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blood transfusion in the critically ill patient

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https://www.readbyqxmd.com/read/29770452/the-effects-of-blood-transfusion-on-red-blood-cell-distribution-width-in-critically-ill-patients-a-pilot-study
#1
Savino Spadaro, Fabio Silvio Taccone, Alberto Fogagnolo, Federico Franchi, Sabino Scolletta, Riccardo Ragazzi, Alberto Fanni, Elisabetta Marangoni, Maurizio Govoni, Roberto Reverberi, Carlo Alberto Volta
BACKGROUND: Red blood cell distribution width (RDW) is a measure of anisocytosis, generally used in the differential diagnosis of anemia. Recently, RDW was associated with increased mortality in critically ill patients. Red blood cell (RBC) transfusions are potential confounders on RDW values interpretation. The aim of this study was to analyze the changes in RDW after RBC transfusion in intensive care unit (ICU) patients. STUDY DESIGN AND METHODS: This was a prospective, observational study including patients admitted to ICU requiring 1 RBC unit...
May 16, 2018: Transfusion
https://www.readbyqxmd.com/read/29768025/the-post-injury-inflammatory-state-and-the-bone-marrow-response-to-anemia
#2
Tyler J Loftus, Juan C Mira, Elizabeth S Miller, Kolenkode B Kannan, Jessica M Plazas, Daniel Delitto, Julie A Stortz, Jennifer E Hagen, Hari K Parvataneni, Kalia K Sadasivan, Scott C Brakenridge, Frederick A Moore, Lyle L Moldawer, Philip A Efron, Alicia M Mohr
RATIONALE: The pathophysiology of persistent injury-associated anemia is incompletely understood, and human data are sparse. OBJECTIVE: To translate pre-clinical findings by characterizing injury-associated anemia among critically ill trauma patients. This study compared elective hip repair patients with an acute stress response to severely injured trauma patients with a prolonged stress response and evaluated the bone marrow response to anemia. METHODS: A translational prospective observational cohort study comparing severely injured, blunt trauma patients who had operative fixation of a hip or femur fracture (n=17) with elective hip repair patients (n=22) and healthy donors (n=8)...
May 16, 2018: American Journal of Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29742788/-the-relevance-of-hemolysis-in-anesthesia-and-intensive-care-medicine
#3
Jan A Graw, David M Baron, Roland C E Francis
Hemolysis leads to an increase of circulating intravascular cell-free hemoglobin. Increased plasma concentrations of cell-free hemoglobin are relevant in critically ill patients because cell-free hemoglobin causes vasoconstriction by depletion of endothelial nitric oxide, oxidative stress, and inflammation. Furthermore, cell-free hemoglobin contributes to tissue injuries such as renal failure and intestinal mucosa damage after cardiac surgery. High concentrations of cell-free hemoglobin are associated with an increased mortality in patients with sepsis...
April 2018: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/29727368/platelet-transfusion-practices-in-critically-ill-children
#4
Marianne E Nellis, Oliver Karam, Elizabeth Mauer, Melissa M Cushing, Peter J Davis, Marie E Steiner, Marisa Tucci, Simon J Stanworth, Philip C Spinella
OBJECTIVES: Little is known about platelet transfusions in pediatric critical illness. We sought to describe the epidemiology, indications, and outcomes of platelet transfusions among critically ill children. DESIGN: Prospective cohort study. SETTING: Multicenter (82 PICUs), international (16 countries) from September 2016 to April 2017. PATIENTS: Children ages 3 days to 16 years prescribed a platelet transfusion in the ICU during screening days...
May 4, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29673409/worldwide-audit-of-blood-transfusion-practice-in-critically-ill-patients
#5
Jean-Louis Vincent, Ulrich Jaschinski, Xavier Wittebole, Jean-Yves Lefrant, Stephan M Jakob, Ghaleb A Almekhlafi, Tommaso Pellis, Swagata Tripathy, Paolo N Rubatto Birri, Yasser Sakr
BACKGROUND: The aim was to describe transfusion practice in critically ill patients at an international level and evaluate the effects of red blood cell (RBC) transfusion on outcomes in these patients. METHODS: This was a pre-planned sub-study of the Intensive Care Over Nations audit, which involved 730 ICUs in 84 countries and included all adult patients admitted between 8 May and 18 May 2012, except admissions for routine postoperative surveillance. RESULTS: ICU and hospital outcomes were recorded...
April 19, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29672869/age-of-transfused-blood-in-critically-ill-adult-trauma-patients-a-prespecified-nested-analysis-of-the-age-of-blood-evaluation-randomized-trial
#6
Robert S Green, Mete Erdogan, Jacques Lacroix, Paul C Hébert, Alan T Tinmouth, Elham Sabri, Tinghua Zhang, Dean A Fergusson, Alexis F Turgeon
BACKGROUND: Blood transfusion is common in the resuscitation of patients with traumatic injury. However, the clinical impact of the length of storage of transfused blood is unclear in this population. STUDY DESIGN AND METHODS: We undertook a prespecified nested analysis of 372 trauma victims of the 2510 critically ill patients from 64 centers treated as part of the Age of Blood Evaluation (ABLE) randomized controlled trial. Patients were randomized according to their trauma status to receive either a transfusion of fresh blood stored not more than 7 days or standard-issue blood...
April 19, 2018: Transfusion
https://www.readbyqxmd.com/read/29664740/ce-a-review-of-current-practice-in-transfusion-therapy
#7
Margaret Carman, Jennifer Schieferle Uhlenbrock, Sara Marie McClintock
: In the United States, roughly 4.5 million patients per year receive transfusions of various blood products. Despite the lifesaving benefits of transfusion therapy, it is an independent risk factor for infection, morbidity, and death in critically ill patients. It's important for nurses to understand the potential complications patients face when blood products are administered and to recognize that patients who have received blood products in the past remain at risk for delayed reactions, including immune compromise and infection...
May 2018: American Journal of Nursing
https://www.readbyqxmd.com/read/29658485/hyperbaric-oxygen-therapy-its-use-in-medical-emergencies-and-its-development-in-hong-kong
#8
J Ks Leung, R Pk Lam
Hyperbaric oxygen therapy is widely accepted as life-saving treatment for decompression illness. Yet its use in acute carbon monoxide poisoning has remained controversial because of inconsistent findings in clinical trials. Hyperbaric oxygen therapy has an adjunctive role in managing gas gangrene, necrotising soft-tissue infection, and crush injury, as supported by case series. Several cases have been reported in the literature detailing the use of hyperbaric oxygen therapy in patients with severe anaemia in whom blood transfusion is not possible...
April 2018: Hong Kong Medical Journal, Xianggang Yi Xue za Zhi
https://www.readbyqxmd.com/read/29606481/frequency-and-risk-factors-for-subsyndromal-delirium-in-an-intensive-care-unit
#9
Chikayo Yamada, Yoko Iwawaki, Kiyomi Harada, Michihiko Fukui, Masafumi Morimoto, Ryuya Yamanaka
OBJECTIVE: Delirium and subsyndromal delirium in critically ill patients are important determinants of long-term functional disability and cognitive impairment. However, few outcome studies on sub-syndromal delirium have been reported. Thus, this study aimed to evaluate the incidence of delirium and sub-syndromal delirium as well as the risk factors and progression to delirium. DESIGN: A prospective cohort study. SETTING: Six bed medical and surgical intensive care unit in Otsu Municipal Hospital in Japan...
March 29, 2018: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
https://www.readbyqxmd.com/read/29552954/red-blood-cell-product-transfusion-thresholds-and-clinical-outcomes
#10
Craig M Lilly, Omar Badawi, Xinggang Liu, Gill Christine S, Ilene Harris
OBJECTIVE: To determine whether patients transfused red blood cell (RBC) products according to guideline-specified pretransfusion hemoglobin (Hb) concentrations or for other reasons were more likely to survive their intensive care unit (ICU) stay. DESIGN: An observational study of 375 478 episodes of ICU care, over 5 years, was performed with ICU survival as the primary outcome. Outcomes were analyzed as a function of pretransfusion Hb concentration for groups with distinct transfusion indications while adjusting for potential confounders...
January 1, 2018: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/29536007/the-non-hemostatic-aspects-of-transfused-platelets
#11
REVIEW
Caroline Sut, Sofiane Tariket, Cécile Aubron, Chaker Aloui, Hind Hamzeh-Cognasse, Philippe Berthelot, Sandrine Laradi, Andreas Greinacher, Olivier Garraud, Fabrice Cognasse
Platelets transfusion is a safe process, but during or after the process, the recipient may experience an adverse reaction and occasionally a serious adverse reaction (SAR). In this review, we focus on the inflammatory potential of platelet components (PCs) and their involvement in SARs. Recent evidence has highlighted a central role for platelets in the host inflammatory and immune responses. Blood platelets are involved in inflammation and various other aspects of innate immunity through the release of a plethora of immunomodulatory cytokines, chemokines, and associated molecules, collectively termed biological response modifiers that behave like ligands for endothelial and leukocyte receptors and for platelets themselves...
2018: Frontiers in Medicine
https://www.readbyqxmd.com/read/29507728/predictors-associated-with-unplanned-hospital-readmission-of-medical-and-surgical-intensive-care-unit-survivors-within-30-days-of-discharge
#12
Tetsu Ohnuma, Daisuke Shinjo, Alan M Brookhart, Kiyohide Fushimi
Background: Reducing the 30-day unplanned hospital readmission rate is a goal for physicians and policymakers in order to improve quality of care. However, data on the readmission rate of critically ill patients in Japan and knowledge of the predictors associated with readmission are lacking. We investigated predictors associated with 30-day rehospitalization for medical and surgical adult patients separately. Methods: Patient data from 502 acute care hospitals with intensive care unit (ICU) facilities in Japan were retrospectively extracted from the Japanese Diagnosis Procedure Combination (DPC) database between April 2012 and February 2014...
2018: Journal of Intensive Care
https://www.readbyqxmd.com/read/29493552/pediatric-trauma-transfusion-and-cognitive-aids
#13
Anna Clebone
PURPOSE OF REVIEW: Trauma is the most common cause of pediatric mortality. Much of the research that led to life-saving interventions in adults, however, has not been replicated in the pediatric population. Children have important physiologic and anatomic differences from adults, which impact hemostasis and transfusion. Hemorrhage is a leading cause of death in trauma, and children have important differences in their coagulation profiles. Transfusion strategies, including the massive transfusion protocol and use of antifibrinolytics, are still controversial...
April 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/29473174/variation-in-red-cell-transfusion-decisions-in-the-intensive-care-unit-a-nationwide-survey-in-the-netherlands
#14
F J Kranenburg, S A Willems, S Le Cessie, P J Marang-van de Mheen, J G van der Bom, M S Arbous
BACKGROUND AND OBJECTIVES: Most guidelines recommend a restrictive transfusion trigger of 7 g/dl. It is unclear whether this resulted in more uniform transfusion practices. The primary objective was to uncover the extent of variation in transfusion decisions within four scenarios of critically ill patients among critical care physicians in the Netherlands. MATERIALS AND METHODS: An online survey comprising four different hypothetical clinical scenarios was sent to all members of the Dutch Society of Intensive Care...
February 23, 2018: Vox Sanguinis
https://www.readbyqxmd.com/read/29462165/thromboelastometry-profile-in-critically-ill-patients-a-single-center-retrospective-observational-study
#15
Tomaz Crochemore, Thiago Domingos Corrêa, Marcus D Lance, Cristina Solomon, Ary Serpa Neto, João Carlos de Campos Guerra, Priscila Scolmeister Lellis, Livia Muller Bernz, Natalia Nunes, Cassio Massashi Mancio, Ana Paula Hitomi Yokoyama, Eliézer Silva
BACKGROUND: Transfusion therapy is associated with increased morbidity, mortality and costs. Conventional coagulation tests (CCT) are weak bleeding predictors, poorly reflecting coagulation in vivo. Thromboelastometry (ROTEM) provides early identification of coagulation disorders and can guide transfusion therapy by goals, reducing blood components transfusion. OBJECTIVE: The aim of this study is to describe coagulation profile of critically ill patients using ROTEM and evaluate the association between CCT and thromboelastometry...
2018: PloS One
https://www.readbyqxmd.com/read/29462086/emergency-sternal-intraosseous-access-for-warm-fresh-whole-blood-transfusion-in-damage-control-resuscitation-sternal-intraosseous-access-in-dcr
#16
Christopher Kalhagen Bjerkvig, Theodor Fosse, Torunn Oveland Apelseth, Joar Sivertsen, Hanne Braathen, Håkon Skogrand Eliassen, Anne Berit Guttormsen, Andrew P Cap, Geir Strandenes
BACKGROUND: Intraosseous (IO) vascular access is increasingly used as an emergency tool for achieving access to the systemic circulation in critically ill patients. The role of IO transfusion of blood in Damage Control Resuscitation is however questionable due to possible inadequate flow rate and hemolysis. Some experts claim that IO transfusion is contraindicated. In this study we have challenged this statement by looking at flow rates of autologous fresh whole blood reinfusion and hemolysis using two of the commonly used FDA-approved and CE-marked sternal needles...
February 17, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29392786/day-or-overnight-transfusion-in-critically-ill-patients-does-it-matter
#17
C Aubron, R K Kandane-Rathnayake, N Andrianopoulos, A Westbrook, S Engelbrecht, I Ozolins, M Bailey, L Murray, D J Cooper, E M Wood, Z K McQuilten
BACKGROUND AND OBJECTIVES: The timing of blood administration in critically ill patients is first driven by patients' needs. This study aimed to define the epidemiology and significance of overnight transfusion in critically ill patients. MATERIALS AND METHODS: This is a post hoc analysis of a prospective multicentre observational study including 874 critically ill patients receiving red blood cells, platelets, fresh frozen plasma (FFP) or cryoprecipitate. Characteristics of patients receiving blood only during the day (8 am up until 8 pm) were compared to those receiving blood only overnight (8 pm up until 8 am)...
April 2018: Vox Sanguinis
https://www.readbyqxmd.com/read/29383722/mechanisms-of-red-blood-cell-transfusion-related-immunomodulation
#18
REVIEW
Kenneth E Remy, Mark W Hall, Jill Cholette, Nicole P Juffermans, Kathleen Nicol, Allan Doctor, Neil Blumberg, Philip C Spinella, Philip J Norris, Mary K Dahmer, Jennifer A Muszynski
Red blood cell (RBC) transfusion is common in critically ill, postsurgical, and posttrauma patients in whom both systemic inflammation and immune suppression are associated with adverse outcomes. RBC products contain a multitude of immunomodulatory mediators that interact with and alter immune cell function. These interactions can lead to both proinflammatory and immunosuppressive effects. Defining clinical outcomes related to immunomodulatory effects of RBCs in transfused patients remains a challenge, likely due to complex interactions between individual blood product characteristics and patient-specific risk factors...
March 2018: Transfusion
https://www.readbyqxmd.com/read/29369437/best-practice-in-critical-care-anaemia-in-acute-and-critical-illness
#19
REVIEW
A B Docherty, A F Turgeon, T S Walsh
Anaemia is common in critical illness, and standard treatment is red blood cell (RBC) transfusion, typically using a restrictive transfusion threshold of 70 g L-1 . However, there are subgroups of patients in whom it is biologically plausible that a higher transfusion threshold may be beneficial, namely, acute sepsis, traumatic brain injury and coexisting cardiovascular disease. In this review article, we will discuss the pathophysiology of anaemia, as well as its prevalence and time course. We will explore the limitations of using haemoglobin concentration as a surrogate for oxygen delivery and the concept of the critical haemoglobin concentration...
April 2018: Transfusion Medicine
https://www.readbyqxmd.com/read/29369066/transfusion-practices-in-traumatic-brain-injury
#20
James M East, Julien Viau-Lapointe, Victoria A McCredie
PURPOSE OF REVIEW: The aim of this review is to summarize the recent studies looking at the effects of anemia and red blood cell transfusion in critically-ill patients with traumatic brain injury (TBI), describe the transfusion practice variations observed worldwide, and outline the ongoing trials evaluating restrictive versus liberal transfusion strategies for TBI. RECENT FINDINGS: Anemia is common among critically-ill patients with TBI, it is also thought to exacerbate secondary brain injury, and is associated with an increased risk of poor outcome...
April 2018: Current Opinion in Anaesthesiology
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