Revisiting transfusion practices in critically ill patients*

Hébert, Paul C.; Fergusson, Dean; Stather, David R.; McIntyre, Lauralyn; Martin, Claudio M.; Doucette, Steve; Blajchman, Morris A.; Graham, Ian D.

doi:10.1097/01.ccm.0000151047.33912.a3

Cited by 76 publications

(61 citation statements)

References 19 publications

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“…Research has shown that smoking directly leads to alterations in platelet membranes and causes impairment of their natural function [13,35,38], therefore it seemed plausible to us that there would be an association between smoking and blood loss after spinal surgery. Should that be the case, it would be a modifiable risk factor that potentially could help patients avoid the neurologic compli cations of bleeding after spine surgery (such as development of a compressive hematoma), and the known deleterious effects of transfusions [15,16,20,32,40,42,43,45,52]. Our results suggest that smoking is strongly associated with increased surgical blood loss and perioperative transfusions in patients undergoing lumbar spine surgery.…”

Section: Discussionmentioning

confidence: 67%

Smoking is Associated with Increased Blood Loss and Transfusion Use After Lumbar Spinal Surgery

McCunniff

Young

Ahmadinia

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Little is known about the association between smoking and intraoperative blood loss and perioperative transfusion use in patients undergoing spinal surgery. However, we found that although many of the common complications and deleterious effects of smoking on surgical patients had been well documented, the aspect of blood loss seemingly had been overlooked despite data reported in nonorthopaedic sources to suggest a possible connection. Questions/Purposes We asked: (1) Is smoking associated with increased estimated blood loss during surgery in patients undergoing lumbar spine surgery? (2) Is smoking associated with increased perioperative transfusion usage?Methods Between 2005 and 2009, 581 lumbar decompression procedures (with or without fusion) were performed at one academic spine center. Of those, 559 (96%) had sufficient chart documentation to categorize patients by smoking status, necessary intra-and postoperative data to allow analysis with respect to bleeding and transfusion-related endpoints, and who did not meet exclusion criteria. Exclusion criteria included: patients whose smoking status did not fit in our two categories, patients with underlying coagulopathy, patients receiving anticoagulants (including aspirin and platelet inhibitors), history of hepatic disease, history of platelet disorder or other blood dyscrasias, and patient or family history of any other known bleeding disorder. Smoking history in packs per day was obtained for all subjects. We defined someone as a smoker if the patient reported smoking up until the day of their surgical procedure; nonsmokers were patients who quit smoking at least 6 weeks before surgery or had no history of smoking. We used a binomial grouping for whether patients did or did not receive a transfusion perioperatively. Age, sex, number of levels of discectomies, number of levels decompressed, number of levels fused, and use of instrumentation were recorded. The same approaches were used for transfusions in all patients regardless of smoking history; decisions were made in consultation between the surgeon and the anesthesia team. Absolute indications for transfusion postoperatively were: a hemoglobin less than 7 g/dL, continued symptoms of dizziness, tachycardia, decreased exertional tolerance, or hypotension that failed to respond to fluid resuscitation. Multiple linear regression analyses correcting for the above variables were performed to determine associations with intraoperative blood loss, while logistic regression was used to analyze perioperative transfusion use.

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Section: Discussionmentioning

confidence: 67%

Smoking is Associated with Increased Blood Loss and Transfusion Use After Lumbar Spinal Surgery

McCunniff

Young

Ahmadinia

et al. 2016

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

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“…First, the response rate to our questionnaire was 43%. While this response rate is within the range of other recently published surveys of critical care professionals [37][38][39][40], our study could certainly be limited by sampling bias. Regarding the potential for sampling bias, the large proportion of female questionnaire-recipients (95%), and respondents (94%), is consistent with existing data showing that 96% of United States SLPs are female [14].…”

Section: Discussionmentioning

confidence: 86%

Diagnosis And Treatment Of Post-Extubation Dysphagia: Results From A National Survey

Macht

Wimbish

Clark

et al. 2012

A46. Intensive Care Unit Management and Rapid Response: Provider and Patient Outcomes

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Purpose-This study sought to determine the utilization of speech-language pathologist (SLPs) for the diagnosis and treatment of post-extubation dysphagia in survivors of mechanical ventilation.Methods-We designed, validated, and mailed a survey to 1,966 inpatient SLPs who routinely evaluate patients for post-extubation dysphagia.Results-The majority of SLP diagnostic evaluations (60%; 95% CI = 59-62%) were performed using clinical techniques with uncertain accuracy. Instrumental diagnostic tests (such as fluoroscopy and endoscopy) are more likely to be available at university than community hospitals. After adjusting for hospital size and academic affiliation, instrumental test use varied significantly by geographical region. Treatments for post-extubation dysphagia usually involved dietary adjustment (76%; 95% CI = 73-79%) and postural changes/compensatory maneuvers (86%; 95% CI = 84-88%), rather than on interventions aimed to improve swallowing function (24%; 95% CI = 21-27%).

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“…Since this study, pre-hospital trauma care, 30 surgical management of trauma, 54 and intensive care staffing 55 have all evolved, and Canadian physicians have adopted a more conservative approach to red blood cell transfusion in critically ill patients. 56 However, the trend to declining injury-related deaths in Canada during the study period may be due to prevention initiatives rather than to advances in the care of trauma patients. 2 In addition, the evidence base, attitudes, beliefs, and practices for transfusion in acute trauma resuscitation are not wellcharacterized.…”

Section: Discussionmentioning

confidence: 99%

Early massive transfusion in trauma patients: Canadian single-centre retrospective cohort study

Mahambrey

Fowler

Pinto

et al. 2009

Can J Anesth/J Can Anesth

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Purpose To determine associations between red blood cell (RBC) transfusion and early and late clinical outcomes in massively transfused adult trauma patients. Methods A retrospective cohort study (1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001) including 260 patients receiving C10 RBC units B24 hr after admission to a university-affiliated trauma centre. We extracted demographic and clinical data and used multivariable regression to determine independent effects of RBC transfusion on clinical outcomes. ]).Conclusions Hospital mortality is high among massively transfused trauma patients. Among early survivors, 48-hr RBC transfusion volume is associated with increased organ dysfunction, but not hospital mortality. Also, it is not associated with 48-hr mortality. Future research should continue to explore methods to improve hemostasis and minimize the need for RBC transfusion. RésuméObjectif De´terminer les associations qui existent entre la transfusion d'e´rythrocytes et les devenirs cliniques R. A. Fowler and N. K. J. Adhikari contributed equally to this study.

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Revisiting transfusion practices in critically ill patients*

Abstract: Canadian physicians appear to have adopted lower transfusion triggers and an increase in the use of single-unit red cell transfusion.

Cited by 76 publications

References 19 publications

Smoking is Associated with Increased Blood Loss and Transfusion Use After Lumbar Spinal Surgery

Smoking is Associated with Increased Blood Loss and Transfusion Use After Lumbar Spinal Surgery

Diagnosis And Treatment Of Post-Extubation Dysphagia: Results From A National Survey

Early massive transfusion in trauma patients: Canadian single-centre retrospective cohort study

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