scholarly journals Restrictive Transfusion Strategy after Cardiac Surgery

2021 ◽  
Vol 134 (3) ◽  
pp. 370-380 ◽  
Author(s):  
Norddine Zeroual ◽  
Cinderella Blin ◽  
Marine Saour ◽  
Hélène David ◽  
Safa Aouinti ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Controlled Trial ◽  
Randomized Study ◽  
Study Groups ◽  
University Hospital ◽  
Control Group ◽  
Transfusion Strategy ◽  
Restrictive Transfusion ◽  
Icu Stay ◽  
Restrictive Transfusion Strategy

Background Recent guidelines on transfusion in cardiac surgery suggest that hemoglobin might not be the only criterion to trigger transfusion. Central venous oxygen saturation (Svo2), which is related to the balance between tissue oxygen delivery and consumption, may help the decision process of transfusion. We designed a randomized study to test whether central Svo2–guided transfusion could reduce transfusion incidence after cardiac surgery. Methods This single center, single-blinded, randomized controlled trial was conducted on adult patients after cardiac surgery in the intensive care unit (ICU) of a tertiary university hospital. Patients were screened preoperatively and were assigned randomly to two study groups (control or Svo2) if they developed anemia (hemoglobin less than 9 g/dl), without active bleeding, during their ICU stay. Patients were transfused at each anemia episode during their ICU stay except the Svo2 patients who were transfused only if the pretransfusion central Svo2 was less than or equal to 65%. The primary outcome was the proportion of patients transfused in the ICU. The main secondary endpoints were (1) number of erythrocyte units transfused in the ICU and at study discharge, and (2) the proportion of patients transfused at study discharge. Results Among 484 screened patients, 100 were randomized, with 50 in each group. All control patients were transfused in the ICU with a total of 94 transfused erythrocyte units. In the Svo2 group, 34 (68%) patients were transfused (odds ratio, 0.031 [95% CI, 0 to 0.153]; P < 0.001 vs. controls), with a total of 65 erythrocyte units. At study discharge, eight patients of the Svo2 group remained nontransfused and the cumulative count of erythrocyte units was 96 in the Svo2 group and 126 in the control group. Conclusions A restrictive transfusion strategy adjusted with central Svo2 may allow a significant reduction in the incidence of transfusion. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

scholarly journals Red blood cell transfusions worsen the outcomes even in critically ill patients undergoing a restrictive transfusion strategy

2012 ◽  
Vol 130 (2) ◽  
pp. 77-83 ◽  
Author(s):  
João Manoel da Silva Junior ◽  
Ederlon Rezende ◽  
Cristina Prada Amendola ◽  
Rafael Tomita ◽  
Daniele Torres ◽  
...  
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Apache Ii Score ◽  
Transfusion Strategy ◽  
Acute Hemorrhage ◽  
Restrictive Transfusion ◽  
Coronary Syndrome ◽  
Icu Stay ◽  
Restrictive Transfusion Strategy

CONTEXT AND OBJECTIVE: Anemia and blood transfusions are common in intensive care. This study aimed to evaluate epidemiology and outcomes among critically ill patients under a restrictive transfusion strategy. DESIGN AND SETTING: Prospective observational cohort study in an intensive care unit (ICU) at a tertiary hospital. METHODS: All adults admitted to the ICU over a one-year period who remained there for more than 72 hours were included, except those with acute coronary syndrome, ischemic stroke, acute hemorrhage, prior transfusion, pregnant women and Jehovah's Witnesses. The restrictive strategy consisted of transfusion indicated when hemoglobin levels were less than or equal to 7.0 g/dl. RESULTS: The study enrolled 167 patients; the acute physiology and chronic health evaluation II (APACHE II) score was 28.9 ± 6.5. The baseline hemoglobin level was 10.6 ± 2.2 g/dl and on day 28, it was 8.2 ± 1.3 g/dl (P < 0.001). Transfusions were administered to 35% of the patients. In the transfusion group, 61.1% did not survive, versus 48.6% in the non-transfusion group (P = 0.03). Transfusion was an independent risk factor for mortality (P = 0.011; odds ratio, OR = 2.67; 95% confidence interval, CI = 1.25 to 5.69). ICU stay and hospital stay were longer in the transfusion group: 20.0 (3.0-83.0) versus 8.0 (3.0-63.0) days (P < 0,001); and 24.0 (3.0-140.0) versus 14.0 (3.0-80.0) days (P = 0.002), respectively. CONCLUSIONS: In critically ill patients, there was a reduction in hemoglobin with increasing length of ICU stay. Moreover, transfusion was associated with worse prognoses.

scholarly journals Effect of the oXiris membrane on microcirculation after cardiac surgery under cardiopulmonary bypass: study protocol for a randomised controlled trial (OXICARD Study)

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e044424
Author(s):  
Osama Abou-Arab ◽  
Pierre Huette ◽  
Guillaume Haye ◽  
Mathieu Guilbart ◽  
Gilles Touati ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Valve Replacement ◽  
Controlled Trial ◽  
Bypass Graft ◽  
Intervention Group ◽  
University Hospital ◽  
Flow Index ◽  
Control Group ◽  
Registration Number

IntroductionCytokine storm and endotoxin release during cardiac surgery with cardiopulmonary bypass (CPB) have been related to vasoplegic shock and organ dysfunction. We hypothesised that early (during CPB) cytokine adsorption with oXiris membrane for patients at high risk of inflammatory syndrome following cardiac surgery may improve microcirculation, endothelial function and outcomes.Methods and analysisThe Oxicard trial is a prospective, monocentric trial, randomising 70 patients scheduled for cardiac surgery. The inclusion criterion is patients aged more than 18 years old undergoing elective cardiac surgery under CPB with an expected CPB time >90 min (double valve replacement or valve replacement plus coronary arterial bypass graft). Patients will be allocated to the intervention group (n=35) or the control group (n=35). In the intervention group, oXiris membrane will be used on the Prismaflex device (Baxter) at blood pump flow of 450 mL/min during cardiac surgery under CPB. In the control group, cardiac surgery under CPB will be conducted as usual without oXiris membrane. An intention-to-treat analysis will be performed. The primary endpoint will be the microcirculatory flow index measured by sublingual microcirculation device at day 1 following cardiac surgery. The secondary endpoints will be other microcirculation variables at CPB end, 6 hours after CPB, at day 1 and at day 2. We also aim to evaluate the occurrence of major cardiovascular and cerebral events (eg, myocardial infarction, stroke, ischaemic mesenteric, resuscitated cardiac arrest, acute kidney injury) within the first 30 days. Cumulative catecholamine use, intensive care unit length of stay, endothelium glycocalyx shedding parameters (syndecan-1, heparan-sulfate and hyaluronic acid), inflammatory cytokines (tumour necrosis factor (TNF) alpha, interleukin 1 (IL1) beta, IL 10, IL 6, lipopolysaccharide, endothelin) and endothelial permeability biomarkers (angiopoietin 1, angiopoietin 2, Tie2 soluble receptor and Vascular Endothelial Growth Factor (VEGF) will also be evaluated.Ethics and disseminationEthical approval has been obtained from the Institutional Review Board of the University Hospital of Amiens (registration number ID RDB: 2019-A02437-50 in February 2020). Results of the study will be disseminated via peer-reviewed publications and presentations at national and international conferences.Trial registration numberNCT04201119.

A STUDY ON THE VARIATION IN CA 72-4 LEVELS OF THE GASTRIC CANCER’S PATIENTS BEFORE AND AFTER SURGERY TREATMENT

2011 ◽  
pp. 81-87
Author(s):  
Thi Thu Huong Hoang ◽  
Minh Vuong Nguyen
Keyword(s):  
Gastric Cancer ◽  
Study Groups ◽  
University Hospital ◽  
Control Group ◽  
Central Hospital ◽  
Before And After

Objectives: Studying on the variation in CA 72-4 levels of the gastric cancer’s patients before and after 10 days and 30 days surgery treatment. Materials and methods: The studying group included 42 gastric cancer’s patients who were examinated and treated in cancerology service of Hue University Hospital and gastroenterology service of Hue Central Hospital. The control group included 30 healthy normal examinated at Hue University Hospital. The study groups were clinical, endoscopic anatopathologic examination diagnosed with gastric cancer and quantitative levels of CA 72-4 in three times points: before surgerying, after surgerying 10 days and 30 days postoperatively. Rerults: The concentration of CA 72-4 in gastric cancer’s patients was 10.06 ± 16.49 U/ml. Clearly higher than the control group 1.2 ± 0.4 U/ml(p <0.01). The rate increased levels of CA 72-4 in gastric cancer’s patients before surgerying was 27.5% and the control group was 0%. After 10 days of surgery, CA 72-4 level was 5.56 ± 8.55 U/ml; 82.5% of patients have reduced levels of CA 72-4 and 17.5% no changes; there are 0% increased cases. After 30 days of surgery, CA 72-4 level was 3.79 ± 6,52 U/ml. CA 72-4 level 10 days after surgering have decreased significantly compared to before surgery (p < 0.05) and 30 days after surgery have decreased significantly compared to after 10 days (p < 0.05). 30 days postoperatively, 90% patients had reduced levels of CA 72-4, 10% no changes, no patient had increased levels of CA 72-4 and no patient be relapsed after 30 days of treatment. Conclusions: CA 72-4 concentrations before surgerying increased 27.5%, after surgery 10 days and 30 days reduced step by step, no case have increased CA 72-4 levels, no case relapsed after 30 days.

scholarly journals Restrictive transfusion strategy for critically injured patients (RESTRIC) trial: a study protocol for a cluster-randomised, crossover non-inferiority trial

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e037238
Author(s):  
Mineji Hayakawa ◽  
Takashi Tagami ◽  
Hiroaki IIjima ◽  
Daisuke Kudo ◽  
Kazuhiko Sekine ◽  
...  
Keyword(s):  
Emergency Department ◽  
Severe Bleeding ◽  
Transfusion Strategy ◽  
Ethical Guidelines ◽  
Restrictive Transfusion ◽  
Cluster Randomised ◽  
Transfusion Requirements ◽  
Injured Patients ◽  
Restrictive Transfusion Strategy ◽  
Rbc Transfusion

IntroductionResuscitation using blood products is critical during the acute postinjury period. However, the optimal target haemoglobin (Hb) levels have not been adequately investigated. With the restrictive transfusion strategy for critically injured patients (RESTRIC) trial, we aim to compare the restrictive and liberal red blood cell (RBC) transfusion strategies.Methods and analysisThis is a cluster-randomised, crossover, non-inferiority trial of patients with severe trauma at 22 hospitals that have been randomised in a 1:1 ratio based on the use of a restrictive or liberal transfusion strategy with target Hb levels of 70–90 or 100–120 g/L, respectively, during the first year. Subsequently, after 1-month washout period, another transfusion strategy will be applied for an additional year. RBC transfusion requirements are usually unclear on arrival at the emergency department. Therefore, patients with severe bleeding, which could lead to haemorrhagic shock, will be included in the trial based on the attending physician’s judgement. Each RBC transfusion strategy will be applied until 7 days postadmission to the hospital or discharge from the intensive care unit. The outcomes measured will include the 28-day survival rate after arrival at the emergency department (primary), the cumulative amount of blood transfused, event-free days and frequency of transfusion-associated lung injury and organ failure (secondary). Demonstration of the non-inferiority of restrictive transfusion will emphasise its clinical advantages.Ethics and disseminationThe trial will be performed according to the Japanese and International Ethical guidelines. It has been approved by the Ethics Committee of each participating hospital and The Japanese Association for the Surgery of Trauma (JAST). Written informed consent will be obtained from all patients or their representatives. The results of the trial will be disseminated to the participating hospitals and board-certified educational institutions of JAST, submitted to peer-reviewed journals for publication, and presented at congresses.Trial registration numberUMIN Clinical Trials Registry; UMIN000034405. Registered 8 October 2018.

scholarly journals Restrictive Transfusion Strategy Is More Effective in Massive Burns: Results of the TRIBE Multicenter Prospective Randomized Trial

2019 ◽  
Vol 184 (Supplement_1) ◽  
pp. 11-15 ◽  
Author(s):  
Tina L Palmieri ◽  
James H Holmes ◽  
Brett Arnoldo ◽  
Michael Peck ◽  
Amalia Cochran ◽  
...  
Keyword(s):  
Wound Healing ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Inhalation Injury ◽  
Transfusion Strategy ◽  
Restrictive Transfusion ◽  
Blood Utilization ◽  
Outcome Differences ◽  
Total Body ◽  
Restrictive Transfusion Strategy

Abstract Objectives Studies suggest that a restrictive transfusion strategy is safe in burns, yet the efficacy of a restrictive transfusion policy in massive burn injury is uncertain. Our objective: compare outcomes between massive burn (≥60% total body surface area (TBSA) burn) and major (20–59% TBSA) burn using a restrictive or a liberal blood transfusion strategy. Methods Patients with burns ≥20% were block randomized by age and TBSA to a restrictive (transfuse hemoglobin &lt;7 g/dL) or liberal (transfuse hemoglobin &lt;10 g/dL) strategy throughout hospitalization. Data collected included demographics, infections, transfusions, and outcomes. Results Three hundred and forty-five patients received 7,054 units blood, 2,886 in massive and 4,168 in restrictive. Patients were similar in age, TBSA, and inhalation injury. The restrictive group received less blood (45.57 ± 47.63 vs. 77.16 ± 55.0, p &lt; 0.03 massive; 11.0 ± 16.70 vs. 16.78 ± 17.39, p &lt; 0.001) major). In massive burn, the restrictive group had fewer ventilator days (p &lt; 0.05). Median ICU days and LOS were lower in the restrictive group; wound healing, mortality, and infection did not differ. No significant outcome differences occurred in the major (20–59%) group (p &gt; 0.05). Conclusions: A restrictive transfusion strategy may be beneficial in massive burns in reducing ventilator days, ICU days and blood utilization, but does not decrease infection, mortality, hospital LOS or wound healing.

scholarly journals The Use of Telehealth Technology in Assessing the Accuracy of Self-Reported Weight and the Impact of a Daily Immediate-Feedback Intervention among Obese Employees

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Nicolaas P. Pronk ◽  
A. Lauren Crain ◽  
Jeffrey J. VanWormer ◽  
Brian C. Martinson ◽  
Jackie L. Boucher ◽  
...  
Keyword(s):  
Body Weight ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Controlled Trial ◽  
Intervention Group ◽  
Study Groups ◽  
Outcome Variable ◽  
Control Group ◽  
Immediate Feedback ◽  
The Impact

Objective.To determine the accuracy of self-reported body weight prior to and following a weight loss intervention including daily self-weighing among obese employees.Methods.As part of a 6-month randomized controlled trial including a no-treatment control group, an intervention group received a series of coaching calls, daily self-weighing, and interactive telemonitoring. The primary outcome variable was the absolute discrepancy between self-reported and measured body weight at baseline and at 6 months. We used general linear mixed model regression to estimate changes and differences between study groups over time.Results.At baseline, study participants underreported their weight by an average of 2.06 (se=0.33) lbs. The intervention group self-reported a smaller absolute body weight discrepancy at followup than the control group.Conclusions.The discrepancy between self-reported and measured body weight appears to be relatively small, may be improved through daily self-monitoring using immediate-feedback telehealth technology, and negligibly impacts change in body weight.

scholarly journals BLOOD TRANSFUSION IN CARDIAC SURGERY- NEED TO FOLLOW BASICS!

2020 ◽  
Vol 7 (3) ◽  
Keyword(s):  
Cardiac Surgery ◽  
Blood Transfusion ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Red Blood Cell Transfusion ◽  
Transfusion Strategy ◽  
Transfusion Threshold ◽  
Restrictive Transfusion ◽  
Conflicting Evidence ◽  
American Society

More and more data is coming in recent times about hazards of blood transfusion. In a landmark TRICC1 trial Euvolemic patients in the intensive care unit (ICU) with Hb<9 g/dl were randomized to a restrictive transfusion strategy for transfusion of PRBCs (transfused if Hb<7 g/dl to maintain Hb between 7 and 9 g/dl) or a liberal strategy (transfused if Hb<10 g/dl to maintain Hb 10-12 g/dl). Mortality was similar in both groups, indicating that liberal transfusions were not beneficial. An Updated Report by the American Society of AnaesthesiologistsTask Force on Perioperative Blood Management tells us restrictive red blood cell transfusion strategy may be safely used to reduce transfusion administration. It further states that The determination of whether hemoglobin concentrations between 6 and 10 g/dl justify or require red blood cell transfusion should be based on potential or actual on going bleeding (rate and magnitude), intravascular volume status, signs of organ ischemia, and adequacy of cardiopulmonary reserve. Should we extrapolate these guidelines in Cardiac surgery? TRACS2 trial concluded that among patients undergoing cardiac surgery, the use of a restrictive perioperative transfusion strategy compared with a more liberal strategy resulted in noninferior rates of the combined outcome of 30-day all-cause mortality and severe morbidity.They advocated use of restrictive strategy, but 5 years later, the authors 3concluded that A restrictive transfusion threshold after cardiac surgery was not superior to a liberal threshold with respect to morbidity or health care costs. With this conflicting evidence, by which way anaesthesiologist to go?

scholarly journals PHARMACOLOGICAL AUGMENTATION OF LUNG RECRUITMENT EFFECTS LN THE THERAPY OF ACUTE RESPIRATORY DISTRESSSYNDROME AFTER CARDIAC SURGERY

2015 ◽  
Vol 7 (1) ◽  
pp. 7-14
Author(s):  
A E Bautin
Keyword(s):  
Cardiac Surgery ◽  
Recruitment Maneuver ◽  
Randomized Study ◽  
Lung Recruitment ◽  
Respiratory Support ◽  
Icu Stay ◽  
Combined Application ◽  
Significant Difference ◽  
Surfactant Administration ◽  
Endobronchial Administration

The aim. To estimate efficacious of combined application of lung recruitment maneuver (LR) and surfactant administration for the treatment of ARDS after cardiac surgery. Materials and methods. 33 cardiac surgery patients with ARDS were included in to prospective, controlled non-randomized study. LR technique was used in 14 patients, who were included into the "LR" group. In 19 cases LR were combined with endobronchial administration of surfactant (Surfactant-BL, ”Biosurf” Russia), these patients were included into the "LR and surfactant" group. Results. Significant difference from baseline FiO 2 observed after 12 h in "LR and surfactant" group and after 24 h in "LR" group. Significant decrease from the baseline PEEP was observed after 48 h in "LR and surfactant" group and after 72 h in "LR" group. The duration of respiratory support was shorter in the "LR and surfactant" group: 87,5 ± 35,3 h vs 175,3 ± 52,5, p <0,001. There was significant difference in the incidences of ventilator-associated pneumonia (VAP): 10.5% in the "LR and surfactant" group and 42.9% in the "LR" group, p <0,05. Furthermore, we found significant difference in the ICU stay period between groups: 132,5 ± 42,2 h in the "LR and surfactant" group vs 282,5 ± 110,2 h in the "LR" group, p <0,01. There was no significant difference between two groups In mortality rate: 3 (15.8%) in the "LR and surfactant" group and 3 (21.4%) in the "LR" group. Conclusions. The combination of LR and surfactant administration decrease the time of respiratory support and ICU stay, reduce the risk of VAP.

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