Pertinence de la prescription des examens biologiques et de la radiographie thoracique en réanimation RFE commune SFAR-SRLF

Lehot, J.-J.; Clec’h, Christophe; Bonhomme, Fanny; Brauner, M.; Chemouni, Frank; Mesmay, M. de; Gayat, Étienne; Guidet, Bertrand; Hejblum, Gilles; Hernu, Romain; Jauréguy, Françoise; Martin, C.; Rousson, Robert; Samama, Meyer-Michel; Schwebel, Carole; Putte, H. Van de; Lemiale, Virginie; Ausset, Sylvain

doi:10.3166/rea-2018-0004

Cited by 4 publications

(2 citation statements)

References 104 publications

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“…The non-pharmacological prevention of anemia in critical care patients consists of interventions designed to decrease these blood losses. The main non-pharmacological interventions designed to reduce the risk of anemia are: blood test reduction strategies, as already proposed in the SFAR-SRLF joint CPG on the relevance of blood tests and chest X-rays in intensive care [13], reduction of the blood volumes drawn and use of blood conservation systems after drawing blood from an arterial catheter.…”

Section: Rationalementioning

confidence: 99%

Management and prevention of anemia (acute bleeding excluded) in adult critical care patients

Lasocki

Pène

Ait‐Oufella

et al. 2020

Ann. Intensive Care

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Objective: Anemia is very common in critical care patients, on admission (affecting about two-thirds of patients), but also during and after their stay, due to repeated blood loss, the effects of inflammation on erythropoiesis, a decreased red blood cell life span, and haemodilution. Anemia is associated with severity of illness and length of stay. Methods: A committee composed of 16 experts from four scientific societies, SFAR, SRLF, SFTS and SFVTT, evaluated three fields: (1) anemia prevention, (2) transfusion strategies and (3) non-transfusion treatment of anemia. Population, Intervention, Comparison, and Outcome (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Analysis of the literature and formulation of recommendations were then conducted according to the GRADE ® methodology. Results: The SFAR-SRLF guideline panel provided ten statements concerning the management of anemia in adult critical care patients. Acute haemorrhage and chronic anemia were excluded from the scope of these recommendations. After two rounds of discussion and various amendments, a strong consensus was reached for ten recommendations. Three of these recommendations had a high level of evidence (GRADE 1±) and four had a low level of evidence (GRADE 2±). No GRADE recommendation could be provided for two questions in the absence of strong consensus. Conclusions: The experts reached a substantial consensus for several strong recommendations for optimal patient management. The experts recommended phlebotomy reduction strategies, restrictive red blood cell transfusion and a single-unit transfusion policy, the use of red blood cells regardless of storage time, treatment of anaemic patients with erythropoietin, especially after trauma, in the absence of contraindications and avoidance of iron therapy (except in the context of erythropoietin therapy).

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Section: Rationalementioning

confidence: 99%

Management and prevention of anemia (acute bleeding excluded) in adult critical care patients

Lasocki

Pène

Ait‐Oufella

et al. 2020

Ann. Intensive Care

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“…International guidelines for monitoring anticoagulation by UFH in the specific population of critically ill surgical patients are not available. In France, current recommendations suggest that UFH anticoagulation should be monitored by anti-Xa activity rather than aPTT in ICU patients [ 1 ], recommendations that are based on single-center and often retrospective studies of small subject numbers that did not include ICU patients [ 2 , 3 ]. One of these studies concluded, “ It remains unclear whether aPTT, anti-Xa, or endogenous thrombin potential provides the most accurate measurement of the global coagulation status of patients receiving UFH ” [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Anticoagulation Monitoring with Activated Partial ThromboPlastin Time and Anti-Xa Activity in Intensive Care Unit Patients: Interest of Thrombin Generation Assay

Billoir

Elie

Levy

et al. 2022

IJMS

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Current guidelines recommend monitoring the anticoagulant effect of unfractionated heparin (UFH) by measuring anti-Xa activity rather than activated partial thromboplastin time (aPTT) in intensive care unit (ICU) patients. The primary objective of this study was to evaluate the correlation of aPTT, anti-Xa activity, and thrombin generation in UFH-treated ICU patients. A prospective observational pilot study was conducted in adult surgical ICU patients treated with UFH. aPTT and anti-Xa activity were monitored daily. The therapeutic target was aPTT between 50 s and 84 s, and/or anti-Xa between 0.3 and 0.7 U/mL. Correlation among aPTT, anti-Xa activity, and thrombin generation was determined by measuring endogenous thrombin potential (ETP), with the inflammatory response evaluated. C-reactive protein (CRP) was used as a marker of inflammatory response. The plasma of 107 samples from 30 ICU patients was analyzed. The correlation between aPTT and anti-Xa activity was 0.66, CI95% [0.54;0.76] (p < 0.0001). Although thrombin generation, aPTT, and anti-Xa were correlated with inflammatory responses, the correlation was higher with thrombin generation and anti-Xa activity compared to aPTT. When aPTT was in a therapeutic range, a low thrombin generation was observed but was 50% inhibited when anti-Xa was in a therapeutic range. Coagulation testing with aPTT, anti-Xa correlated with thrombin generation. A 50% decrease in thrombin generation was observed when anti-Xa was within a therapeutic range. Further work is needed to evaluate coagulation biomarker responses and clinical outcomes in specific ICU populations.

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Rationalisation de la prescription des examens biologiques : état des lieux en réanimation

Ben Souissi,

Haddad,

Mebazaa

2024

Anesthésie & Réanimation

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Pertinence de la prescription des examens biologiques et de la radiographie thoracique en réanimation RFE commune SFAR-SRLF

Cited by 4 publications

References 104 publications

Management and prevention of anemia (acute bleeding excluded) in adult critical care patients

Management and prevention of anemia (acute bleeding excluded) in adult critical care patients

Anticoagulation Monitoring with Activated Partial ThromboPlastin Time and Anti-Xa Activity in Intensive Care Unit Patients: Interest of Thrombin Generation Assay

Rationalisation de la prescription des examens biologiques : état des lieux en réanimation

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