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Plasma transfusion in the intensive care unit
MMT. van Haeren, SJ. Raasveld, S. de Bruin, MC. Reuland, C. van den Oord, J. Schenk, C. Aubron, J. Bakker, M. Cecconi, A. Feldheiser, HJ. de Grooth, J. Meier, TWL. Scheeren, Z. McQuilten, A. Flint, T. Hamid, M. Piagnerelli, TT. Mahečić, J. Benes,...
Jazyk angličtina Země Spojené státy americké
Typ dokumentu časopisecké články, pozorovací studie, multicentrická studie
Grantová podpora
GNT1189490
National Blood Authority of Australia and a National Health and Medical Research Council (NHMRC) Synergy
GNT1194811
National Health and Medical Research Council (NHMRC) Emerging Leader Investigator
09150172010047
ZonMw Vidi
PubMed
39696779
DOI
10.1111/trf.18071
Knihovny.cz E-zdroje
- MeSH
- jednotky intenzivní péče * MeSH
- krevní plazma * MeSH
- krvácení terapie etiologie prevence a kontrola MeSH
- lidé středního věku MeSH
- lidé MeSH
- převod jednotlivých krevních složek * MeSH
- prospektivní studie MeSH
- senioři MeSH
- směrnice pro lékařskou praxi jako téma MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- pozorovací studie MeSH
BACKGROUND: Current guidelines discourage prophylactic plasma use in non-bleeding patients. This study assesses global plasma transfusion practices in the intensive care unit (ICU) and their alignment with current guidelines. STUDY DESIGN AND METHODS: This was a sub-study of an international, prospective, observational cohort. Primary outcomes were in-ICU occurrence rate of plasma transfusion, proportion of plasma events of total blood products events, and number of plasma units per event. Secondary outcomes included transfusion indications, INR/PT, and proportion of events for non-bleeding indications. RESULTS: Of 3643 patients included, 356 patients (10%) experienced 547 plasma transfusion events, accounting for 18% of total transfusion events. A median of 2 (IQR 1, 2) units was given per event excluding massive transfusion protocol (MTP) and 3 (IQR 2, 6) when MTP was activated. MTP accounted for 39 (7%) of events. Indications of non-MTP events included active bleeding (54%), prophylactic (25%), and pre-procedure (12%). Target INR/PT was stated for 43% of transfusion events; pre-transfusion INR/PT or visco-elastic hemostatic assays (VHA) were reported for 73%. Thirty-seven percent of events were administered for non-bleeding indications, 54% with a pre-transfusion INR < 3.0 and 30% with an INR < 1.5. DISCUSSION: Plasma transfusions occurred in 10% of ICU patients. Over a third were given for non-bleeding indications and might have been avoidable. Target INR/PT was not stated in more than half of transfusions, and pre-transfusion INR/PT or VHA was not reported for 27%. Further research and education is needed to optimize guideline implementation and to identify appropriate indications for plasma transfusion.
Department for Internal Medicine University of Ljubljana Ljubljana Slovenia
Department of Anesthesia and Intensive Care Military Medical Academy Belgrade Belgrade Serbia
Department of Anesthesiology Aga Khan University Hospital Nairobi Kenya
Department of Anesthesiology Amsterdam University Medical Center Amsterdam the Netherlands
Department of Anesthesiology and Intensive Care IRCCS Humanitas Research Hospital Milan Italy
Department of Anesthesiology and Intensive Care Kepler University Clinic Linz Austria
Department of Anesthesiology University Medical Center Groningen Groningen the Netherlands
Department of Cardiothoracic Surgery Interbalkan Medical Center Thessaloniki Greece
Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
Department of Clinical Science and Education Södersjukhuset Karolinska Institutet Stockholm Sweden
Department of Critical Care Asgar Ali Hospital Dhaka Bangladesh
Department of Intensive Care Adults Erasmus MC University Medical Centers Rotterdam the Netherlands
Department of Intensive Care Amsterdam University Medical Centers Amsterdam the Netherlands
Department of Intensive Care CHU Charleroi Marie Curie Charleroi Belgium
Department of Intensive Care Pontificia Universidad Católica de Chile Santiago Chile
Faculty of Medicine University of Tripoli Tripoli Libya
Intensive Care Service Hospital Universitario La Paz Madrid Spain
Médecine Intensive Réanimation CHU de Brest Université de Bretagne Occidentale Brest France
Nuffield Department of Clinical Neurosciences University of Oxford Oxford UK
School of Public Health and Preventive Medicine Monash University Melbourne Australia
Unidad de Cuidados Intensivos Hospital Vicente Corral Moscoso Cuenca Ecuador
Citace poskytuje Crossref.org
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- $a BACKGROUND: Current guidelines discourage prophylactic plasma use in non-bleeding patients. This study assesses global plasma transfusion practices in the intensive care unit (ICU) and their alignment with current guidelines. STUDY DESIGN AND METHODS: This was a sub-study of an international, prospective, observational cohort. Primary outcomes were in-ICU occurrence rate of plasma transfusion, proportion of plasma events of total blood products events, and number of plasma units per event. Secondary outcomes included transfusion indications, INR/PT, and proportion of events for non-bleeding indications. RESULTS: Of 3643 patients included, 356 patients (10%) experienced 547 plasma transfusion events, accounting for 18% of total transfusion events. A median of 2 (IQR 1, 2) units was given per event excluding massive transfusion protocol (MTP) and 3 (IQR 2, 6) when MTP was activated. MTP accounted for 39 (7%) of events. Indications of non-MTP events included active bleeding (54%), prophylactic (25%), and pre-procedure (12%). Target INR/PT was stated for 43% of transfusion events; pre-transfusion INR/PT or visco-elastic hemostatic assays (VHA) were reported for 73%. Thirty-seven percent of events were administered for non-bleeding indications, 54% with a pre-transfusion INR < 3.0 and 30% with an INR < 1.5. DISCUSSION: Plasma transfusions occurred in 10% of ICU patients. Over a third were given for non-bleeding indications and might have been avoidable. Target INR/PT was not stated in more than half of transfusions, and pre-transfusion INR/PT or VHA was not reported for 27%. Further research and education is needed to optimize guideline implementation and to identify appropriate indications for plasma transfusion.
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