Erythropoiesis-stimulating Agents in Critically Ill Trauma Patients

French, Craig; Glassford, Neil J; Gantner, Dashiell; Higgins, Alisa; Cooper, Jamie; Nichol, Alistair; Skrifvars, Markus B.; Imberger, Georgina; Presneill, Jeffrey; Bailey, Michael; Bellomo, Rinaldo

doi:10.1097/sla.0000000000001746

Cited by 28 publications

(15 citation statements)

References 33 publications

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“…Although it does not strictly refer to surgical patients, a recent meta‐analysis also found a reduction in mortality rates (risk ratio (RR) 0.63, 95%CI 0.49–0.79, p < 0.0001) in critically ill trauma patients who received rHuEPO (nine studies, 2607 patients), without increasing the risk of thromboembolic complications . In cardiac surgery patients, rHuEPO seems to exert neurological and renal protective effect .…”

Section: Is There a Role For Erythropoiesis‐stimulating Agents?mentioning

confidence: 99%

An international consensus statement on the management of postoperative anaemia after major surgical procedures

Múñoz

Acheson

Bisbe³

et al. 2018

Anaesthesia

164

153

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Despite numerous guidelines on the management of anaemia in surgical patients, there is no pragmatic guidance for the diagnosis and management of anaemia and iron deficiency in the postoperative period. A number of experienced researchers and clinicians took part in a two-day expert workshop and developed the following consensus statement. After presentation of our own research data and local policies and procedures, appropriate relevant literature was reviewed and discussed. We developed a series of best-practice and evidence-based statements to advise on patient care with respect to anaemia and iron deficiency in the postoperative period. These statements include: a diagnostic approach to iron deficiency and anaemia in surgical patients; identification of patients appropriate for treatment; and advice on practical management and follow-up that is easy to implement. Available data allow the fulfilment of the requirements of Pillar 1 of Patient Blood Management. We urge national and international research funding bodies to take note of these recommendations, particularly in terms of funding large-scale prospective, randomised clinical trials that can most effectively address the important clinical questions and this clearly unmet medical need.

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Section: Is There a Role For Erythropoiesis‐stimulating Agents?mentioning

confidence: 99%

An international consensus statement on the management of postoperative anaemia after major surgical procedures

Múñoz

Acheson

Bisbe³

et al. 2018

Anaesthesia

164

153

View full text Add to dashboard Cite

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“…Several meta-analyses [57][58][59][60][61] [60]. However, the authors of these meta-analyses downgraded the GRADE score in view of the high risk of bias, the inconsistency and the imprecision of the studies.…”

Section: Rationalementioning

confidence: 99%

“….49-0.79)][57]. Note that only the meta-analysis by Zarychanski et al, based on seven randomised controlled trials, evaluated the impact of ESA on red blood cell requirements and reported a reduction of red blood cell utilisation with an RR of 0.73 (0.64-0.84)…”

mentioning

confidence: 99%

Management and prevention of anemia (acute bleeding excluded) in adult critical care patients

Lasocki

Pène

Ait‐Oufella

et al. 2020

Ann. Intensive Care

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Objective: Anemia is very common in critical care patients, on admission (affecting about two-thirds of patients), but also during and after their stay, due to repeated blood loss, the effects of inflammation on erythropoiesis, a decreased red blood cell life span, and haemodilution. Anemia is associated with severity of illness and length of stay. Methods: A committee composed of 16 experts from four scientific societies, SFAR, SRLF, SFTS and SFVTT, evaluated three fields: (1) anemia prevention, (2) transfusion strategies and (3) non-transfusion treatment of anemia. Population, Intervention, Comparison, and Outcome (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Analysis of the literature and formulation of recommendations were then conducted according to the GRADE ® methodology. Results: The SFAR-SRLF guideline panel provided ten statements concerning the management of anemia in adult critical care patients. Acute haemorrhage and chronic anemia were excluded from the scope of these recommendations. After two rounds of discussion and various amendments, a strong consensus was reached for ten recommendations. Three of these recommendations had a high level of evidence (GRADE 1±) and four had a low level of evidence (GRADE 2±). No GRADE recommendation could be provided for two questions in the absence of strong consensus. Conclusions: The experts reached a substantial consensus for several strong recommendations for optimal patient management. The experts recommended phlebotomy reduction strategies, restrictive red blood cell transfusion and a single-unit transfusion policy, the use of red blood cells regardless of storage time, treatment of anaemic patients with erythropoietin, especially after trauma, in the absence of contraindications and avoidance of iron therapy (except in the context of erythropoietin therapy).

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“…Trial sequential analysis (TSA) was conducted to evaluate the reliability of the result using TSA software (version 0.9.5.10 Beta, Copenhagen Trial Unit) [ 25 ]. TSA performs a cumulative meta-analysis, which creates a Z curve of the summarized observed effect (the cumulative number of included patients and events) and the monitoring boundaries for benefit, harm, and futility, and the required information size (RIS, the sample size needed in a meta-analysis to detect or reject a certain intervention effect) [ 26 – 29 ]. TSA boundaries were constructed to assess the risk of random error when the number of available participants is less than the RIS and the potential necessity for repeated updates [ 30 ].…”

Section: Methodsmentioning

confidence: 99%

Utility of posaconazole therapeutic drug monitoring and assessment of plasma concentration threshold for effective prophylaxis of invasive fungal infections: a meta-analysis with trial sequential analysis

et al. 2018

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BackgroundPosaconazole therapeutic drug monitoring (TDM) is increasingly used in clinical practice. However, the utility of posaconazole TDM and the target of posaconazole plasma concentration for clinical successful prophylaxis remain uncertain and controversial. The aim of this study was to evaluate posaconazole exposure-response relationship and determine an optimum posaconazole concentration for prophylaxis against invasive fungal infections (IFIs).MethodsBibliographic databases were searched (from inception to September 2017) to select studies including the clinical outcomes below and above concentration cut-off value of 0.5 mg/L and 0.7 mg/L. The reliability of the results were evaluated with trial sequential analysis (TSA).ResultsTwenty-eight studies with 1930 patients included were analyzed. The results of our pooled analysis demonstrated that patients with posaconazole plasma concentrations over 0.5 mg/L were twice more likely to achieve successful responses compared with those with lower concentrations (odds ratio, OR = 1.98, 95% confidence interval, CI 1.09–3.58, P = 0.02) while the threshold, 0.7 mg/L showed no significant difference (OR = 1.84, 95% CI 0.94–3.63, P = 0.08). The TSA results showed that there was sufficient information to support these findings.ConclusionsAn optimal posaconazole concentration target of 0.5 mg/L is suggested to ensure the clinical prophylactic efficacy and may help reduce the dosage and dose-dependent toxicity comparing with the target of 0.7 mg/L.Electronic supplementary materialThe online version of this article (10.1186/s12879-018-3055-3) contains supplementary material, which is available to authorized users.

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Erythropoiesis-stimulating Agents in Critically Ill Trauma Patients

Cited by 28 publications

References 33 publications

An international consensus statement on the management of postoperative anaemia after major surgical procedures

An international consensus statement on the management of postoperative anaemia after major surgical procedures

Management and prevention of anemia (acute bleeding excluded) in adult critical care patients

Utility of posaconazole therapeutic drug monitoring and assessment of plasma concentration threshold for effective prophylaxis of invasive fungal infections: a meta-analysis with trial sequential analysis

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