Cargando…
Should we restrict erythrocyte transfusion in early goal directed protocols?
BACKGROUND: Early goal-directed therapy has been endorsed in the guidelines of the Surviving Sepsis Campaign as a key strategy among patients presenting with severe sepsis or septic shock. But more importantly, early goal-directed therapy also became standard care for non-septic critically ill patie...
Autores principales: | , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2015
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4428088/ https://www.ncbi.nlm.nih.gov/pubmed/25956725 http://dx.doi.org/10.1186/s12871-015-0054-4 |
_version_ | 1782370835968819200 |
---|---|
author | Meybohm, Patrick Shander, Aryeh Zacharowski, Kai |
author_facet | Meybohm, Patrick Shander, Aryeh Zacharowski, Kai |
author_sort | Meybohm, Patrick |
collection | PubMed |
description | BACKGROUND: Early goal-directed therapy has been endorsed in the guidelines of the Surviving Sepsis Campaign as a key strategy among patients presenting with severe sepsis or septic shock. But more importantly, early goal-directed therapy also became standard care for non-septic critically ill patients and was adopted for high-risk surgical patients. DISCUSSION: Importantly, transfusion of red blood cells is a central part of many protocols of early goal-directed therapy to indicate the need for use of inotropes and red blood cells, as both central venous saturation and hematocrit are used as transfusion triggers. However, burgeoning data has strongly linked transfusion with worse clinical outcomes. If correct, could these early goal-directed therapy ‚bundles’ have better outcome if a restrictive transfusion practice is adopted? SUMMARY: Early goal-directed therapy has evolved as standard care for most of critically ill patients, and many protocols contain transfusion of red blood cells targeting high hemoglobin level as a key element. As red blood cell transfusions are associated with increased morbidity and mortality, transfusion thresholds need to be more individualized. |
format | Online Article Text |
id | pubmed-4428088 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-44280882015-05-13 Should we restrict erythrocyte transfusion in early goal directed protocols? Meybohm, Patrick Shander, Aryeh Zacharowski, Kai BMC Anesthesiol Debate BACKGROUND: Early goal-directed therapy has been endorsed in the guidelines of the Surviving Sepsis Campaign as a key strategy among patients presenting with severe sepsis or septic shock. But more importantly, early goal-directed therapy also became standard care for non-septic critically ill patients and was adopted for high-risk surgical patients. DISCUSSION: Importantly, transfusion of red blood cells is a central part of many protocols of early goal-directed therapy to indicate the need for use of inotropes and red blood cells, as both central venous saturation and hematocrit are used as transfusion triggers. However, burgeoning data has strongly linked transfusion with worse clinical outcomes. If correct, could these early goal-directed therapy ‚bundles’ have better outcome if a restrictive transfusion practice is adopted? SUMMARY: Early goal-directed therapy has evolved as standard care for most of critically ill patients, and many protocols contain transfusion of red blood cells targeting high hemoglobin level as a key element. As red blood cell transfusions are associated with increased morbidity and mortality, transfusion thresholds need to be more individualized. BioMed Central 2015-05-09 /pmc/articles/PMC4428088/ /pubmed/25956725 http://dx.doi.org/10.1186/s12871-015-0054-4 Text en © Meybohm et al.; licensee BioMed Central. 2015 This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Debate Meybohm, Patrick Shander, Aryeh Zacharowski, Kai Should we restrict erythrocyte transfusion in early goal directed protocols? |
title | Should we restrict erythrocyte transfusion in early goal directed protocols? |
title_full | Should we restrict erythrocyte transfusion in early goal directed protocols? |
title_fullStr | Should we restrict erythrocyte transfusion in early goal directed protocols? |
title_full_unstemmed | Should we restrict erythrocyte transfusion in early goal directed protocols? |
title_short | Should we restrict erythrocyte transfusion in early goal directed protocols? |
title_sort | should we restrict erythrocyte transfusion in early goal directed protocols? |
topic | Debate |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4428088/ https://www.ncbi.nlm.nih.gov/pubmed/25956725 http://dx.doi.org/10.1186/s12871-015-0054-4 |
work_keys_str_mv | AT meybohmpatrick shouldwerestricterythrocytetransfusioninearlygoaldirectedprotocols AT shanderaryeh shouldwerestricterythrocytetransfusioninearlygoaldirectedprotocols AT zacharowskikai shouldwerestricterythrocytetransfusioninearlygoaldirectedprotocols |