tailieunhanh - Báo cáo y học: "Debate: Transfusing to normal hemoglobin levels improves outcome"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học General Psychiatry cung cấp cho các bạn kiến thức về ngành y đề tài: Debate: Transfusing to normal hemoglobin levels improves outcome. | Available online http content 5 2 064 Commentary Debate Transfusing to normal hemoglobin levels improves outcome Marilyn T Haupt Oregon Health Sciences University Portland Oregon USA Correspondence Oregon Health Sciences University Critical Care Services 3181 SW Sam Jackson Park Road Portland OR 97201 USA. Tel 1 503 494 0189 fax 1 503 494 0334 e-mail hauptm@ Received 21 February 2001 Accepted 28 February 2001 Published 7 March 2001 Critical Care 2001 5 64-66 2001 BioMed Central Ltd Print ISSN 1364-8535 Online ISSN 1466-609X Abstract Red cells are uniquely designed to transport oxygen and facilitate oxygen uptake by systemic tissues. Blood transfusions are thus logical therapeutic choices in patients who exhibit signs of oxygen debt. A small number of studies that have addressed patients with metabolic or physiologic signs of oxygen debt or regional ischaemia suggest that liberal blood transfusion strategies improve outcome. Therefore armed with an understanding of the variety of clinical presentations characterising oxygen debt as well as an appreciation of the risks involved blood transfusions should be considered in all critically ill patients. This includes the consideration of liberalized hemoglobin triggers and hemoglobin thresholds in normal ranges. Keywords blood transfusion hematocrit hemoglobin ischemia oxygen debt oxygen utilisation Introduction The ability of red blood cells to facilitate the journey of oxygen from the atmosphere to the mitochondrion has been repeatedly demonstrated in a vast literature of mammalian physiology. The physical characteristics of red cells and the properties of their contents allow these cells to increase the solubility of plasma for oxygen by about 30fold. In addition the affinity of red cells for oxygen is modulated by regional acid-base conditions to favor oxygen loading at the pulmonary alveolar capillary interface as well as unloading at the tissue level. At present there are no clinically available

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