Estimation of blood loss during adult burn surgery

Farny, Boris; Fontaine, Mathieu; Latarjet, J; Poupelin, Jean-Charles; Voulliaume, D.; Ravat, François

doi:10.1016/j.burns.2018.04.019

Cited by 23 publications

(6 citation statements)

References 28 publications

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“…Several strategies have been described in literature to reduce blood loss during surgery (i.e., topical adrenaline, tourniquets and tranexamic acid) [ 2 ]. Despite the use of these techniques, blood loss remains substantial [ 3 , 4 ]. This leads to allogenic blood transfusions with all associated risks and costs [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of tranexamic acid in burn patients undergoing surgery – a systematic review and meta-analysis

Slob,

Gigengack,

van Baar

et al. 2024

BMC Anesthesiol

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Summary Background Reducing blood loss during excisional surgery in burn patients remains a challenge. Tranexamic acid during surgery can potentially reduce blood loss. The use of tranexamic acid during excisional surgery in burn patients has recently been described in a review and meta-analysis. However, quality assessment on studies included was not performed and this review did not apply independent reviewers. Quality assessment of studies investigating the effectiveness of tranexamic acid in burn patients is crucial before concusions can be drawn. Therefore, we conducted a systematic review and meta-analysis of the literature investigating the effectiveness of tranexamic acid in burn patients undergoing surgery. Methods A systematic review and meta-analysis of the literature was conducted. The study was pre-registered in PROSPERO database (CRD42023396183). Results Five studies including two randomised controlled trials (RCTs) with a total of 303 patients were included. Risk of bias of the included studies was moderate to high. Individual results of the studies were heterogeneous. In three studies of moderate quality the administration of tranexamic acid resulted in a reduction of blood loss per unit excised area, accounting as moderate level of evidence. In two low-quality studies and one moderate quality study the administration of tranexamic acid resulted in a reduction of transfused packed Red Blood Cells (pRBC’s), accounting for moderate level of evidence. Postoperative haemoglobin levels were higher after tranexamic acid administration in one study, accounting for insufficient evidence. Meta-analysis pooling overall blood loss from two separate RCTs failed to detect a statistically significant reduction. Substantial heterogeneity was observed. Conclusions Moderate level of evidence indicates that tranexamic acid reduces blood loss per unit of excised area and transfusion of packed Red Blood Cells. Results indicate that tranexamic acid can be beneficial in burn patients undergoing surgery. More high-quality research is needed to confirm these results. Future studies should focus on the dosing of tranexamic acid, the administration approaches, and even consider combining these approaches. Trial Registration PROSPERO: CRD42023396183

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Section: Introductionmentioning

confidence: 99%

Effectiveness of tranexamic acid in burn patients undergoing surgery – a systematic review and meta-analysis

Slob,

Gigengack,

van Baar

et al. 2024

BMC Anesthesiol

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“…Burns are common and severe injuries, often necessitating intensive care treatment and long hospitalisation [1][2][3]. Throughout hospitalisation, burn patients are susceptible to hospital-acquired anaemia (HAA) for several reasons: The burn injury itself often causes impaired hemopoiesis [4], whereas repeated surgeries and dressing changes often result in significant blood loss [5][6][7][8]. Further reasons for HAA in burn patients include episodes of systemic inflammatory response, comorbidities, and coagulopathies associated with the insult of the injury.…”

Section: Introductionmentioning

confidence: 99%

Total Body Surface Area Adjusted Daily Diagnostic Blood Loss May Be Higher in Minor Burns—Are Our Patients the Victims of Daily Routine?

Smolle,

Persson,

Lind

et al. 2024

EBJ

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Burns are common and devastating injuries, often necessitating intensive care treatment and long-term hospitalisation, making burn patients susceptible to hospital-acquired anaemia and blood transfusion. The purpose of this study was to assess diagnostic blood loss in burn patients at the burn intensive care unit (BICU) at Uppsala University Hospital between 1 September 2016 and 30 June 2019. Medical records were screened; age, gender, mechanism, % total body surface area (TBSA), Baux score, length of stay, days on the respirator, days of continuous renal replacement therapy, number of operations, and number of blood tests per patient were assessed. Volume per blood test was estimated as the volume needed for the specific test tube. A total of 166 patients were included in the study. The mean TBSA was 18.0% ± 20, and the mean length of stay was 17.0 ± 41 days. Median diagnostic blood loss was 13.1 mL/day/patient (IQR 7.0, 23.9) and correlated positively with burn extent, Baux score, and mortality. Daily diagnostic blood loss/%TBSA/patient was 1.2 mL (IQR 0.7, 2.3). Transfusion of blood products occurred in 73/166 patients (44%). In conclusion, diagnostic blood loss is greatly influenced by TBSA extent. The diagnostic blood loss can reach significant levels and may affect the transfusion rate.

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“…3 Also, large wound debridement and skin graft can produce massive blood loss, and then, this process may be involved in hemostasis disorders by consuming coagulation factors and could further generate hypothermia. 6 Additionally, such pathophysiological changes may have a negative impact on the coagulation system, resulting in coagulopathies, which range from severe traumatic coagulopathy (ATC) to disseminated intravascular coagulation (DIC). 7,8 Later, anemia may originate from chronic bleeding from unhealed wounds, augmented red cell damage, bone marrow suppression, erythropoietin (EPO)-resistant iron deficiency, and nutritional deficiencies.…”

Section: Introductionmentioning

confidence: 99%

“…During the first 2 weeks following burn, anemia mostly occurs due to the blood loss directly through the burned area or the hemodilution from fluid resuscitation 3 . Also, large wound debridement and skin graft can produce massive blood loss, and then, this process may be involved in hemostasis disorders by consuming coagulation factors and could further generate hypothermia 6 . Additionally, such pathophysiological changes may have a negative impact on the coagulation system, resulting in coagulopathies, which range from severe traumatic coagulopathy (ATC) to disseminated intravascular coagulation (DIC) 7,8 .…”

Section: Introductionmentioning

confidence: 99%

Temporal trends, predictors of blood transfusion and in‐hospital outcomes among patients with severe burn injury in the United States—A national database‐based analysis

Peng

Yang

et al. 2022

Transfusion

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Background: Severe burn can be accompanied by life-threatening bleeding on some occasions, thus, blood transfusion is often required in these patients during their hospitalization. Therefore, we aimed to examine temporal trends, predictors, and in-hospital outcomes of blood transfusion in these patients in the United States.Methods: The National Inpatient Sample was used to identify severe burn patients between January 2010 and September 2017 in the United States.Trends in the utilization of blood transfusion were analyzed using the Cochran-Armitage trend test. Moreover, propensity score matching (PSM) was employed, and then in-hospital outcomes were compared between these two groups in the matched cohort. Multivariable logistic regressions were further used to validate the results of PSM.Results: Among 27,260 severe burn patients identified during the study period, 2120 patients (7.18%) received blood transfusion. Blood transfusion rates decreased significantly from 9.52% in 2010 to 5.02% in 2017 (p for trend <.001). In the propensity-matched cohort (2120 pairs with and without transfusion), patients transfused were at increased risk of in-hospital mortality (13.3% vs 8.77%, p < .001), overall postoperative complications (88.3% vs 72.59%, p < .001), longer hospital stays (defined as > median hospital stays = 5 d) (73.8% vs 50.6%, p < .001) and increased overall cost (defined as > median overall costs = 30,746) (81.6% vs 57.3%, p < .001). This was also the case for the multivariable analysis. Conclusions: Blood transfusion following severe burn injury may be associated with worse clinical outcomes. The utility for blood transfusion in burn patients warrants further prospective exploration.Chi Peng and Fan Yang contributed equally to this work and are listed as co-first authors.

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Estimation of blood loss during adult burn surgery

Cited by 23 publications

References 28 publications

Effectiveness of tranexamic acid in burn patients undergoing surgery – a systematic review and meta-analysis

Effectiveness of tranexamic acid in burn patients undergoing surgery – a systematic review and meta-analysis

Total Body Surface Area Adjusted Daily Diagnostic Blood Loss May Be Higher in Minor Burns—Are Our Patients the Victims of Daily Routine?

Temporal trends, predictors of blood transfusion and in‐hospital outcomes among patients with severe burn injury in the United States—A national database‐based analysis

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