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Hao X, Chen Y, Wang L, Jia M, Lu Y. Sodium citrate effectively used in shed mediastinal blood autotransfusion after cardiac surgery. Perfusion 2024; 39:1106-1112. [PMID: 37060259 DOI: 10.1177/02676591231171271] [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] [Indexed: 04/16/2023]
Abstract
BACKGROUND We used sodium citrate as an alternative anticoagulation agent to heparin in the procedure of autologous blood transfusion with patients with postoperative haemorrhage after CPB. The aim of study was to evaluate the efficacy and safety of sodium citrate used in shed mediastinal blood autotransfusion after cardiac surgery. METHODS Ninety-three patients were divided into two groups in this study. In the control group, 52 patients' shed mediastinal blood was discarded. The reinfusion group consisted of 41 patients receiving a reinfusion of washed autologous red cells from shed mediastinal blood. Each 400 mL shed blood sample was anticoagulated by 140 mL of 1.6% diluted sodium citrate in the washing procedure using a blood recovery machine. Hemoglobin (Hb), hematocrit (Hct), and electrolyte concentrations in both the patients and shed mediastinal blood were measured before and after this procedure. RESULTS The mean volume of autotransfused shed blood was 239.5 ± 54.6 mL.The Hct of the washed red cells was 56.8 ± 6.1%. Significantly, fewer units of allogeneic blood were required per patient in the reinfusion group at 24 h postoperatively (2.91 ± 1.34 vs 4.03 ± 0.19 U, p = 0.002). At 24 h postoperatively, Hb and Hct levels were higher in the reinfusion group than in the control group. The calcium ion concentration was very low in the shed mediastinal blood, 0.25 ± 0.08 mmol/L, and was lower after washing, 0.15 ± 0.04 mmol/L. CONCLUSIONS Sodium citrate, as an alternative anticoagulant agent, can be used in autologous shed mediastinal blood transfusion after CPB cardiac surgery. This procedure can effectively reduce the amount of allogeneic blood for patients with haemorrhage.
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Affiliation(s)
- Xinghai Hao
- Cardiac Surgery Department, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China
| | - Yueling Chen
- Department of Thoracic and Cardiovascular Surgery, Beijing Luhe Hospital Affiliated to Capital Medical University, Beijing, China
| | - Liangshan Wang
- Cardiac Surgery Department, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China
| | - Ming Jia
- Cardiac Surgery Department, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China
| | - Yang Lu
- Stomatology Department, Peiking University Third Hospital, Beijing, China
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Kazamer A, Ilinca R, Vesa S, Lorenzovici L, Stanescu-Spinu II, Ganea I, Greabu M, Miricescu D, Biczo A, Ionescu D. A Potential Indicator for Assessing Patient Blood Management Standard Implementation. Healthcare (Basel) 2023; 11:2233. [PMID: 37628431 PMCID: PMC10454481 DOI: 10.3390/healthcare11162233] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/13/2023] [Accepted: 08/05/2023] [Indexed: 08/27/2023] Open
Abstract
(1) Background: Patient blood management (PBM) program as a multidisciplinary practice and a standard of care for the anemic surgical patient has an increasingly important role in reducing transfusions and optimizing both clinical outcomes and costs. Documented success of PBM implementation is not sufficient for implementation of recommendations and correct use at hospital level. The primary objective of our study was to define a composite patient blood management process safety index-Safety Index in PBM (SIPBM)-that measures the impact of screening and treating anemic patients on the efficiency and effectiveness of the patient care process undergoing elective surgery. (2) Methods: We conducted a retrospective comparative study in a tertiary hospital by collecting data and analyzing the Safety Index in PBM (SIPBM) in patients undergoing major elective surgical procedures. (3) Results: The percentage of patients from the total of 354 patients (178 in 2019 and 176 in 2022) included in the study who benefited from preoperative iron treatment increased in 2022 compared to 2019 from 27.40% to 36.71%. The median value of the SIPBM was 1.00 in both periods analyzed, although there is a significant difference between the two periods (p < 0.005), in favor of 2022. (4) Conclusions: Measuring the effectiveness of PBM implementation and providing ongoing feedback through the Safety Index in PBM (SIPBM) increases the degree to which opportunities to improve the PBM process are identified. The study represents a first step for future actions and baselines to develop tools to measure the safety and impact of the patient blood management process in the surgical field.
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Affiliation(s)
- Andrea Kazamer
- CREST Association, 48 Alexandru Odobescu Street, 440069 Satu Mare, Romania
- Department of Anaesthesia and Intensive Care I, Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania; (S.V.); (D.I.)
| | - Radu Ilinca
- Discipline of Medical Informatics and Biostatistics, Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, 4-6 Eforie Street, 050037 Bucharest, Romania
| | - Stefan Vesa
- Department of Anaesthesia and Intensive Care I, Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania; (S.V.); (D.I.)
| | - Laszlo Lorenzovici
- Faculty of Technical and Human Sciences, Sapientia Hungarian University of Transylvania, 4 Matei Corvin Street, 400112 Cluj-Napoca, Romania;
| | - Iulia-Ioana Stanescu-Spinu
- Discipline of Biochemistry, Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Street, 050474 Bucharest, Romania; (I.-I.S.-S.); (M.G.); (D.M.)
| | - Ionela Ganea
- Department of Modern Languages, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Street, 050474 Bucharest, Romania;
| | - Maria Greabu
- Discipline of Biochemistry, Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Street, 050474 Bucharest, Romania; (I.-I.S.-S.); (M.G.); (D.M.)
| | - Daniela Miricescu
- Discipline of Biochemistry, Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Street, 050474 Bucharest, Romania; (I.-I.S.-S.); (M.G.); (D.M.)
| | - Andras Biczo
- Department Hamm 2 Manufacturing and Production Technology, Hamm-Lippstadt University of Applied Sciences, Allee 76-78, D-59063 Hamm, Germany;
| | - Daniela Ionescu
- Department of Anaesthesia and Intensive Care I, Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania; (S.V.); (D.I.)
- Outcome Research Consortium, Cleveland, OH 44195, USA
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Ziaka M, Exadaktylos A. ARDS associated acute brain injury: from the lung to the brain. Eur J Med Res 2022; 27:150. [PMID: 35964069 PMCID: PMC9375183 DOI: 10.1186/s40001-022-00780-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 07/29/2022] [Indexed: 01/10/2023] Open
Abstract
A complex interrelation between lung and brain in patients with acute lung injury (ALI) has been established by experimental and clinical studies during the last decades. Although, acute brain injury represents one of the most common insufficiencies in patients with ALI and acute respiratory distress syndrome (ARDS), the underlying pathophysiology of the observed crosstalk remains poorly understood due to its complexity. Specifically, it involves numerous pathophysiological parameters such as hypoxemia, neurological adverse events of lung protective ventilation, hypotension, disruption of the BBB, and neuroinflammation in such a manner that the brain of ARDS patients-especially hippocampus-becomes very vulnerable to develop secondary lung-mediated acute brain injury. A protective ventilator strategy could reduce or even minimize further systemic release of inflammatory mediators and thus maintain brain homeostasis. On the other hand, mechanical ventilation with low tidal volumes may lead to self-inflicted lung injury, hypercapnia and subsequent cerebral vasodilatation, increased cerebral blood flow, and intracranial hypertension. Therefore, by describing the pathophysiology of ARDS-associated acute brain injury we aim to highlight and discuss the possible influence of mechanical ventilation on ALI-associated acute brain injury.
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Affiliation(s)
- Mairi Ziaka
- Department of Internal Medicine, Thun General Hospital, Thun, Switzerland
| | - Aristomenis Exadaktylos
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, Bern, Switzerland
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