Transfusion thresholds for guiding red blood cell transfusion

Carson, Jeffrey L.; Stanworth, Simon; Dennis, Jane A; Trivella, Marialena; Roubinian, Nareg; Fergusson, Dean; Triulzi, Darrell J.; Dorée, Carolyn; Hébert, Paul C.

doi:10.1002/14651858.cd002042.pub5

Cited by 130 publications

(164 citation statements)

References 166 publications

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“…The findings provide good evidence that transfusions with allogeneic RBCs can be avoided in most patients with hemoglobin thresholds between 7.0 g/dL and 8.0 g/dL. However, existing studies have reported that some subsets of patients may benefit from RBCs to maintain higher hemoglobin concentrations and that future research should focus on these clinical contexts [ 31 ]. A recent study stated that a threshold value of 7 g/dL for RBC transfusion in critically ill patients in the intensive care unit is generally reliable [ 26 ].…”

Section: Discussionmentioning

confidence: 87%

Association between Anemia and New-Onset Atrial Fibrillation in Critically Ill Patients in the Intensive Care Unit: A Retrospective Cohort Analysis

Sertçakacılar

Yıldız

2022

Clinics and Practice

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New-onset atrial fibrillation (NOAF) is one of the leading causes of morbidity and mortality, especially in older patients in the intensive care unit (ICU). Although many comorbidities are associated with NOAF, the effect of anemia on the onset of atrial fibrillation is still unknown. This study aimed to test the hypothesis that anemia is associated with an increased risk of developing NOAF in critically ill patients in intensive care. We performed a retrospective analysis of critically ill patients who underwent routine hemoglobin and electrocardiography monitoring in the ICU. Receiver operating characteristics analysis determined the hemoglobin (Hb) value that triggered NOAF formation. Bivariate correlation was used to determine the relationship between anemia and NOAF. The incidence of NOAF was 9.9% in the total population, and 12.8% in the patient group with anemia. Analysis of 1931 patients revealed a negative association between anemia and the development of NOAF in the ICU. The stimulatory Hb cut-off value for the formation of NOAF was determined as 9.64 g/dL. Anemia is associated with the development of NOAF in critically ill patients in intensive care.

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Section: Discussionmentioning

confidence: 87%

Association between Anemia and New-Onset Atrial Fibrillation in Critically Ill Patients in the Intensive Care Unit: A Retrospective Cohort Analysis

Sertçakacılar

Yıldız

2022

Clinics and Practice

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“…The activation of inflammation during blood transfusion was closely related to the severity of postoperative pain. A meta-analysis also confirmed that the restrictive allogeneic blood transfusion strategy could reduce the perioperative infection rate without increasing the incidence of complications such as cardiac events or mortality ( 34 ). Retrospective analysis of a single central database also confirmed that perioperative blood transfusion was independently associated with poor prognosis in patients with GC ( 35 ).…”

Section: Discussionmentioning

confidence: 90%

Predictive Factors for Acute Postoperative Pain After Open Radical Gastrectomy for Gastric Cancer

Xie

Wei

et al. 2022

Front. Public Health

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BackgroundPain has become an important factor in evaluating patients' quality of life and clinical treatment. For gastric cancer (GC) patients, open radical gastrectomy (OG) causes significant trauma to the body, increases patients' pain after operation, and delays early recovery. The aim of this study was to investigate the predictive factors of acute pain after OG within postoperative 72 h.MethodsFrom March 2020 to September 2021, 307 patients who underwent OG were included in the study in Nanjing Drum Tower Hospital. The predictors included demographic predictors, pathological data, surgical predictors, and intraoperative predictors. The pain scores at 12, 24, 48, and 72 h after operation were evaluated by numeric rating scale (NRS). The predictors of acute pain were determined by univariate and multivariate analysis.ResultsThe average pain score (NRS) of patients showed a downward trend over time within 72 h after OG. Multivariate analysis indicated that total gastrectomy (OR 1.823, 95% CI 1.094–3.040, P < 0.05), AJCC TNM stage (II) (OR.232, 95% CI 0.062–0.872, P < 0.05), AJCC TNM stage(III) (OR.185, 95% CI 0.049–0.698, P < 0.05), BMI (kg/m2) (OR 1.75, 95% CI 1.029–2.976, P < 0.05), distant metastasis (OR 3.054, 95% CI 1.019–9.155, P < 0.05), intraoperative transfusion (OR 2.246, 95% CI 1.267–3.982, P < 0.01) were significant predictive factors for acute pain after OG.ConclusionReasonable postoperative acute pain control was the prerequisite for accelerating the postoperative rehabilitation of patients. In order to reduce the occurrence of excessive or insufficient analgesia, it was necessary for patients who underwent OG to formulate appropriate analgesics according to risk factors.

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“…We defined hypovolaemia as indexed deviation of PDD measured BV from estimated BV≤0.9. After the protocolised preoperative haemodynamic optimisation, insertion of lumbar epidural catheter and BV‐measurements, patients received transfusion with red packed blood cells if Hb <6 mmol l −1 23,24 …”

Section: Methodsmentioning

confidence: 99%

“…After the protocolised preoperative haemodynamic optimisation, insertion of lumbar epidural catheter and BV-measurements, patients received transfusion with red packed blood cells if Hb <6 mmol l À1 . 23,24 After discharge from the PCU, patients were treated according to local guidelines for surgery and until discharge. We obtained information on the level of self-evaluated pain, reported by the Numeric Rating Scale (NRS).…”

Section: Protocol; Preoperative Monitoring and Resuscitationmentioning

confidence: 99%

Fluid‐responsiveness, blood volume and perfusion in preoperative haemodynamic optimisation of hip fracture patients; a prospective observational study

Agerskov

Sørensen

Højlund

et al. 2022

Acta Anaesthesiol Scand

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Background Preoperative resuscitation strategies in patients with hip fracture (HF) are lacking. We aimed to investigate fluid‐responsiveness, peripheral perfusion index (PPI) and blood volume (BV)‐status in patients with HF undergoing resuscitation in the preoperative phase. Methods In a prospective observational study, we evaluated preoperative fluid‐responsiveness, indices of perfusion and BV before and after lumbar epidural analgesia in 50 patients with HF shortly after admittance. Results Initially, 18 (36%) patients were fluid‐responsive (≥10% increased SV in response to 250 ml fluid bolus) and 13 (26%) presented hypovolaemia (deviation of measured BV from estimated BV ≤ 0.9). According to fluid‐responsiveness, no difference in absolute values of cardiac index (CI) (2.7 L [2.1–3.3] vs. 2.8 L [2.3–3.4], p = .5) was seen, but cardiac output (CO) rose significantly in the hypovolaemic patients: 9% [5–18] vs. 1% [−3–7], p = .004. After epidural analgesia, 26 (52%) patients were again fluid‐responsive and 15 (30%) were hypovolaemic. CI was now significantly lower in fluid‐responsive patients (2.2 L [1.7–2.7] vs. 2.9 L [2.3–3.5], p = .001). Prior to epidural analgesia, no significant trend towards hypovolaemic patients having lower indices of perfusion was seen. After epidural analgesia, more patients with hypovolaemia presented with PPI≤1.5 (8 (53%) vs. 3 (9%), p = .001) and absolute values of PPI were also significantly lower if IBV was low (1.4 [0.9–3.2] vs. 3.2 [2.4–4.8], p = .01). PPI correlated with hypovolaemia after epidural analgesia (rho 0.4 [0.1–0.7], p = .007). Conclusions Preoperative fluid‐responsivity in HF patients might be attributable to elements of hypovolaemia and sympathetic compensatory ability conjointly, confounding the use of SV‐guided resuscitation. PPI could be associated with BV, which may support clinicians during perioperative haemodynamic optimisation.

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Transfusion thresholds for guiding red blood cell transfusion

Abstract: Transfusion thresholds for guiding red blood cell transfusion.

Cited by 130 publications

References 166 publications

Association between Anemia and New-Onset Atrial Fibrillation in Critically Ill Patients in the Intensive Care Unit: A Retrospective Cohort Analysis

Association between Anemia and New-Onset Atrial Fibrillation in Critically Ill Patients in the Intensive Care Unit: A Retrospective Cohort Analysis

Predictive Factors for Acute Postoperative Pain After Open Radical Gastrectomy for Gastric Cancer

Fluid‐responsiveness, blood volume and perfusion in preoperative haemodynamic optimisation of hip fracture patients; a prospective observational study

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