tailieunhanh - Báo cáo khoa học: " Blood management in intensive care medicine: CRIT and ABC — what can we learn"

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: Blood management in intensive care medicine: CRIT and ABC — what can we learn? | Available online http content 8 2 89 Commentary Blood management in intensive care medicine CRIT and ABC -what can we learn Donat R Spahn1 and Carlos Marcucci2 1 Professor and Chairman Department of Anesthesiology University Hospital Lausanne Switzerland 2Staff Anesthesiologist Department of Anesthesiology University Hospital Lausanne Switzerland Correspondence Donat R Spahn Published online 27 February 2004 Critical Care 2004 8 89-90 DOI cc2833 This article is online at http content 8 2 89 2004 BioMed Central Ltd Print ISSN 1364-8535 Online ISSN 1466-609X Abstract In 284 US intensive care units the CRIT study Anemia and blood transfusion in the critically ill -Current clinical practice in the United States assessed allogeneic red blood cell RBC transfusion and outcome in 4892 patients. As in the former European ABC study Anemia and blood transfusion in the critically ill the mean pretransfusion hemoglobin was approximately g dl and RBC transfusions were independently associated with an increased mortality. These studies were purely observational and therefore despite the finest statistical models indicating that RBC transfusions were independently associated with a higher mortality it remains possible that this adverse outcome is not due to a harmful effect of RBC transfusion in itself but merely reflects the fact that transfused patients were sicker to start with. The definitive call is still out but one mechanism by which RBC transfusion might be harmful now appears less likely namely storage lesion. In the CRIT study mortality was not increased in patients receiving old RBCs 14days stored versus fresh RBCs. The effect of leukoreduction could not be assessed since mainly nonleukoreduced RBCs were transfused. The evidence is mounting however that RBC transfusions are efficacious only when oxygen delivery is compromised. What can be done to diminish the use of RBC transfusions its costs and side .