHct overdiagnosed anemia in 46.7% of hypervolemic patients. CONCLUSION Use of blood volume analysis in critically ill patients may help to distinguish true anemia from hemodilution, potentially preventing unnecessary interventions.
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A prospective randomized trial using blood volume analysis in addition to pulmonary artery catheter, compared with pulmonary artery catheter alone, to guide shock resuscitation in critically ill surgical patients. Shock 2011; 35:220-8. [PMID: 20926981 DOI: 10.1097/shk.0b013e3181fc9178] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Measurement of blood volume (BV) may guide fluid and red blood cell management in critically ill patients when capillary leak from shock and fluid resuscitation makes assessment of intravascular volume difficult. This is a prospective randomized trial of critically ill surgical patients with septic shock, severe sepsis, severe respiratory failure, and/or cardiovascular collapse. The control group received fluid management based on pulmonary artery catheter parameters and red blood cell transfusions based on hematocrit values. The BV group received fluid and red blood cell transfusions based on BV analyses in addition to pulmonary artery catheter parameters. Blood volume was measured using the radioisotope tracer technique with iodine 131-labeled albumin. This allowed direct measurement of plasma volume and calculation of the red blood cell volume. The control group was blinded to the BV results. There were statistically significantly more times when the control group (compared with the BV group) demonstrated hypervolemia (48% vs. 37%) and red blood cell deficiency (33% vs. 16%). There was a delay in red blood cell transfusions administered to the control group by 1.5 +/- 2 days at which time the abnormality became clinically evident. Blood volume analyses provided additional information to the clinicians resulting in a change in treatment in 44% of the time to patients randomized to the BV group. The mortality rates were significantly different between the two groups (8% for the BV group and 24% in the control group; P = 0.03). Blood volume measurements allowed the physicians to promptly treat physiologic disturbances in both red blood cell volume and plasma volume, resulting in improved survival.
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