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[PMID]:29261655
[Au] Autor:Khan KS; Moore PAS; Wilson MJ; Hooper R; Allard S; Wrench I; Beresford L; Roberts TE; McLoughlin C; Geoghegan J; Daniels JP; Catling S; Clark VA; Ayuk P; Robson S; Gao-Smith F; Hogg M; Lanz D; Dodds J; SALVO study group
[Ad] Endereço:Women's Health Research Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom.
[Ti] Título:Cell salvage and donor blood transfusion during cesarean section: A pragmatic, multicentre randomised controlled trial (SALVO).
[So] Source:PLoS Med;14(12):e1002471, 2017 Dec.
[Is] ISSN:1549-1676
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Excessive haemorrhage at cesarean section requires donor (allogeneic) blood transfusion. Cell salvage may reduce this requirement. METHODS AND FINDINGS: We conducted a pragmatic randomised controlled trial (at 26 obstetric units; participants recruited from 4 June 2013 to 17 April 2016) of routine cell salvage use (intervention) versus current standard of care without routine salvage use (control) in cesarean section among women at risk of haemorrhage. Randomisation was stratified, using random permuted blocks of variable sizes. In an intention-to-treat analysis, we used multivariable models, adjusting for stratification variables and prognostic factors identified a priori, to compare rates of donor blood transfusion (primary outcome) and fetomaternal haemorrhage ≥2 ml in RhD-negative women with RhD-positive babies (a secondary outcome) between groups. Among 3,028 women randomised (2,990 analysed), 95.6% of 1,498 assigned to intervention had cell salvage deployed (50.8% had salvaged blood returned; mean 259.9 ml) versus 3.9% of 1,492 assigned to control. Donor blood transfusion rate was 3.5% in the control group versus 2.5% in the intervention group (adjusted odds ratio [OR] 0.65, 95% confidence interval [CI] 0.42 to 1.01, p = 0.056; adjusted risk difference -1.03, 95% CI -2.13 to 0.06). In a planned subgroup analysis, the transfusion rate was 4.6% in women assigned to control versus 3.0% in the intervention group among emergency cesareans (adjusted OR 0.58, 95% CI 0.34 to 0.99), whereas it was 2.2% versus 1.8% among elective cesareans (adjusted OR 0.83, 95% CI 0.38 to 1.83) (interaction p = 0.46). No case of amniotic fluid embolism was observed. The rate of fetomaternal haemorrhage was higher with the intervention (10.5% in the control group versus 25.6% in the intervention group, adjusted OR 5.63, 95% CI 1.43 to 22.14, p = 0.013). We are unable to comment on long-term antibody sensitisation effects. CONCLUSIONS: The overall reduction observed in donor blood transfusion associated with the routine use of cell salvage during cesarean section was not statistically significant. TRIAL REGISTRATION: This trial was prospectively registered on ISRCTN as trial number 66118656 and can be viewed on http://www.isrctn.com/ISRCTN66118656.
[Mh] Termos MeSH primário: Perda Sanguínea Cirúrgica/prevenção & controle
Transfusão de Sangue Autóloga/métodos
Cesárea
Recuperação de Sangue Operatório/métodos
[Mh] Termos MeSH secundário: Adulto
Doadores de Sangue
Cesárea/efeitos adversos
Cesárea/métodos
Feminino
Seres Humanos
Planejamento de Assistência ao Paciente
Gravidez
Prognóstico
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171227
[Lr] Data última revisão:
171227
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171221
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pmed.1002471


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[PMID]:28953650
[Au] Autor:Liao XY; Zuo SS; Meng WT; Zhang J; Huang Q; Gou DM
[Ad] Endereço:aDepartment of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi bDepartment of Anesthesiology, Zhengzhou Central Hospital, Zhengzhou, Henan cLaboratory of Stem Cell Biology, State Key Laboratory of Biotherapy dKey Laboratory of Transplant Engineering and Immunology, Ministry of Health, West China Hospital, Sichuan University, Chengdu eDepartment of Anesthesiology, Hospital of Honghuagang District, Zunyi, Guizhou, China.
[Ti] Título:Intraoperative blood salvage may shorten the lifespan of red blood cells within 3 days postoperatively: A pilot study.
[So] Source:Medicine (Baltimore);96(39):e8143, 2017 Sep.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Intraoperative blood salvage (IBS) recovers most lost blood, and is widely used in the clinic. It is unclear why IBS does not reduce long-term postoperative requirements for red blood cells (RBCs), and 1 possibility is that IBS affects RBC lifespan. METHODS: Prospectively enrolled patients who underwent spine, pelvic, or femur surgery not involving allogeneic RBC transfusion were grouped based on whether they received IBS or not. Volumes of blood lost and of RBCs salvaged during surgery were recorded. Total blood cell counts, levels of plasma-free hemoglobin, and CD235a-positive granulocytes were determined perioperatively. RESULTS: Although intraoperative blood loss was higher in the IBS group (n = 45) than in the non-IBS group (n = 52) (P < .001), hemoglobin levels were similar between groups (P = .125) at the end of surgery. Hemoglobin levels increased in non-IBS patients (4 ±â€Š11 g/L), but decreased in IBS patients (-7 ±â€Š12 g/L) over the first 3 postoperative days. Nadir hemoglobin levels after surgery were higher in the non-IBS group (107 ±â€Š12 g/L) than in the IBS group (91 ±â€Š12 g/L). Salvaged RBC volume correlated with hemoglobin decrease (r = 0.422, P = .004). In multivariate analysis, salvaged RBC volume was an independent risk factor for hemoglobin decrease (adjusted odds ratio 1.002, 95% confidence interval 1.001-1.004, P = .008). Flow cytometry showed the numbers of CD235a-positive granulocytes after surgery to be higher in the IBS group than in the non-IBS group (P < .05). CONCLUSION: IBS may shorten the lifespan of RBCs by triggering their engulfment upon re-infusion (China Clinical Trial Registry ChiCTR-OCH-14005140).
[Mh] Termos MeSH primário: Anemia
Transfusão de Sangue Autóloga
Sobrevivência Celular/fisiologia
Eritrócitos/fisiologia
Recuperação de Sangue Operatório
Procedimentos Ortopédicos
Complicações Pós-Operatórias
[Mh] Termos MeSH secundário: Adulto
Anemia/diagnóstico
Anemia/etiologia
Anemia/fisiopatologia
Anemia/prevenção & controle
Perda Sanguínea Cirúrgica/prevenção & controle
Transfusão de Sangue Autóloga/efeitos adversos
Transfusão de Sangue Autóloga/métodos
Volume Sanguíneo/fisiologia
Contagem de Eritrócitos/métodos
Feminino
Hemoglobinas/análise
Seres Humanos
Masculino
Meia-Idade
Recuperação de Sangue Operatório/efeitos adversos
Recuperação de Sangue Operatório/métodos
Procedimentos Ortopédicos/efeitos adversos
Procedimentos Ortopédicos/métodos
Avaliação de Processos e Resultados (Cuidados de Saúde)
Complicações Pós-Operatórias/diagnóstico
Complicações Pós-Operatórias/fisiopatologia
Complicações Pós-Operatórias/prevenção & controle
Estudos Prospectivos
Medição de Risco
Fatores de Risco
Estatística como Assunto
[Pt] Tipo de publicação:CLINICAL STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Hemoglobins)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171016
[Lr] Data última revisão:
171016
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170928
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008143


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[PMID]:28732458
[Au] Autor:Castaño C; Cubells C; Remollo S; García-Sort MR; Terceño M
[Ad] Endereço:1 Interventional Neuroradiology Unit, Hospital Universitario Germans Trias i Pujol, Badalona, Universidad Autónoma de Barcelona, Barcelona, Spain.
[Ti] Título:Use of a complete autologous blood recovery system (the Sorin Xtra® Autotransfusion System) during mechanical thrombectomy of extensive cerebral venous sinus thrombosis.
[So] Source:Interv Neuroradiol;23(5):531-537, 2017 Oct.
[Is] ISSN:2385-2011
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Background The endovascular therapy for cerebral venous sinus thrombosis (CVST) is currently accepted as a second-line treatment for patients who have failed or those in whom systemic anticoagulation is contraindicated or in a subgroup of patients presenting with rapid neurologic deterioration. A number of different mechanical and pharmacologic endovascular strategies have been reported, either as separate or combined approaches. These new catheters and aspiration systems have a high power and vacuum capacity, which carries a risk of anemization of the patient and hypovolemic shock, being necessitating the transfusion of the patient. Material and methods Because of the problems that donor blood transfusion can bring, we describe the use of a Sorin Xtra® Autotransfusion System (ATS). This complete autologous blood recovery system was designed for use in procedures where medium- to high-volume blood loss occurs, such as major surgeries. We have adapted it to recover all the blood aspirated during the mechanical thrombectomy procedures of the dural cerebral venous sinuses, since they are procedures that can cause a significant loss of blood. One advantage to this is the patient receives his or her own blood instead of donor blood, so there is no risk of contracting outside diseases or transfusion reactions. Conclusions This technical note describes a novel and previously unpublished technical approach to CVST that can be immediately applied to clinical practice. It also raises awareness among the interventional neuroradiologist and anesthesiologist communities about novel, potentially lifesaving endovascular treatments in patients with extensive CVST.
[Mh] Termos MeSH primário: Transfusão de Sangue Autóloga/instrumentação
Recuperação de Sangue Operatório/instrumentação
Trombose dos Seios Intracranianos/terapia
Trombectomia/métodos
[Mh] Termos MeSH secundário: Angiografia Cerebral
Terapia Combinada
Traumatismos Craniocerebrais/complicações
Feminino
Seres Humanos
Imagem por Ressonância Magnética
Masculino
Meia-Idade
Trombose dos Seios Intracranianos/diagnóstico por imagem
Trombose dos Seios Intracranianos/etiologia
Tomografia Computadorizada por Raios X
Adulto Jovem
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171108
[Lr] Data última revisão:
171108
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170723
[St] Status:MEDLINE
[do] DOI:10.1177/1591019917720908


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[PMID]:28528916
[Au] Autor:Cybulska P; Goss C; Tew WP; Parameswaran R; Sonoda Y
[Ad] Endereço:Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
[Ti] Título:Indications for and complications of transfusion and the management of gynecologic malignancies.
[So] Source:Gynecol Oncol;146(2):416-426, 2017 Aug.
[Is] ISSN:1095-6859
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Anemia, which is highly prevalent in oncology patients, is one of the most established negative prognostic factors for several gynecologic malignancies. Multiple factors can cause or contribute to the development of anemia in patients with gynecologic cancers; these factors include blood loss (during surgery or directly from the tumor), renal impairment (caused by platinum-based chemotherapy), and marrow dysfunction (from metastases, chemotherapy, and/or radiation therapy). Several peri- and intra-operative strategies can be used to optimize patient management and minimize blood loss related to surgery. Blood transfusions are routinely employed as corrective measures against anemia; however, blood transfusions are one of the most overused healthcare interventions. There are safe and effective evidence-based blood transfusion strategies used in other patient populations that warrant further investigation in the surgical oncology setting. Blood is a valuable healthcare resource, and clinicians can learn to use it more judiciously through knowledge of the potential risks and complications of blood interventions, as well as the ability to properly identify the patients most likely to benefit from such interventions.
[Mh] Termos MeSH primário: Anemia/terapia
Transfusão de Eritrócitos/métodos
Neoplasias dos Genitais Femininos/cirurgia
Hematínicos/uso terapêutico
Hemodiluição/métodos
Recuperação de Sangue Operatório/métodos
Assistência Perioperatória/métodos
[Mh] Termos MeSH secundário: Lesão Pulmonar Aguda/etiologia
Anemia/etiologia
Antifibrinolíticos/uso terapêutico
Perda Sanguínea Cirúrgica/prevenção & controle
Transfusão de Eritrócitos/efeitos adversos
Feminino
Neoplasias dos Genitais Femininos/complicações
Seres Humanos
Imunomodulação
Infecção/etiologia
Ferro/uso terapêutico
Recidiva Local de Neoplasia/epidemiologia
Ácido Tranexâmico/uso terapêutico
Reação Transfusional/etiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Antifibrinolytic Agents); 0 (Hematinics); 6T84R30KC1 (Tranexamic Acid); E1UOL152H7 (Iron)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170727
[Lr] Data última revisão:
170727
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170523
[St] Status:MEDLINE


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[PMID]:28238873
[Au] Autor:Liu JM; Fu BQ; Chen WZ; Chen JW; Huang SH; Liu ZL
[Ad] Endereço:Department of Orthopaedic Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, P. R. China.
[Ti] Título:Cell Salvage Used in Scoliosis Surgery: Is It Really Effective?
[So] Source:World Neurosurg;101:568-576, 2017 May.
[Is] ISSN:1878-8769
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Scoliosis surgery usually is associated with large volume of intraoperative blood loss, and cell salvage is used commonly to filter and retranfusion autologous blood to patients. The efficacy of using cell salvage in scoliosis surgery, however, is still controversial. OBJECTIVE: The purpose of this study is to make clear that intraoperative use of cell salvage is effective to decrease the volume of perioperative allogenic blood transfusion in scoliosis surgery. METHODS: A meta-analysis was conducted to identify the relevant studies from PubMed, Embase, Medline, Cochrane library, and Google scholar until July 2016. All randomized trials and controlled clinical studies comparing the clinical outcomes of using cell salvage versus noncell salvage in scoliosis surgery were retrieved for the meta-analysis. The data were analyzed by RevMan 5.3. RESULTS: A total of 7 studies with 562 patients were included in this meta-analysis. Based on the analysis, the volumes of perioperative and postoperative allogenic red blood cell (RBC) transfusion in cell salvage group were significantly less than those in control group (P = 0.04 and P = 0.01); however, no significant difference was detected in the amount of intraoperative allogenic RBC transfusion and the risk of patients needing allogenic blood transfusion between the 2 groups (P = 0.14 and P = 0.61). Both the hemoglobin and hematocrit levels on the first day after surgery were significantly greater in cell salvage group than those in control group (P = 0.002 and P < 0.001). No significant differences, however, were noted in neither hemoglobin nor hematocrit level at the time of discharge between the 2 groups (P = 0.76 and P = 0.32). One of the included study reported the number of patients with complications related to transfusion in the two groups, which was not significant different (P = 0.507). CONCLUSIONS: Cell salvage significantly reduced the volumes of perioperative and postoperative allogenic RBC transfusion in scoliosis surgery and increased the hemoglobin and hematocrit levels on the first day postoperatively. In addition, it seemed not to increase the rate of transfusion complications during the surgery.
[Mh] Termos MeSH primário: Complicações Intraoperatórias/prevenção & controle
Recuperação de Sangue Operatório/métodos
Escoliose/cirurgia
[Mh] Termos MeSH secundário: Seres Humanos
Complicações Intraoperatórias/diagnóstico
Recuperação de Sangue Operatório/tendências
Ensaios Clínicos Controlados Aleatórios como Assunto/métodos
Escoliose/diagnóstico
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170925
[Lr] Data última revisão:
170925
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170228
[St] Status:MEDLINE


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[PMID]:28233319
[Au] Autor:Seyfried TF; Gruber M; Streithoff F; Mandle RJ; Pawlik MT; Busse H; Hansen E
[Ad] Endereço:Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany.
[Ti] Título:The impact of bowl size, program setup, and blood hematocrit on the performance of a discontinuous autotransfusion system.
[So] Source:Transfusion;57(3):589-598, 2017 Mar.
[Is] ISSN:1537-2995
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Cell salvage is an essential element in the concept of blood management. Modern devices provide different bowl sizes and sensor-directed programs to optimally adjust to varying clinical situations. STUDY DESIGN AND METHODS: In an experimental performance study, the discontinuous autotransfusion device XTRA (LivaNova/Sorin) was evaluated using fresh donor blood anticoagulated with heparin 5 U/mL and adjusted to a hematocrit of 10% or 25%, representing orthopedic or cardiac surgery. Test blood was processed with the autotransfusion device XTRA in four different bowls (55 mL, 125 mL, 175 mL, and 225 mL) and in three different program modes (a standard program, an optimized program, and an emergency program). RESULTS: Processing speed increased with bowl size and with the emergency program (range, 6.4-29.8 mL red blood cells [RBCs]/min). The RBC recovery rate exceeded 90% for all bowls and programs except the 55-mL bowl with the emergency program. Plasma elimination exceeded 95% for all bowls and programs except the 225-mL bowl with the emergency and standard programs. Maximal RBC recovery (range, 94.7%-97.6%) and plasma elimination (range, 98.7%-99.5%) were obtained with the medium-sized bowls (125 mL and 175 mL) and the optimized program. Elimination rates for potassium or plasma free hemoglobin were consistently lower than for protein or albumin and were highest for heparin. CONCLUSIONS: Increased hematocrit and RBC recovery rates are obtained with the optimized program Popt with the discontinuous autotransfusion device. The emergency program Pem speeds up the process but leads to RBC loss and reduced plasma elimination rates; therefore, it should be restricted to emergency situations. All four different sized bowls have high performance. Plasma elimination is represented best by protein or albumin elimination rates.
[Mh] Termos MeSH primário: Transfusão de Sangue Autóloga
Recuperação de Sangue Operatório
Procedimentos Ortopédicos
Software
[Mh] Termos MeSH secundário: Transfusão de Sangue Autóloga/instrumentação
Transfusão de Sangue Autóloga/métodos
Feminino
Hematócrito
Seres Humanos
Masculino
Recuperação de Sangue Operatório/instrumentação
Recuperação de Sangue Operatório/métodos
[Pt] Tipo de publicação:CLINICAL TRIAL; JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170621
[Lr] Data última revisão:
170621
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170225
[St] Status:MEDLINE
[do] DOI:10.1111/trf.13954


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[PMID]:28195859
[Au] Autor:Parker LM; Yazer MH; Waters JH
[Ad] Endereço:From the *University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; †Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; ‡The Institute for Transfusion Medicine, Pittsburgh, Pennsylvania; §Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and ‖The McGowan Institute for Regenerative Medicine, Pittsburgh, Pennsylvania.
[Ti] Título:Metallosis Identified via Intraoperative Cell Salvage: A Case Report.
[So] Source:A A Case Rep;8(4):67-69, 2017 Feb 15.
[Is] ISSN:2325-7237
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Intraoperative cell salvage, whereby shed surgical blood is recovered for autologous reinfusion, is frequently used during hip arthroplasty because of the potential for significant blood loss. The following cases describe 2 instances in which chromium and cobalt particles from patients' metal-on-metal hip implants were identified within the blood recovery system. Results of heavy metal testing during the second case suggest that the use of a leukocyte reduction filter effectively reduces metal concentrations to below normal circulating levels. However, the reinfusion of cell salvage blood containing obvious metallic particles cannot be recommended until the effectiveness of leukocyte reduction filters in removing heavy metals has been further tested.
[Mh] Termos MeSH primário: Artroplastia de Quadril
Cromo/sangue
Cobalto/sangue
Intoxicação por Metais Pesados
Prótese de Quadril/efeitos adversos
Recuperação de Sangue Operatório
Envenenamento/sangue
Complicações Pós-Operatórias/sangue
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Feminino
Seres Humanos
Masculino
Metais Pesados/sangue
Envenenamento/diagnóstico
Envenenamento/etiologia
Complicações Pós-Operatórias/diagnóstico
Complicações Pós-Operatórias/etiologia
Reoperação
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Metals, Heavy); 0R0008Q3JB (Chromium); 3G0H8C9362 (Cobalt)
[Em] Mês de entrada:1702
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170215
[St] Status:MEDLINE
[do] DOI:10.1213/XAA.0000000000000428


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[PMID]:27898431
[Au] Autor:Füllenbach C; Zacharowski K; Meybohm P
[Ad] Endereço:Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany.
[Ti] Título:Improving outcome of trauma patients by implementing patient blood management.
[So] Source:Curr Opin Anaesthesiol;30(2):243-249, 2017 Apr.
[Is] ISSN:1473-6500
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE OF REVIEW: Patient blood management aims to improve patient outcome and safety by reducing the number of unnecessary red blood cell transfusions and vitalizing patient-specific anemia reserves. While this is increasingly recognized as best clinical practice in elective surgery, the implementation in the setting of trauma is restrained because of typically nonelective (emergency) surgery and, in specific circumstances, allogeneic blood transfusions as life-saving therapy. RECENT FINDINGS: Viscoelastic diagnostics allow a precise identification of trauma-induced coagulopathy. A coagulation factor concentrate-based therapy is increasingly recognized as a fast and effective concept to correct coagulopathy and minimize blood loss. Using smaller tubes has a great potential to reduce the severity of phlebotomy-induced anemia. Washed cell salvage may reduce the number of allogeneic blood transfusions. Intravenous iron (with or without erythropoietin) may result in an increase of hemoglobin levels and reduced red blood cell transfusion requirements. Although a restrictive transfusion strategy is recommended in general, a target hemoglobin level of 7-9 g/dl is recommended in acute bleeding patients. SUMMARY: In the setting of trauma, options to avoid unnecessary blood loss and reduce blood transfusion are manifold. These are likely to improve safety and outcome of trauma patients while potentially reducing therapeutic costs.
[Mh] Termos MeSH primário: Transtornos da Coagulação Sanguínea/terapia
Perda Sanguínea Cirúrgica/prevenção & controle
Transfusão de Sangue/métodos
Hemorragia/terapia
Ferimentos e Lesões/terapia
[Mh] Termos MeSH secundário: Anemia/terapia
Transtornos da Coagulação Sanguínea/etiologia
Eritropoetina
Hemorragia/etiologia
Seres Humanos
Monitorização Fisiológica/métodos
Recuperação de Sangue Operatório
Resultado do Tratamento
Ferimentos e Lesões/complicações
Ferimentos e Lesões/cirurgia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (EPO protein, human); 11096-26-7 (Erythropoietin)
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170517
[Lr] Data última revisão:
170517
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161130
[St] Status:MEDLINE
[do] DOI:10.1097/ACO.0000000000000427


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[PMID]:27720494
[Au] Autor:Narula J; Kiran U; Malhotra Kapoor P; Choudhury M; Rajashekar P; Kumar Chowdhary U
[Ad] Endereço:Department of Cardiac Anesthesiology, Cardio-Thoracic and Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India. Electronic address: jatin.narula.13@gmail.com.
[Ti] Título:Assessment of Changes in Hemodynamics and Intrathoracic Fluid Using Electrical Cardiometry During Autologous Blood Harvest.
[So] Source:J Cardiothorac Vasc Anesth;31(1):84-89, 2017 Feb.
[Is] ISSN:1532-8422
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To evaluate the effect of autologous blood harvest (ABH)-induced volume shifts using electrical cardiometry (EC) in patients with pulmonary artery hypertension secondary to left heart disease. DESIGN: Prospective, randomized, controlled trial. SETTING: A tertiary care hospital. PARTICIPANTS: The study comprised 50 patients scheduled to undergo heart valve replacement. INTERVENTIONS: Patients were divided randomly into 2 experimental groups that were distinguished by whether ABH was performed. Blood volume extracted in the test group was replaced simultaneously with 1:1 colloid (Tetraspan; B Braun Melsungen, Melsungen, Germany). Hemodynamic, respiratory, and EC-derived parameters were recorded at predefined set points (T1 [post-induction/pre-ABH] and T2 [20 minutes post-ABH]). MEASUREMENTS AND MAIN RESULTS: Withdrawal of 15% of blood volume in the ABH group caused significant reductions in thoracic fluid content (TFC) (-10.1% [-15.0% to -6.1%]); right atrial pressure (-23% [-26.6% to -17.6%]); mean arterial pressure (-12.6% [-22.2% to -3.8%]); airway pressures: (peak -6.2% [-11.7% to -2.8%] and mean -15.4% [-25.0% to -8.3%]); and oxygenation index (-10.34% [-16.4% to -4.8%]). Linear regression analysis showed good correlation between the percentage change in TFC after ABH and the percentage of change in right atrial pressure, stroke volume variation, autologous blood extracted, peak and mean airway pressures, and oxygen index. CONCLUSIONS: In addition to its proven role in blood conservation, therapeutic benefits derived from ABH include decongestion of volume-loaded patients, decrease in TFC, and improved gas exchange. EC tracks beat-to-beat fluid and hemodynamic fluctuations during ABH and helps in the execution of an early patient-specific, goal-directed therapy, allowing for its safe implementation in patients with pulmonary hypertension secondary to left heart disease.
[Mh] Termos MeSH primário: Líquidos Corporais/fisiologia
Implante de Prótese de Valva Cardíaca
Recuperação de Sangue Operatório/métodos
Cavidade Torácica/fisiopatologia
[Mh] Termos MeSH secundário: Adulto
Cardiografia de Impedância/métodos
Feminino
Hemodinâmica/fisiologia
Seres Humanos
Hipertensão Pulmonar/fisiopatologia
Cuidados Intraoperatórios/métodos
Masculino
Meia-Idade
Monitorização Intraoperatória/métodos
Estudos Prospectivos
Volume Sistólico/fisiologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170906
[Lr] Data última revisão:
170906
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161011
[St] Status:MEDLINE


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[PMID]:27591910
[Au] Autor:Buys WF; Buys M; Levin AI
[Ad] Endereço:Department of Anesthesiology and Critical Care, Faculty of Health Sciences, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa. Electronic address: wfbuys@gmail.com.
[Ti] Título:Reinfusate Heparin Concentrations Produced by Two Autotransfusion Systems.
[So] Source:J Cardiothorac Vasc Anesth;31(1):90-98, 2017 Feb.
[Is] ISSN:1532-8422
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Cell saver reinfusate ideally should contain low, clinically insignificant heparin concentrations. The American Association of Blood Banks has defined the clinically insignificant threshold as 0.5 IU/mL. Furthermore, there is uncertainty about the meaning of cell saver "heparin elimination rates." These concerns prompted the authors' independent investigation of reinfusate heparin concentrations of devices used in their institution. It was hypothesized that cell saver reinfusates contain clinically insignificant heparin concentrations. DESIGN: Two prospective, pragmatic, sequential, observational, single-center studies. SETTING: University teaching hospital. PARTICIPANTS: A total of 32 and 31 patients for on-pump cardiac surgery were enrolled in the Sorin (Dideco) Electa and Sorin Xtra studies, respectively. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Postcardiac surgery reinfusate heparin concentrations were measured using a modified anti-Xa chromogenic assay. Heparin concentrations above 0.5 IU/mL were present in 56% (95% confidence interval, 35% to 68%) of Sorin Xtra reinfusates. Heparin concentrations in the Sorin (Dideco) Electa reinfusates were lower than recommended in 29 of 32 reinfusates. Only 3 of 32 Sorin (Dideco) Electa reinfusates (9.4%; 95% confidence interval 3.2% to 24%) exhibited heparin concentrations exceeding 0.5 IU/mL. CONCLUSIONS: Sorin (Dideco) Electa reinfusates contained heparin concentrations below the American Association of Blood Banks recommended threshold in 90.6% of cases, while Sorin Xtra reinfusate heparin concentrations exceeded this recommendation in 56% of cases. Measurement of cell saver reinfusate heparin concentrations necessitates the use of a modified chromogenic assay. Studies explicitly should confirm that such a modification was indeed used. Periodic quality control of reinfusate composition is recommended.
[Mh] Termos MeSH primário: Anticoagulantes/sangue
Transfusão de Sangue Autóloga/instrumentação
Procedimentos Cirúrgicos Cardíacos
Heparina/sangue
Recuperação de Sangue Operatório/métodos
[Mh] Termos MeSH secundário: Adulto
Transfusão de Sangue Autóloga/métodos
Ponte Cardiopulmonar
Feminino
Seres Humanos
Masculino
Meia-Idade
Cuidados Pós-Operatórios/métodos
Estudos Prospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Anticoagulants); 9005-49-6 (Heparin)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170906
[Lr] Data última revisão:
170906
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160905
[St] Status:MEDLINE



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