Management pacienta se závažným traumatickým krvácením zahrnuje postupy damage control resuscitation, jejichž součástí je kromě chirurgického řešení krvácení aplikace masivního transfuzního protokolu. Cílem tohoto sdělení je představit masivní transfuzní protokol a vybrané skórovací systémy pro včasnou detekci závažně krvácejících pacientů. Využití standardizovaného protokolu aktivace masivního transfuzního protokolu vede ke snížení letality na vykrvácení a spotřeby transfuzních přípravků v traumacentrech.
The management of severe traumatic bleeding includes damage control resuscitation procedures including, in addition to surgical bleeding control, the application of the massive transfusion protocol. The aim of this paper is to present the massive transfusion protocol and selected scoring systems for an early detection of patients with severe post-traumatic bleeding. The use of a standardized protocol to activate the massive transfusion protocol reduces lethality due to severe traumatic bleeding and the consumption of blood products in trauma centers.
- Klíčová slova
- masivní transfuzní protokol,
- MeSH
- krevní transfuze * metody MeSH
- krvácení etiologie terapie MeSH
- lidé MeSH
- resuscitace metody MeSH
- traumatologická centra MeSH
- Check Tag
- lidé MeSH
- Klíčová slova
- Walking Blood Bank,
- MeSH
- ABO systém krevních skupin krev MeSH
- krevní transfuze metody ošetřování MeSH
- kurzy a stáže v nemocnici * MeSH
- první pomoc metody ošetřování MeSH
- urgentní zdravotnické služby metody MeSH
- Publikační typ
- zprávy MeSH
- MeSH
- darování krve MeSH
- konzervace krve MeSH
- krevní transfuze * klasifikace metody MeSH
- lidé MeSH
- potransfuzní reakce klasifikace MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
PURPOSE: Various strategies are utilised to reduce blood loss and allogenic blood transfusion for posterior instrumented correction of Adolescent Idiopathic Scoliosis (AIS). The aim of this study was to evaluate post-operative blood transfusion requirements to determine whether routine cross matching of blood is essential. METHODS: This is a prospective case series of 84 patients who underwent posterior correction of AIS between September 2016 and March 2018. We reviewed demographic, operative, radiological data and transfusion requirements. Results of transfusion requirements in 44 patients who underwent Ponte osteotomies (F:M = 36:8; mean age 14.8 years) were compared with 40 patients (F:M = 9:31; mean age 14.4 years) who did not and provided the control group. A transfusion trigger of 80 mg/dl with clinical caveats was utilised. Cross matching and procurement costs of allogenic blood/unit were ascertained. RESULTS: Five patients required postoperative blood transfusion on days 2 or 3. Anaesthetic time (p = 0.0003) and preoperative Cobb angle (p = 0.0166) were significant variables between both groups and post-operative Hb (p = 0.0084) and number of levels fused (p = 0.0312) being significant in patients requiring transfusion. Unutilised units on the day of the operation incurred £30,030 (£380/patient or £154/unit) in operational costs. CONCLUSION: Our audit demonstrates that transfusion on the day of the operation was not required. We recommend that routine crossmatching is not essential for primary posterior correction for AIS with blood conservation techniques. Blood grouping with availability of urgent blood is sufficient at the onset of operation. This has financial implications and cost savings. LEVELS OF EVIDENCE: III.
- MeSH
- krevní transfuze metody MeSH
- krvácení při operaci prevence a kontrola MeSH
- kyfóza * MeSH
- lidé MeSH
- mladiství MeSH
- retrospektivní studie MeSH
- skolióza * chirurgie MeSH
- určování krevní skupiny a křížové zkoušky MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mladiství MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- krevní transfuze * metody MeSH
- lidé MeSH
- paliativní péče * metody MeSH
- služby domácí péče MeSH
- směrnice pro lékařskou praxi jako téma MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- úvodníky MeSH
BACKGROUND: The shortage of blood products has become a worldwide problem, especially during the COVID-19 Pandemic. Here, we investigated whether a point of care (POC) approach to perioperative bleeding and coagulopathy based on rotational thromboelastometry (ROTEM) results could decrease perioperative blood loss and the perioperative consumption of blood products during lung transplantation. METHODS: Patients undergoing bilateral lung transplantation were randomized into two groups: In the first group, designated the "non POC" group, the management of perioperative bleeding and coagulopathy was based on the clinical experience of the anesthesiologist; in the second group, designated the "POC" group, the management of perioperative bleeding, and coagulopathy was based on the ROTEM results. RESULTS: After performing an interim statistical analysis, the project was prematurely terminated as the results were significantly in favor of the POC approach. Data were analyzed for the period January 2018 until June 2020 when 67 patients were recruited into the study. There was significantly decreased perioperative blood loss in the POC group (n = 31 patients) with p = 0.013, decreased perioperative consumption of RBC with p = 0.009, and decreased perioperative consumption of fresh frozen plasma with p < 0.0001 (practically no fresh frozen plasma was used in the POC group) without deteriorating clot formation in secondary and primary hemostasis as compared to the non POC group (n = 36). CONCLUSION: POC management of perioperative bleeding and coagulopathy based on ROTEM results is a promising strategy to decrease perioperative blood loss and the consumption of blood products in lung transplantation.
- MeSH
- COVID-19 epidemiologie MeSH
- hemostáza fyziologie MeSH
- koagulopatie diagnóza etiologie terapie MeSH
- krevní transfuze metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- pandemie * MeSH
- SARS-CoV-2 MeSH
- transplantace plic škodlivé účinky MeSH
- tromboelastografie metody MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
