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Báo cáo y học: "Red blood cell transfusion in patients with subarachnoid hemorrhage: a multidisciplinary North American survey"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Red blood cell transfusion in patients with subarachnoid hemorrhage: a multidisciplinary North American survey. | Kramer et al. Critical Care 2011 15 R30 http ccforum.eom content 15 1 R30 KS CRITICAL CARE RESEARCH Open Access Red blood cell transfusion in patients with subarachnoid hemorrhage a multidisciplinary North American survey I I KrsìrYicir K ich d l l Oirinndr2 I Cl isirci 3 ĂnHrotA K l INHirlafh4 I rrr H D J 1atR I cd5 Potor m I d Dr ll IV6 Andreas H Mdmei Michael N DUHiger Jose I Suarez Andrew M INdlUeCM Loch R Macdonald Peter D Le Roux Abstract Introduction Anemld Is associated with poor outcomes In patients with aneurysmal subarachnoid hemorrhage SAH . It remains unclear whether this association can be modified with more aggressive use of red blood cell RBC transfusions. The degree to which restrictive thresholds have been adopted in neurocritical care patients remains unknown. Methods We performed a survey of North American academic neurointensivists vascular neurosurgeons and multidisciplinary intensivists who regularly care for patients with SAH to determine hemoglobin Hb concentrations which commonly trigger a decision to initiate transfusion. We also assessed minimum and maximum acceptable Hb goals in the context of a clinical trial and how decision-making is influenced by advanced neurological monitoring clinician characteristics and patient-specific factors. Results The survey was sent to 531 clinicians of whom 282 53 responded. In a hypothetical patient with highgrade SAH WFNS 4 the mean Hb concentration at which clinicians administered RBCs was 8.19 g dL 95 CI 8.07 to 8.30 g dL . Transfusion practices were comparatively more restrictive in patients with low-grade SAH mean Hb 7.85 g dL 95 CI 7.73 to 7.97 g dL P 0.0001 and more liberal in patients with delayed cerebral ischemia DCI mean Hb 8.58 g dL 95 CI 8.45 to 8.72 g dL P 0.0001 . In each setting there was a broad range of opinions. The majority of respondents expressed a willingness to study a restrictive threshold of 8 g dL 92 and a liberal goal of 10 g dl 75 in both cases the preferred transfusion .