Intraoperative Bleeding Management: An Updating Literature Review: Review Article

Background: Intraoperative bleeding remains a major complication during and after surgery, leading to increased morbidity and mortality. Several influences determine the complex causes of bleeding in surgical patients. About 75 to 90% of early intraoperative and postoperative bleeding is due to technical factors. In some cases, however, acquired or congenital coagulopathies can stimulate, if not directly cause, surgical bleeding. Objectives: This paper aims to overview etiology, causes, diagnosis, and updated management of intraoperative bleeding. Methods: The review article ran from July 1, 2021 to October 31, 2021. We searched articles on etiology, causes, and treatments published in English worldwide in the Medline, EBSCO and PubMed databases. No software was used to analyze the data. Team members reviewed the data to determine initial results. Results: All patients scheduled for elective surgery should be screened for possible hemostatic defects using tests, and, if necessary, laboratory tests. Treatment of intraoperative bleeding consists of identifying patients at risk and understanding the effect of surgery on hemostasis. For patients at high risk of bleeding, a pre-operative meeting with a multidisciplinary team (anesthesiologist, surgeon, hematologist, radiologist) can discuss the correct surgical procedure. Conclusion: Technical variables account for 75-90% of initial intraoperative and postoperative bleeding. However, in other cases it is associated with acquired or congenital coagulation disorders. All patients scheduled for elective surgery should be checked for problems with hemostasis. Treatment of intraoperative bleeding involves identifying those at risk and understanding the effect of surgery on hemostasis.

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The Papworth Bleeding Risk Score: a stratification scheme for identifying cardiac surgery patients at risk of excessive early postoperative bleeding

European Journal of Cardio-Thoracic Surgery ◽

10.1016/j.ejcts.2010.10.003 ◽

2011 ◽

Vol 39 (6) ◽

pp. 924-930 ◽

Cited By ~ 75

Author(s):

Alain Vuylsteke ◽

Christina Pagel ◽

Caroline Gerrard ◽

Brian Reddy ◽

Samer Nashef ◽

...

Keyword(s):

At Risk ◽

Cardiac Surgery ◽

Risk Score ◽

Postoperative Bleeding ◽

Bleeding Risk ◽

Patients At Risk

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Coagulopathy in the Intensive Care Unit

Critical Care Nurse ◽

10.4037/ccn2012164 ◽

2012 ◽

Vol 32 (5) ◽

pp. 48-59 ◽

Cited By ~ 4

Author(s):

Diane K. Dressler

Keyword(s):

At Risk ◽

Potential Problem ◽

Postoperative Bleeding ◽

Clinical Manifestations ◽

Conservation Strategies ◽

Trauma Patients ◽

Transfusion Therapy ◽

Complex Process ◽

Patients At Risk ◽

Complex Surgery

Coagulopathy is a potential problem for many critically ill patients, placing them at risk for hemorrhage. Critical illness activates both hemostasis and the inflammatory-immune system, leading to both physiological and potentially pathophysiological responses. Following complex surgery or trauma, patients are at high risk for development of problems such as thrombocytopenia and postoperative bleeding, challenging nurses to recognize and manage these problems. The clinical manifestations of coagulopathy may be obvious or occult, and correlation with the coagulation panel results is a complex process. Transfusion of blood and components has long been an important part of patient management, but is known to put patients at risk for transfusion-related complications. Current clinical practice guidelines provide blood conservation strategies and criteria to guide decisions on transfusion therapy.

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Patient and caregiver perspectives on a tool to identify undiagnosed dementia: A qualitative study

10.21203/rs.3.rs-513568/v1 ◽

2021 ◽

Author(s):

Lorella Palazzo ◽

Clarissa Hsu ◽

Deborah Barnes ◽

Marlaine Figueroa-Gray ◽

Mikael Anne Greenwood-Hickman ◽

...

Keyword(s):

At Risk ◽

Treatment Options ◽

Improve Patient Care ◽

Dementia Diagnosis ◽

Kaiser Permanente ◽

Team Members ◽

Dementia Risk ◽

Patients At Risk ◽

Improve Patient

Abstract BACKGROUND Early detection of dementia may improve patient care and quality of life, yet as many as half of patients are undiagnosed. Electronic health record (EHR) data could potentially be used to help to identify patients at risk of having undiagnosed dementia who could be targeted for outreach and assessment, but acceptability to patients and caregivers is unknown. METHOD We conducted five focus groups at Kaiser Permanente Washington, an integrated healthcare system in Washington State, to explore feelings about timing of dementia diagnosis, use of EHR-33 based tools to predict risk of undiagnosed dementia, and communication about risk. Two team members analyzed transcripts using inductive thematic coding. RESULTS Participant groups included: patients with dementia or mild cognitive impairment, patients with neither diagnosis, and caregivers. People who were non-white or Hispanic were oversampled. Forty patients and caregivers (63% women; 59% non-white/Hispanic) participated in focus 39 groups. Participants supported early diagnosis, describing benefits such as time to adjust to the disease, plan, involve caregivers, and identify resources. They also acknowledged the possible psychosocial toll of receiving the diagnosis. Participants also supported use of an EHR-based tool, but some worried about accuracy and privacy. Participants emphasized that information about dementia risk should be communicated thoughtfully by a trusted provider and should include advice about prognosis, treatment options and other resources. CONCLUSION Overall, patients and caregivers supported using EHR-based tools to help identify patients at risk of having undiagnosed dementia. Such tools must be implemented carefully to address concerns and ensure patients and caregivers are adequately supported.

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