Transfusion
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The objective of this study was to determine the incidence, risk factors, and outcome of transfusion-associated circulatory overload (TACO) in a cohort of mixed intensive care unit patients and to compare risk factors with those for cardiac overload in the absence of transfusion. ⋯ The incidence of TACO is high in a mixed intensive care unit population. The risk factors identified for TACO are cardiac failure, renal failure, and degree of positive fluid balance. A positive fluid balance may be less essential in the onset of TACO than in the onset of circulatory overload in the absence of transfusion.
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The risks and benefits of red blood cell (RBC) transfusion in palliative care patients remain poorly understood. We reviewed the literature to summarize available information on RBC transfusion in this population. ⋯ In palliative care, RBC transfusion may provide symptom relief and improve subjective well-being, though the duration and magnitude of this effect, and transfusion-associated risks specific to this population remain unclear. Currently, no high quality evidence exists to support or guide the use of RBC transfusion in this population. Moreover, the clinical heterogeneity within the palliative population limits the interpretation of most studies.
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Comparative Study
Blood utilization in revision versus first-time cardiac surgery: an update in the era of patient blood management.
Relative to first-time (primary) cardiac surgery, revision cardiac surgery is associated with increased transfusion requirements, but studies comparing these cohorts were performed before patient blood management (PBM) and blood conservation measures were commonplace. The current study was performed as an update to determine if this finding is still evident in the PBM era. ⋯ In the era of PBM, with restrictive transfusion strategies and a variety of methods for blood conservation, revision cardiac surgery patients continue to have substantially greater transfusion requirements relative to primary cardiac surgery patients. This difference in transfusion requirement was greater than what has been previously reported in the pre-PBM era.
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Multicenter Study Observational Study
Preoperative management of colorectal cancer-induced iron deficiency anemia in clinical practice: data from a large observational cohort.
Preoperative anemia prevalence among colorectal cancer (CRC) patients is high and may adversely influence postoperative outcome. This study assesses the efficacy of a preoperative anemia managing protocol in CRC. ⋯ Compared to standard care, IVI was more effective in treating preoperative anemia in CRC patients and appeared to reduce infection rate, although it did not reduce postoperative RBCT.
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Major bleeding in orthotopic liver transplantation is associated with significant morbidity and mortality. Limited literature exists regarding comparative effectiveness of prothrombin complex concentrate and fibrinogen concentrate during orthotopic liver transplantation on blood product utilization. ⋯ The intraoperative use of prothrombin complex concentrate and fibrinogen concentrate during orthotopic liver transplantation did not reduce intraoperative blood product requirements at a single institution.