Anaesthesia
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As COVID-19 disease escalates globally, optimising patient outcome during this catastrophic healthcare crisis is the number one priority. The principles of patient blood management are fundamental strategies to improve patient outcomes and should be given high priority in this crisis situation. The aim of this expert review is to provide clinicians and healthcare authorities with information regarding how to apply established principles of patient blood management during the COVID-19 pandemic. ⋯ We discuss how preventative and control measures implemented during the COVID-19 crisis could affect the prevalence of anaemia, and highlight issues regarding the diagnosis and treatment of anaemia in patients requiring elective or emergency surgery. In addition, we review aspects related to patient blood management of critically ill patients with known or suspected COVID-19, and discuss important alterations of the coagulation system in patients hospitalised due to COVID-19. Finally, we address special considerations pertaining to supply-demand and cost-benefit issues of patient blood management during the COVID-19 pandemic.
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An editorial on pandemic information overload?
Yep. 😉
But setting aside the irony of adding 2,000 more words on COVID-19 information overload, Kearsley & Duffy neatly explore the challenge:
"Since the outbreak of this pandemic, our e-mail inboxes, social media feeds and even general news outlets have become saturated with new guidelines, revisions of guidelines, new protocols and updated protocols, all subject to constant amendments."
What's the thesis?
The authors' argument is that too much information in the era of COVID may be a bad thing: the marginal benefit of 'more' may be overwhelmed by the negative cost.
They acknowledge the tension between the pragmatic and perfect when it comes to information sources in the face of a rapidly advancing disease – and in particular the recurrent waves of shifting clinical guidelines.
Kearsley & Duffy mention the important role of rapid research, worryingly tempered by a surge in volume, but fall in quality, along with mainstream promotion of non-peer reviewed and pre-print investigations. They note how information technology in the pandemic climate exploits our biases: confirmation, anchoring, and novelty.
At an individual level they discuss the risk of pandemic 'alert fatigue', the growth of social media and excessive information sharing making quality assessment difficult, and the negative effect of both on well-being.
The take-home
We each have significant personal responsibility to consider the consequences when sharing information, especially if incomplete or risk of misunderstanding when stripped of context.
summary"As we learn to live with this virus it is important for us to be cognisant that we are all at risk of error; we need to work to reduce information overload and focus on unifying our approach to both information dissemination and presentation. We must go back to basics and apply the well-practiced human factors principles of good teamwork, communication and leadership.
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We need to avoid a situation where a crisis is overmanaged and underlead; “Ipsa scientia potestas est" or 'knowledge itself is power' – from what COVID-19 is teaching us however, can too much knowledge be a bad thing?"
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Multicenter Study Observational Study
Peri-operative administration of tranexamic acid in lower limb arthroplasty: a multicentre, prospective cohort study.
In the UK, tranexamic acid is recommended for all surgical procedures where expected blood loss exceeds 500 ml. However, the optimal dose, route and timing of administration are not known. This study aimed to evaluate current practice of peri-operative tranexamic acid administration. ⋯ Current standard of care in the UK is to administer 1000 mg of tranexamic intravenously either pre- or intra-operatively. Approximately one-third of patients present for surgery with anaemia, although the overall red blood cell transfusion rate is low. These data provide useful comparators when assessing the efficacy of tranexamic acid and other patient blood management interventions in future studies.
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In patients with pre-operative anaemia undergoing cardiac surgery, combination treatment with intravenous iron, subcutaneous erythropoietin alpha, vitamin B12 and oral folic acid reduces allogeneic blood product transfusions. It is unclear if certain types of anaemia particularly benefit from this treatment. We performed a post-hoc analysis of anaemic patients from a randomised trial on the 'Effect of ultra-short-term treatment of patients with iron deficiency or anaemia undergoing cardiac surgery'. ⋯ Baseline ferritin and endogenous erythropoietin were negatively associated with change in reticulocyte count on postoperative day 5, with an unstandardised regression coefficient B of -0.08 (95%CI -0.14 to -0.02) and -0.14 (95%CI -0.23 to -0.06), respectively. Quadruple anaemia treatment was effective regardless of the cause of anaemia and its effect manifested early in the peri-operative recovery phase. The more pronounced a deficiency was, the stronger the subsequent boost to erythropoiesis may have been.