Best practice in critical care: anaemia in acute and critical illness

Docherty, Annemarie B; Turgeon, AF; Walsh, Timothy

doi:10.1111/tme.12505

Cited by 38 publications

(32 citation statements)

References 103 publications

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“…RCTs in paediatric as well as in adult critically ill patients have demonstrated that restrictive red blood cell (RBC) transfusion strategies are equal or non-inferior to liberal strategies with regard to organ function and outcomes [50]. Although certain subpopulations might benefit from a higher haemoglobin levels, an RBC transfusion target of 7 g/dL is recommended in hemodynamically stable patients [51]. Whether the same target can be extended to brain-dead donors is unclear [8] since no RCTs have addressed this issue, or have examined the effect of transfusion on oxygen delivery (DO 2 ) to tissues or organs.…”

Section: Anaemiamentioning

confidence: 99%

Management of the brain-dead donor in the ICU: general and specific therapy to improve transplantable organ quality

et al. 2019

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To provide a practical overview of the management of the potential organ donor in the intensive care unit. Methods: Seven areas of donor management were considered for this review: hemodynamic management; fluids and electrolytes; respiratory management; endocrine management; temperature management; anaemia and coagulation; infection management. For each subchapter, a narrative review was conducted. Results and conclusions: Most elements in the current recommendations and guidelines are based on pathophysiological reasoning, epidemiological observations, or extrapolations from general ICU management strategies, and not on evidence from randomized controlled trials. The cardiorespiratory management of brain-dead donors is very similar to the management of critically ill patients, and the same applies to the management of anaemia and coagulation. Central diabetes insipidus is of particular concern, and should be diagnosed based on clinical criteria. Depending on the degree of vasopressor dependency, it can be treated with intermittent desmopressin or continuous vasopressin, intravenously. Temperature management of the donor is an area of uncertainty, but it appears reasonable to strive for a core temperature of > 35 °C. The indications and controversies regarding endocrine therapies, in particular thyroid hormone replacement therapy, and corticosteroid therapy, are discussed. The potential donor should be assessed clinically for infections, and screening tests for specific infections are an essential part of donor management. Although the rate of infection transmission from donor to receptor is low, certain infections are still a formal contraindication to organ donation. However, new antiviral drugs and strategies now allow organ donation from certain infected donors to be done safely.

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Section: Anaemiamentioning

confidence: 99%

Management of the brain-dead donor in the ICU: general and specific therapy to improve transplantable organ quality

et al. 2019

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“…Moreover, iron has multiple regulatory effects on immune function, among others blocking anti-microbial immune pathways or stimulating the production of the anti-inflammatory cytokine IL-10 [ 10 ]. As a consequence, this functional iron deficiency leads to anemia of inflammation (AI) or anemia of chronic disease (ACD) which is also found in critically ill patients [ 11 , 12 ] (Additional file 1 ). ACD is diagnosed upon the presence of reduced hemoglobin levels, increased concentrations of inflammation markers, low circulating iron levels, a reduced saturation of transferrin, along with normal or increased concentrations of ferritin [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Linkage of alterations in systemic iron homeostasis to patients’ outcome in sepsis: a prospective study

et al. 2020

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Background Sepsis, a dysregulated host response following infection, is associated with massive immune activation and high mortality rates. There is still a need to define further risk factors and laboratory parameters predicting the clinical course. Iron metabolism is regulated by both, the body’s iron status and the immune response. Iron itself is required for erythropoiesis but also for many cellular and metabolic functions. Moreover, iron availability is a critical determinant in infections because it is an essential nutrient for most microbes but also impacts on immune function and intravascular oxidative stress. Herein, we used a prospective study design to investigate the putative impact of serum iron parameters on the outcome of sepsis. Methods Serum markers of iron metabolism were measured in a prospective cohort of 61 patients (37 males, 24 females) with sepsis defined by Sepsis-3 criteria in a medical intensive care unit (ICU) and compared between survivors and non-survivors. Regulation of iron parameters in patients stratified by focus of infection and co-medication as well as association of the markers with sepsis severity scores and survival were investigated with linear and logistic regression corrected for sex and age effects. Results Positive correlations of increased serum iron and ferritin concentrations upon ICU admission with the severity of organ failure (SOFA score) and with mortality were observed. Moreover, high TF-Sat, elevated ferritin and serum iron levels and low transferrin concentrations were associated with reduced survival. A logistic regression model consisting of SOFA and transferrin saturation (SOFA–TF-Sat) had the best predictive power for survival in septic ICU patients. Of note, administration of blood transfusions prior to ICU admission resulted in increased TF-Sat and reduced survival of septic patients. Conclusions Our study could show an important impact of serum iron parameters on the outcome of sepsis. Furthermore, we identified transferrin saturation as a stand-alone predictor of sepsis survival and as a parameter of iron metabolism which may in a combined model improve the prediction power of the SOFA score. Trial registration The study was carried out in accordance with the recommendations of the Declaration of Helsinki on biomedical research. The study was approved by the institutional ethics review board of the Medical University Innsbruck (study AN2013-0006).

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“…Patients with sepsis or septic shock are often anemic and undergo red blood cell (RBC) transfusion. This intervention may restore the balance between oxygen supply and demand by increasing oxygen delivery into tissue [1, 2]. However, RBC transfusion may also lead to deleterious events such as cardiovascular overload, acute kidney injury, acute lung injury, infectious complications, and immunomodulation [3–5].…”

Section: Introductionmentioning

confidence: 99%

Liberal versus restrictive red blood cell transfusion strategy in sepsis or septic shock: a systematic review and meta-analysis of randomized trials

Hirano¹,

Miyoshi²,

Kondo³

et al. 2019

Crit Care

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Background We assessed the effect of liberal versus restrictive red blood cell transfusion strategy on survival outcome in sepsis or septic shock by systematically reviewing the literature and synthesizing evidence from randomized controlled trials (RCTs). Methods We searched the MEDLINE, Cochrane Central Register of Controlled Trials, and Web of Science databases. We included RCTs that compared mortality between a liberal transfusion strategy with a hemoglobin threshold of 9 or 10 g/dL and a restrictive transfusion strategy with a hemoglobin threshold of 7 g/dL in adults with sepsis or septic shock. Two investigators independently screened citations and conducted data extraction. The primary outcome was 28- or 30-day mortality. Secondary outcomes were 60- and 90-day mortality, use of life support at 28 days of admission, and number of patients transfused during their intensive care unit stay. DerSimonian-Laird random-effects models were used to report pooled odds ratios (ORs). Results A total of 1516 patients from three RCTs were included; 749 were randomly assigned to the liberal transfusion group and 767 to the restrictive strategy group. Within 28–30 days, 273 patients (36.4%) died in the liberal transfusion group, while 278 (36.2%) died in the restrictive transfusion group (pooled OR, 0.99; 95% confidence interval [CI], 0.67–1.46). For the primary outcome, heterogeneity was observed among the studies ( I 2 = 61.0%, χ 2 = 5.13, p = 0.08). For secondary outcomes, only two RCTs were included. There were no significant differences in secondary outcomes between the two groups. Conclusions We could not show any difference in 28- or 30-day mortality between the liberal and restrictive transfusion strategies in sepsis or septic shock patients by meta-analysis of RCTs. Our results should be interpreted with caution due to the existence of heterogeneity. As sepsis complicates a potentially wide range of underlying diseases, further trials in carefully selected populations are anticipated. Trial registration This present study was registered in the PROSPERO database ( CRD42018108578 ). Electronic supplementary material The online version of this article (10.1186/s13054-019-2543-1) contains supplementary material, which is available to authorized users.

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Best practice in critical care: anaemia in acute and critical illness

Cited by 38 publications

References 103 publications

Management of the brain-dead donor in the ICU: general and specific therapy to improve transplantable organ quality

Management of the brain-dead donor in the ICU: general and specific therapy to improve transplantable organ quality

Linkage of alterations in systemic iron homeostasis to patients’ outcome in sepsis: a prospective study

Liberal versus restrictive red blood cell transfusion strategy in sepsis or septic shock: a systematic review and meta-analysis of randomized trials

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