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首页> 外文期刊>The American Journal of Surgery >Restrictive red blood cell transfusion: not just for the stable intensive care unit patient.
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Restrictive red blood cell transfusion: not just for the stable intensive care unit patient.

机译：限制性红细胞输注：不仅限于稳定的重症监护病房患者。

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BACKGROUND: Multiple studies report that patients receiving red blood cell (RBC) transfusion in the intensive care unit (ICU) are more likely to experience complications. Despite these findings, surgical patients are frequently transfused for operative procedures, trauma, and burns. We hypothesized that a RBC transfusion guideline would safely decrease our use of RBC transfusions in the ICU and lower the hematocrit at which our trauma and burn patients were transfused, both in the stable and symptomatic patient. METHODS: For each episode of RBC transfusion, the pretransfusion vital signs and reasons for transfusion were recorded prospectively from August 2003 through April 2004. Before institution of the transfusion guideline, which stressed withholding transfusion for hematocrit over 23 in asymptomatic patients, intensive education of all caregivers occurred. Data from all transfusions during 2005 were also reviewed for long-term compliance with the guideline. RESULTS: Eighty-two of 316 ICU patients (26%) had 315 RBC transfusion events during the initial study period. Mean transfusion hematocrits decreased from 26.6 +/- 4.7 to 23.9 +/- 2.6 (P .0003) for all patients. For the follow-up period in 2005, 94 of 523 patients (18%) were transfused in the ICU at a mean transfusion hematocrit of 24.1 for symptomatic (P .0001) and 22.5 for asymptomatic patients (P .0001). Low hematocrit was the most frequently cited reason for transfusion for all patients in the first part of the study, whereas hemodynamic instability (n = 91 events) and perioperative losses (n = 49 events) ranked highest for symptomatic patients. CONCLUSION: A transfusion guideline accompanied by intensive education is effective in reducing RBC transfusions in a trauma-burn ICU. A lower hematocrit was well tolerated in both the symptomatic and asymptomatic groups of surgical patients. With education and follow-up, the changes in transfusion practices were durable and affected transfusion practices for both asymptomatic and symptomatic patients.
机译：背景：多项研究报告说，在重症监护病房（ICU）接受红细胞（RBC）输血的患者更有可能出现并发症。尽管有这些发现，外科手术患者经常因手术，外伤和烧伤而被输血。我们假设，在稳定和有症状的患者中，RBC输血指南将安全地减少我们在ICU中对RBC输血的使用，并降低输注创伤和烧伤患者的血细胞比容。方法：从2003年8月至2004年4月，对每一次RBC输血事件均预先记录了输血前的生命体征和输血原因。在制定输血指南之前，该指南强调对无症状患者中的超过23名患者禁用血细胞比容输血，对所有患者进行强化教育照顾者发生了。还对2005年期间所有输血的数据进行了审查，以确保长期遵守该准则。结果：316 ICU患者中的八十二（26％）在最初的研究期间有315 RBC输血事件。所有患者的平均输血血细胞比容从26.6 +/- 4.7降至23.9 +/- 2.6（P <.0003）。在2005年的随访期间，在ICU中输注了523例患者中的94例（18％），有症状的平均输血比容为24.1（P <.0001），无症状的平均输血比容为22.5（P <.0001）。在研究的第一部分中，低血细胞比容是所有患者最常被提及的输血原因，而有症状患者的血流动力学不稳定（n = 91事件）和围手术期丢失（n = 49事件）是最高的。结论：输血指导方针与强化教育相结合，可有效减少烧伤重症监护病房中的红细胞输血。有症状和无症状的手术患者均对较低的血细胞比容有良好的耐受性。通过教育和跟进，无症状患者和有症状患者的输血方法变化是持久的，并影响了输血方法。

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