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Mostaza JM, Pintó X, Armario P, Masana L, Real JT, Valdivielso P, Arrobas-Velilla T, Baeza-Trinidad R, Calmarza P, Cebollada J, Civera-Andrés M, Cuende Melero JI, Díaz-Díaz JL, Espíldora-Hernández J, Fernández Pardo J, Guijarro C, Jericó C, Laclaustra M, Lahoz C, López-Miranda J, Martínez-Hervás S, Muñiz-Grijalvo O, Páramo JA, Pascual V, Pedro-Botet J, Pérez-Martínez P, Puzo J. SEA 2024 Standards for Global Control of Vascular Risk. Clin Investig Arterioscler 2024; 36:133-194. [PMID: 38490888 DOI: 10.1016/j.arteri.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/03/2024] [Indexed: 03/17/2024]
Abstract
One of the objectives of the Spanish Society of Arteriosclerosis is to contribute to the knowledge, prevention and treatment of vascular diseases, which are the leading cause of death in Spain and entail a high degree of disability and health expenditure. Atherosclerosis is a multifactorial disease and its prevention requires a global approach that takes into account the associated risk factors. This document summarises the current evidence and includes recommendations for patients with established vascular disease or at high vascular risk: it reviews the symptoms and signs to evaluate, the laboratory and imaging procedures to request routinely or in special situations, and includes the estimation of vascular risk, diagnostic criteria for entities that are vascular risk factors, and general and specific recommendations for their treatment. Finally, it presents aspects that are not usually referenced in the literature, such as the organisation of a vascular risk consultation.
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Affiliation(s)
- José María Mostaza
- Servicio de Medicina Interna, Unidad de Lípidos y Arteriosclerosis, Hospital La Paz-Carlos III, Madrid, España.
| | - Xavier Pintó
- Unidad de Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitario Bellvitge, Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y Nutrición (CIBERobn), Fundación para la Investigación y Prevención de las Enfermedades Cardiovasculares (FIPEC), Universidad de Barcelona, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Barcelona, España
| | - Pedro Armario
- Servicio de Medicina Interna, Área de Atención Integrada de Riesgo Vascular, Complex Hospitalari Universitari Moisès Broggi, Consorci Sanitari Integral (CSI), Sant Joan Despí, Universidad de Barcelona, Barcelona, España
| | - Luis Masana
- Unidad de Medicina Vascular y Metabolismo (UVASMET), Institut d'Investigació Sanitària Pere Virgili (IISPV), Hospital Universitari Sant Joan de Reus, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Universitat Rovira i Virgili, Tarragona, España
| | - José T Real
- Servicio de Endocrinología y Nutrición, Hospital Clínico, Universidad de València, Valencia, España; Departamento de Medicina, Universidad de Valencia, Valencia, España; CIBER de Diabetes y Enfermedades Metabólicas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, España
| | - Pedro Valdivielso
- Unidad de Lípidos, Servicio de Medicina Interna, Hospital Universitario Virgen de la Victoria, Málaga, España; Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA-Bionand), Universidad de Málaga, Málaga, España
| | - Teresa Arrobas-Velilla
- Laboratorio de Nutrición y RCV, UGC de Bioquímica clínica, Hospital Virgen Macarena, Sevilla, España
| | | | - Pilar Calmarza
- Servicio de Bioquímica Clínica, Hospital Universitario Miguel Servet, Zaragoza, España; Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Investigación Sanitaria (ISS) de Aragón, Universidad de Zaragoza, Zaragoza, España
| | - Jesús Cebollada
- Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - Miguel Civera-Andrés
- Servicio de Endocrinología y Nutrición, Hospital Clínico, Universidad de València, Valencia, España; Departamento de Medicina, Universidad de Valencia, Valencia, España
| | - José I Cuende Melero
- Consulta de Riesgo Cardiovascular, Servicio de Medicina Interna, Complejo Asistencial Universitario de Palencia, Palencia, España
| | - José L Díaz-Díaz
- Sección de Medicina Interna, Unidad de Lípidos y Riesgo Cardiovascular, Hospital Abente y Lago Complejo Hospitalario Universitario A Coruña, La Coruña, España
| | - Javier Espíldora-Hernández
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA-Bionand), Universidad de Málaga, Málaga, España; Unidad de Lípidos y Unidad Asistencial de Hipertensión Arterial- Riesgo Vascular (HTA-RV), UGC Medicina Interna, Hospital Universitario Virgen de la Victoria, Málaga, España
| | - Jacinto Fernández Pardo
- Servicio de Medicina Interna, Hospital General Universitario Reina Sofía de Murcia, Universidad de Murcia, Murcia, España
| | - Carlos Guijarro
- Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Universidad Rey Juan Carlos, Alcorón, España
| | - Carles Jericó
- Servicio de Medicina Interna, Área de Atención Integrada de Riesgo Vascular, Complex Hospitalari Universitari Moisès Broggi, Consorci Sanitari Integral (CSI), Sant Joan Despí, Universidad de Barcelona, Barcelona, España
| | - Martín Laclaustra
- Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Investigación Sanitaria (ISS) de Aragón, Universidad de Zaragoza, Zaragoza, España
| | - Carlos Lahoz
- Servicio de Medicina Interna, Unidad de Lípidos y Arteriosclerosis, Hospital La Paz-Carlos III, Madrid, España
| | - José López-Miranda
- Unidad de Lípidos y Arteriosclerosis, UGC de Medicina Interna, Hospital Universitario Reina Sofía, Córdoba, España; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, España; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, España
| | - Sergio Martínez-Hervás
- Servicio de Endocrinología y Nutrición, Hospital Clínico, Universidad de València, Valencia, España; Departamento de Medicina, Universidad de Valencia, Valencia, España; CIBER de Diabetes y Enfermedades Metabólicas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, España
| | - Ovidio Muñiz-Grijalvo
- Servicio de Medicina Interna, UCERV, UCAMI, Hospital Virgen del Rocío de Sevilla, Sevilla, España
| | - José A Páramo
- Servicio de Hematología, Clínica Universidad de Navarra, Navarra, España; Laboratorio Aterotrombosis, CIMA, Universidad de Navarra, Pamplona, España
| | - Vicente Pascual
- Centro de Salud Palleter, Universidad CEU-Cardenal Herrera, Castellón, España
| | - Juan Pedro-Botet
- Unidad de Lípidos y Riesgo Vascular, Servicio de Endocrinología y Nutrición, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - Pablo Pérez-Martínez
- Unidad de Lípidos y Arteriosclerosis, UGC de Medicina Interna, Hospital Universitario Reina Sofía, Córdoba, España; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, España; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, España
| | - José Puzo
- Servicio de Bioquímica Clínica, Unidad de Lípidos, Hospital General Universitario San Jorge de Huesca, Huesca, España; Departamento de Medicina, Universidad de Zaragoza, Zaragoza, España
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Moral V, Abad Motos A, Jericó C, Antelo Caamaño ML, Ripollés Melchor J, Bisbe Vives E, García Erce JA. Management of peri-surgical anemia in elective surgery. Conclusions and recommendations according to Delphi-UCLA methodology. Rev Esp Anestesiol Reanim (Engl Ed) 2024:S2341-1929(24)00083-0. [PMID: 38670490 DOI: 10.1016/j.redare.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/22/2023] [Accepted: 11/25/2023] [Indexed: 04/28/2024]
Abstract
INTRODUCTION Preoperative anemia affects approximately one third of surgical patients. It increases the risk of blood transfusion and influences short- and medium-term functional outcomes, increases comorbidities, complications and costs. The "Patient Blood Management" (PBM) programs, for integrated and multidisciplinary management of patients, are considered as paradigms of quality care and have as one of the fundamental objectives to correct perioperative anemia. PBM has been incorporated into the schemes for intensified recovery of surgical patients: the recent Enhanced Recovery After Surgery 2021 pathway (in Spanish RICA 2021) includes almost 30 indirect recommendations for PBM. OBJECTIVE To make a consensus document with RAND/UCLA Delphi methodology to increase the penetration and priority of the RICA 2021 recommendations on PBM in daily clinical practice. MATERIAL AND METHODS A coordinating group composed of 6 specialists from Hematology-Hemotherapy, Anesthesiology and Internal Medicine with expertise in anemia and PBM was formed. A survey was elaborated using Delphi RAND/UCLA methodology to reach a consensus on the key areas and priority professional actions to be developed at the present time to improve the management of perioperative anemia. The survey questions were extracted from the PBM recommendations contained in the RICA 2021 pathway. The development of the electronic survey (Google Platform) and the management of the responses was the responsibility of an expert in quality of care and clinical safety. Participants were selected by invitation from speakers at AWGE-GIEMSA scientific meetings and national representatives of PBM-related working groups (Seville Document, SEDAR HTF section and RICA 2021 pathway participants). In the first round of the survey, the anonymized online questionnaire had 28 questions: 20 of them were about PBM concepts included in ERAS guidelines (2 about general PBM organization, 10 on diagnosis and treatment of preoperative anemia, 3 on management of postoperative anemia, 5 on transfusion criteria) and 8 on pending aspects of research. Responses were organized according to a 10-point Likter scale (0: strongly disagree to 10: strongly agree). Any additional contributions that the participants considered appropriate were allowed. They were considered consensual because all the questions obtained an average score of more than 9 points, except one (question 14). The second round of the survey consisted of 37 questions, resulting from the reformulation of the questions of the first round and the incorporation of the participants' comments. It consisted of 2 questions about general organization of PBM programme, 15 questions on the diagnosis and treatment of preoperative anemia; 3 on the management of postoperative anemia, 6 on transfusional criteria and finally 11 questions on aspects pending od future investigations. Statistical treatment: tabulation of mean, median and interquartiles 25-75 of the value of each survey question (Tables 1, 2 and 3). RESULTS Except for one, all the recommendations were accepted. Except for three, all above 8, and most with an average score of 9 or higher. They are grouped into: 1.- "It is important and necessary to detect and etiologically diagnose any preoperative anemia state in ALL patients who are candidates for surgical procedures with potential bleeding risk, including pregnant patients". 2.- "The preoperative treatment of anemia should be initiated sufficiently in advance and with all the necessary hematinic contributions to correct this condition". 3.- "There is NO justification for transfusing any unit of packed red blood cells preoperatively in stable patients with moderate anemia Hb 8-10g/dL who are candidates for potentially bleeding surgery that cannot be delayed." 4.- "It is recommended to universalize restrictive criteria for red blood cell transfusion in surgical and obstetric patients." 5.- "Postoperative anemia should be treated to improve postoperative results and accelerate postoperative recovery in the short and medium term". CONCLUSIONS There was a large consensus, with maximum acceptance,strong level of evidence and high recommendation in most of the questions asked. Our work helps to identify initiatives and performances who can be suitables for the implementation of PBM programs at each hospital and for all patients.
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Affiliation(s)
- V Moral
- Department of Anaesthesia. Hospital Universitario Sant Pau and Universidad Autónoma de Barcelona, Barcelona, Spain
| | - A Abad Motos
- Department of Anaesthesiology, Hospital Universitario Donostia, San Sebastián, Spain; Spanish Perioperative Audit and Research Network (ReDGERM), Zaragoza, Spain; Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anesthesiology and Critical Care (SEDAR).
| | - C Jericó
- Servicio de Medicina Interna, Complex Hospitalari Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona, Spain; Grupo Multidisciplinar para el Estudio y Manejo de la Anemia del Paciente Quirúrgico (Anemia Working Group España, www.awge.org); Grupo Español de Rehabilitación Multimodal (GERM, www.grupogerm.es); Grupo de Investigación Gestión en el Paciente Sangrante-PBM, Instituto de Investigación Sanitaria, Hospital Universitaria La Paz (IdiPAZ), Madrid, Spain
| | - M L Antelo Caamaño
- Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud, Osasunbidea, Pamplona, Spain
| | - J Ripollés Melchor
- Spanish Perioperative Audit and Research Network (ReDGERM), Zaragoza, Spain; Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anesthesiology and Critical Care (SEDAR); Department of Anesthesiology, and Critical Care, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - E Bisbe Vives
- Grupo Multidisciplinar para el Estudio y Manejo de la Anemia del Paciente Quirúrgico (Anemia Working Group España, www.awge.org); Department of Anaesthesiology, Parc de Salut Mar, Barcelona, Spain
| | - J A García Erce
- Grupo Multidisciplinar para el Estudio y Manejo de la Anemia del Paciente Quirúrgico (Anemia Working Group España, www.awge.org); Grupo Español de Rehabilitación Multimodal (GERM, www.grupogerm.es); Grupo de Investigación Gestión en el Paciente Sangrante-PBM, Instituto de Investigación Sanitaria, Hospital Universitaria La Paz (IdiPAZ), Madrid, Spain; Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud, Osasunbidea, Pamplona, Spain.
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Muñoz M, Aragón S, Ballesteros M, Bisbe-Vives E, Jericó C, Llamas-Sillero P, Meijide-Míguez HM, Rayó-Martin E, Rodríguez-Suárez MJ. Executive summary of the consensus document on the management of perioperative anemia in Spain. Rev Clin Esp 2024; 224:225-232. [PMID: 38423382 DOI: 10.1016/j.rceng.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 02/07/2024] [Indexed: 03/02/2024]
Abstract
Perioperative anemia is an independent risk factor for postoperative morbidity and mortality. However, conceptual, logistical and administrative barriers persist that hinder the widespread implementation of protocols for their management. The project coordinator convened a multidisciplinary group of 8 experienced professionals to develop perioperative anemia management algorithms, based on a series of key points (KPs) related to its prevalence, consequences, diagnosis and treatment. These KPs were assessed using a 5-point Likert scale, from "strongly disagree [1]" to "strongly agree [5]". For each KP, consensus was reached when receiving a score of 4 or 5 from at least 7 participants (>75%). Based on the 36 KPs agreed upon, diagnostic-therapeutic algorithms were developed that we believe can facilitate the implementation of programs for early identification and adequate management of perioperative anemia, adapted to the characteristics of the different institutions in our country.
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Affiliation(s)
- M Muñoz
- Departamento de Especialidades Quirúrgicas, Bioquímica e Inmunología. Facultad de Medicina, Universidad de Málaga, Málaga, Spain.
| | - S Aragón
- Servicio de Anestesiología, Reanimación y Terapia del Dolor, Hospital de la Ribera, Valencia, Spain.
| | - M Ballesteros
- Servicio de Hematología y Hemoterapia, H.G.U. Gregorio Marañón, Madrid, Spain.
| | - E Bisbe-Vives
- Servicio de Anestesiología, Hospital del Mar, Barcelona, Spain.
| | - C Jericó
- Servicio de Medicina Interna, Complex Hospitalari Moisès Broggi, Barcelona, Spain.
| | - P Llamas-Sillero
- Servicio de Hematología y Hemoterapia, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain.
| | - H M Meijide-Míguez
- Servicio de Medicina Interna, Hospital Quironsalud A Coruña, Grupo de Trabajo de Asistencia Compartida y Medicina Consultiva (SEMI), A Coruña, Spain.
| | - E Rayó-Martin
- Medicina de familia, EAP SARDENYA, Barcelona, Spain.
| | - M J Rodríguez-Suárez
- Servicio de Ginecología y Obstetricia, Hospital Universitario Central de Asturias, Oviedo, Spain.
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García-Erce JA, Jericó C, Abad-Motos A, Rodríguez García J, Antelo Caamaño ML, Domingo Morera JM, Sola Lapeña C, Arroyo JL, Fernández Fuertes F, Zalba Marcos S, Cerdán Rodríguez G, Laso Morales MJ, Bueno Cabrera JL, Chica E, Recasens V, Zabalegui A, Balen E, Urrechaga E, Abad-Gurumeta A, Quintana Díaz M. PBM: Now more than ever necessary. Revista Española de Anestesiología y Reanimación (English Edition) 2022; 69:351-354. [PMID: 35760689 PMCID: PMC9226968 DOI: 10.1016/j.redare.2021.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/30/2021] [Indexed: 11/24/2022]
Affiliation(s)
- J A García-Erce
- Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud, Osasunbidea, Pamplona, España, Grupo Español de Rehabilitación Multimodal (GERM), Instituto Aragonés de Ciencias de la Salud, Zaragoza, España, PBM Group, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.
| | - C Jericó
- Servicio de Medicina Interna, Hospital Sant Joan Despí Barcelona, Spain
| | - A Abad-Motos
- Servicio de Anestesiología, Hospital Universitario Infanta Leonor de Madrid, Grupo Español de Rehabilitación Multimodal (GERM), Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain
| | - J Rodríguez García
- Servicio de Medicina Preventiva, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - M L Antelo Caamaño
- Servicio de Apoyo a la Gestión Clínica y Continuidad Asistencial, Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | | | - J L Arroyo
- Banco de Sangre y Tejidos de Cantabria, Santander, Spain
| | - F Fernández Fuertes
- Servicio Hematología y Hemoterapia, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - S Zalba Marcos
- Servicio de Hematología y Hemoterapia, Hospital García Orcoyen, Estella (Navarra), Spain
| | - G Cerdán Rodríguez
- Servicio de Anestesiología, Hospital García Orcoyen, Estella (Navarra), Spain
| | - M J Laso Morales
- Servicio de Anestesiología, Hospital Universitario Parc Taulí, Sabadell, Barcelona, Spain
| | - J L Bueno Cabrera
- Servicio de Hematología y Hemoterapia, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - E Chica
- Servicio de Hematología y Hemoterapia, Hospital Universitario de Getafe, Getafe, Spain
| | - V Recasens
- Servicio de Hematología y Hemoterapia, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - A Zabalegui
- Servicio de Análisis Clínico, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - E Balen
- Servicio de Cirugía General, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - E Urrechaga
- Biocruces Bizkaia Research Institute, Bilbao, Spain
| | - A Abad-Gurumeta
- Servicio de Anestesiología, Hospital Universitario Infanta Leonor de Madrid, Grupo Español de Rehabilitación Multimodal (GERM), Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain
| | - M Quintana Díaz
- Servicio de Cuidados Intensivos, Hospital Universitario La Paz, PBM Group, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
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García-Erce JA, Jericó C, Abad-Motos A, Rodríguez García J, Antelo Caamaño ML, Domingo Morera JM, Sola Lapeña C, Arroyo JL, Fernández Fuertes F, Zalba Marcos S, Cerdán Rodríguez G, Laso Morales MJ, Bueno Cabrera JL, Chica E, Recasens V, Zabalegui A, Balen E, Urrechaga E, Abad-Gurrumenta A, Quintana Díaz M. PBM: Now more than ever necessary. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 69:S0034-9356(21)00181-X. [PMID: 34563367 PMCID: PMC8486592 DOI: 10.1016/j.redar.2021.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 01/12/2023]
Affiliation(s)
- J A García-Erce
- Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud, Osasunbidea, Pamplona, España; Grupo Español de Rehabilitación Multimodal (GERM), Instituto Aragonés de Ciencias de la Salud, Zaragoza, España; PBM Group, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, España.
| | - C Jericó
- Servicio de Medicina Interna, Hospital Sant Joan Despí Barcelona, España
| | - A Abad-Motos
- Servicio de Anestesiología, Hospital Universitario Infanta Leonor de Madrid; Grupo Español de Rehabilitación Multimodal (GERM), Instituto Aragonés de Ciencias de la Salud, Zaragoza, España
| | - J Rodríguez García
- Servicio de Medicina Preventiva, Hospital Universitario Son Espases, Palma de Mallorca, España
| | - M L Antelo Caamaño
- Servicio de Apoyo a la Gestión Clínica y Continuidad Asistencial, Complejo Hospitalario de Navarra, Pamplona, España
| | | | | | - J L Arroyo
- Banco de Sangre y Tejidos de Cantabria, Santander, España
| | - F Fernández Fuertes
- Servicio Hematología y Hemoterapia, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, España
| | - S Zalba Marcos
- Servicio de Hematología y Hemoterapia, Hospital García Orcoyen, Estella (Navarra), España
| | - G Cerdán Rodríguez
- Servicio de Anestesiología, Hospital García Orcoyen, Estella (Navarra), España
| | - M J Laso Morales
- Servicio de Anestesiología, Hospital Universitario Parc Taulí, Sabadell, Barcelona, España
| | - J L Bueno Cabrera
- Servicio de Hematología y Hemoterapia, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - E Chica
- Servicio de Hematología y Hemoterapia, Hospital Universitario de Getafe, Getafe, España
| | - V Recasens
- Servicio de Hematología y Hemoterapia, Hospital Universitario Miguel Servet, Zaragoza, España
| | - A Zabalegui
- Servicio de Análisis Clínico, Complejo Hospitalario de Navarra, Pamplona, España
| | - E Balen
- Servicio de Cirugía General, Complejo Hospitalario de Navarra, Pamplona, España
| | - E Urrechaga
- Biocruces Bizkaia Research Institute, Bilbao, España
| | - A Abad-Gurrumenta
- Servicio de Anestesiología, Hospital Universitario Infanta Leonor de Madrid; Grupo Español de Rehabilitación Multimodal (GERM), Instituto Aragonés de Ciencias de la Salud, Zaragoza, España
| | - M Quintana Díaz
- Servicio de Cuidados Intensivos, Hospital Universitario La Paz; PBM Group, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, España
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6
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Abad-Motos A, Ripollés-Melchor J, Jericó C, Basora M, Aldecoa C, Cabellos-Olivares M, Navarro-Pérez R, Bisbe E, García-Erce JA. Patient Blood Management for primary hip and knee replacement. A survey among POWER.2 study researchers. Rev Esp Anestesiol Reanim (Engl Ed) 2020; 67:237-244. [PMID: 32165061 DOI: 10.1016/j.redar.2020.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 12/28/2019] [Accepted: 01/09/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Implementation of Patient Blood Management programs remain variable in Europe, and even in centres with well-established PBM programs variability exists in transfusion practices. OBJECTIVES AND METHODS We conducted a survey in order to assess current practice in perioperative Patient Blood Management in patients undergoing total hip and knee replacement among researchers involved in POWER.2 Study in Spain (an observational prospective study evaluating enhanced recovery pathways in orthopaedic surgery). RESULTS A total of 322 responses were obtained (37.8%). Half of responders check Haemoglobin levels in patients at least 4 weeks before surgery; 35% treat all anaemic patients, although 99.7% consider detection and treatment of preoperative anaemia could influence the postoperative outcomes. Lack of infrastructure (76%) and lack of time (51%) are the main stated reasons not to treat anaemic patients. Iron status is routinely checked by 19% before surgery, and 36% evaluate it solely in the anaemic patient. Hb<9.9 g/dl is the threshold to delay surgery for 61% of clinicians, and 22% would consider transfusing preoperatively clinically stable patients without active bleeding. The threshold to transfuse patients without cardiovascular disease is 8 g/dl for 43%, and 7 g/dl for 34% of the responders; 75% of clinicians consider they use "restrictive thresholds", and 90% follow the single unit transfusion policy. CONCLUSIONS The results of our survey show variability in clinical practice in Patient Blood Management in major orthopaedic surgery, despite being the surgery with the greatest tradition in these programs.
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Affiliation(s)
- A Abad-Motos
- Servicio de Anestesiología y Reanimación, Hospital Universitario Infanta Leonor, Madrid, España; RedGERM, Spanish Perioperative Audit and Research Network, Zaragoza, España.
| | - J Ripollés-Melchor
- Servicio de Anestesiología y Reanimación, Hospital Universitario Infanta Leonor, Madrid, España; RedGERM, Spanish Perioperative Audit and Research Network, Zaragoza, España
| | - C Jericó
- Servicio de Medicina Interna, Hospital Sant Joan Despí-Moisés Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona, España; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, España; Anemia Working Group España (AWGE)
| | - M Basora
- Servicio de Anestesiología y Reanimación, Hospital Clínic Universitari, Barcelona, España; Anemia Working Group España (AWGE)
| | - C Aldecoa
- Servicio de Anestesiología y Reanimación, Hospital Universitario Río Hortega, Valladolid, España; RedGERM, Spanish Perioperative Audit and Research Network, Zaragoza, España
| | - M Cabellos-Olivares
- Servicio de Anestesiología y Reanimación, Hospital Universitario de Guadalajara, Guadalajara, España
| | - R Navarro-Pérez
- Servicio de Anestesiología y Reanimación, Hospital Universitario Clínico San Carlos, Madrid, España
| | - E Bisbe
- Servicio de Anestesiología y Reanimación, Parc de Salut Mar, Barcelona, España; Anemia Working Group España (AWGE)
| | - J A García-Erce
- Banco de Sangre y Tejidos de Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona, Navarra, España; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, España; Anemia Working Group España (AWGE)
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Armario P, Jericó C, Vila L, Freixa R, Martin-Castillejos C, Rotllan M. Área de Atención Integrada de Riesgo Vascular: un nuevo modelo organizativo para el control global de los factores de riesgo. Hipertensión y Riesgo Vascular 2017; 34:72-77. [DOI: 10.1016/j.hipert.2016.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 10/18/2016] [Indexed: 10/20/2022]
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Jericó C, Knobel H, Sorli ML, Montero M, Guelar A, Pedro-Botet J. Prevalencia de factores de riesgo cardiovascular en pacientes con infección por el VIH. Rev Clin Esp 2006; 206:556-9. [PMID: 17178075 DOI: 10.1157/13096303] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION To determine the prevalence of cardiovascular risk factors in human immunodeficiency virus (HIV)-infected patients. PATIENTS AND METHOD A cross-sectional study was performed with HIV-infected patients aged 20 or over managed at the outpatient Infectious Disease Unit during 2003. Clinical and epidemiological characteristics of HIV infection and cardiovascular risk factors were evaluated. RESULTS The final 760 patients included in the study had a mean of 1.5 cardiovascular risk factors, with smoking being the most prevalent (66.8%; CI 95%: 63.4-70.2). The cardiovascular risk factor of age and gender was present in 26.4% (CI 95%: 23.3-29.7) of patients and family history of premature coronary heart disease in 14.3% (CI 95%: 11.8-16.9). The prevalence of hypertension and diabetes mellitus was 13.2% (CI 95%: 10.8-15.8) and 4.3% (CI 95%: 3.0-6.0), respectively. High density lipoprotein (HDL) cholesterol concentration under 40 mg/dl was found in 29.3% (CI 95%: 26.1-32.7) and above 60 mg/dl in 16.3% (CI 95%: 13.8-19.1). Twenty-five patients (3.3%; CI 95%: 2.1-4.8) had suffered overt cardiovascular disease. CONCLUSION Smoking and HDL cholesterol were the main cardiovascular risk factors in this HIV-infected cohort.
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Affiliation(s)
- C Jericó
- Servicio de Medicina Interna y Enfermedades Infecciosas, Hospital del Mar, Universidad Autónoma de Barcelona, Barcelona, España
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Pedro-Botet J, Jericó C. Etiopatogenia de la arteriosclerosis. Aspectos celulares y moleculares del daño vascular. Aten Primaria 2005. [DOI: 10.1016/s0212-6567(05)70579-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Sorli ML, Jericó C, Pedro-Botet J. [Bilateral otitis media as presentation form of microscopic polyangiitis]. An Med Interna 2004; 21:364-5. [PMID: 15347248 DOI: 10.4321/s0212-71992004000700015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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Jericó C, Knobel H, Montero M, Sorli M, López-Colomés J, Pedro-Botet J. W09.228 Prevalence of metabolic syndrome (MS) among HIV-infected patients. ATHEROSCLEROSIS SUPP 2004. [DOI: 10.1016/s1567-5688(04)90227-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Jericó C, Sorli ML, Pedro-Botet J. Masa paravertebral como primera manifestación de un hepatocarcinoma. Gastroenterología y Hepatología 2004; 27:69-70. [PMID: 14733883 DOI: 10.1016/s0210-5705(03)79090-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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