scholarly journals Influence of tissue perfusion on the outcome of high-risk surgical patients needing blood transfusion

Critical Care ◽  
2008 ◽  
Vol 12 (S2) ◽  
Author(s):  
JM Silva ◽  
DO Toledo ◽  
A Gulinelli ◽  
FG Correa ◽  
KR Genga ◽  
...  
Keyword(s):  
High Risk ◽  
Blood Transfusion ◽  
Tissue Perfusion ◽  
Surgical Patients

Absence of Beneficial Effect of Acute Normovolemic Hemodilution Combined with Aprotinin on Allogeneic Blood Transfusion Requirements in Cardiac Surgery

2002 ◽  
Vol 96 (2) ◽  
pp. 276-282 ◽  
Author(s):  
Laurent Höhn ◽  
Alexandre Schweizer ◽  
Marc Licker ◽  
Denis R. Morel
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
High Risk ◽  
Blood Transfusion ◽  
Allogeneic Blood ◽  
Surgical Patients ◽  
Control Group ◽  
Acute Normovolemic Hemodilution ◽  
Normovolemic Hemodilution ◽  
Normal Cardiac Function

Background The efficacy of acute normovolemic hemodilution (ANH) in decreasing allogeneic blood requirements remains controversial during cardiac surgery. Methods In a prospective, randomized study, 80 adult cardiac surgical patients with normal cardiac function and no high risk of ischemic complications were subjected either to ANH, from a mean hematocrit of 43% to 28%, or to a control group. Aprotinin and intraoperative blood cell salvage were used in both groups. Blood (autologous or allogeneic) was transfused when the hematocrit was less than 17% during cardiopulmonary bypass, less than 25% after cardiopulmonary bypass, or whenever clinically indicated. Results The amount of whole blood collected during ANH ranged from 10 to 40% of the patients' estimated blood volume. Intraoperative and postoperative blood losses were not different between control and ANH patients (total blood loss, control: 1,411 +/- 570 ml, n = 41; ANH: 1,326 +/- 509 ml, n = 36). Allogeneic blood was given in 29% of control patients (median, 2; range, 1-3 units of packed erythrocytes) and in 33% of ANH patients (median, 2; range, 1-5 units of packed erythrocytes; P = 0.219). Preoperative and postoperative platelet count, prothrombin time, and partial thromboplastin time were similar between groups. Perioperative morbidity and mortality were not different in both groups, and similar hematocrit values were observed at hospital discharge (33.7 +/- 3.9% in the control group and 32.6 +/- 3.7% in the ANH group; nonsignificant) Conclusions Hemodilution is not an effective means to lower the risk of allogeneic blood transfusion in elective cardiac surgical patients with normal cardiac function and in the absence of high risk for coronary ischemia, provided standard intraoperative cell saving and high-dose aprotinin are used.

Maintaining Tissue Perfusion in High-Risk Surgical Patients

2011 ◽  
Vol 112 (6) ◽  
pp. 1384-1391 ◽  
Author(s):  
Sanderland T. Gurgel ◽  
Paulo do Nascimento
Keyword(s):  
High Risk ◽  
Tissue Perfusion ◽  
Surgical Patients

Influence of tissue perfusion on the outcome of surgical patients who need blood transfusion

2009 ◽  
Vol 24 (3) ◽  
pp. 426-434 ◽  
Author(s):  
João Manoel Silva ◽  
Diogo Oliveira Toledo ◽  
Danielle Dourado Magalhães ◽  
Marco Aurélio Cícero Pinto ◽  
André Gulinelli ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Tissue Perfusion ◽  
Surgical Patients

Maintaining Tissue Perfusion in High-Risk Surgical Patients

2012 ◽  
Vol 56 (1) ◽  
pp. 13-14
Author(s):  
Sanderland T. Gurgel ◽  
Paulo do Nascimento
Keyword(s):  
High Risk ◽  
Tissue Perfusion ◽  
Surgical Patients

Quality management in the prophylaxis of venous thrombembolism - Results of a survey including 464 medical and surgical patients

VASA ◽  
2011 ◽  
Vol 40 (2) ◽  
pp. 123-130
Author(s):  
Klein-Weigel ◽  
Richter ◽  
Arendt ◽  
Gerdsen ◽  
Härtwig ◽  
...  
Keyword(s):  
Renal Function ◽  
High Risk ◽  
Quality Management ◽  
High Risk Group ◽  
Surgical Patients ◽  
Medical Patients ◽  
Risk Status ◽  
Vte Prophylaxis ◽  
Safety Concerns

Background: We surveyed the quality of risk stratification politics and monitored the rate of entries to our company-wide protocol for venous thrombembolism (VTE) prophylaxis in order to identify safety concerns. Patients and methods: Audit in 464 medical and surgical patients to evaluate quality of VTE prophylaxis. Results: Patients were classified as low 146 (31 %), medium 101 (22 %), and high risk cases 217 (47 %). Of these 262 (56.5 %) were treated according to their risk status and in accordance with our protocol, while 9 more patients were treated according to their risk status but off-protocol. Overtreatment was identified in 73 (15.7 %), undertreatment in 120 (25,9 %) of all patients. The rate of incorrect prophylaxis was significantly different between the risk categories, with more patients of the high-risk group receiving inadequate medical prophylaxis (data not shown; p = 0.038). Renal function was analyzed in 392 (84.5 %) patients. In those patients with known renal function 26 (6.6 %) received improper medical prophylaxis. If cases were added in whom prophylaxis was started without previous creatinine control, renal function was not correctly taken into account in 49 (10.6 %) of all patients. Moreover, deterioration of renal function was not excluded within one week in 78 patients (16.8 %) and blood count was not re-checked in 45 (9.7 %) of all patients after one week. There were more overtreatments in surgical (n = 53/278) and more undertreatments in medical patients (n = 54/186) (p = 0.04). Surgeons neglected renal function and blood controls significantly more often than medical doctors (p-values for both < 0.05). Conclusions: We found a low adherence with our protocol and substantial over- and undertreatment in VTE prophylaxis. Besides, we identified disregarding of renal function and safety laboratory examinations as additional safety concerns. To identify safety problems associated with medical VTE prophylaxis and “hot spots” quality management-audits proved to be valuable instruments.

Closure of median sternotomy by the Sternal Talon®-system in high-risk cardiac surgical patients

2010 ◽  
Vol 58 (S 01) ◽  
Author(s):  
M Müller ◽  
C Heilmann ◽  
S Sorg ◽  
S Kueri ◽  
M Thoma ◽  
...  
Keyword(s):  
High Risk ◽  
Median Sternotomy ◽  
Surgical Patients
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