ABSTRACT
La hemorragia masiva es una entidad frecuente que se asocia a una elevada morbimortalidad. Ante la necesidad de la implementación y estandarización de su manejo, se realizó una revisión sistemática de la literatura, con extracción de recomendaciones en base a las evidencias existentes. A partir de las mismas se redactó un documento de consenso multidisciplinar. Desde las definiciones de hemorragia masiva y transfusión masiva, se establecen recomendaciones de actuación estructuradas en las medidas generales de manejo de las mismas (valoración clínica de la hemorragia, manejo de la hipotermia, reposición de la volemia, reanimación hipotensiva y cirugía de contención de daños), monitorización de la volemia, administración de hemocomponentes (concentrado de hematíes, plasma fresco, plaquetas, y óptima relación de administración entre ellos), y de hemostáticos (complejo protrombínico, fibrinógeno, factor VIIa, antifibrinolíticos) (AU)
Massive haemorrhage is common and often associated with high morbidity and mortality. We perform a systematic review of the literature, with extraction of the recommendations from the existing evidences because of the need for its improvement and the management standardization. From the results we found, we wrote a multidisciplinary consensus document. We begin with the agreement in the definitions of massive haemorrhage and massive transfusion, and we do structured recommendations on their general management (clinical assessment of bleeding, hypothermia management, fluid therapy, hypotensive resuscitation and damage control surgery), blood volume monitoring, blood products transfusion (red blood cells, fresh frozen plasma, platelets and their best transfusion ratio), and administration of hemostatic components (prothrombin complex, fibrinogen, factor VIIa, antifibrinolytic agents) (AU)
Subject(s)
Humans , Male , Female , Hemorrhage/blood , Hemorrhage/metabolism , Blood Transfusion/methods , Plasma/metabolism , Anesthesia/methods , Cardiopulmonary Resuscitation/methods , Thrombosis/blood , Hypothermia/diagnosis , Hemorrhage/complications , Hemorrhage/diagnosis , Blood Transfusion , Plasma/cytology , Anesthesia/classification , Cardiopulmonary Resuscitation/standards , Thrombosis/genetics , Hypothermia/complicationsABSTRACT
Massive haemorrhage is common and often associated with high morbidity and mortality. We perform a systematic review of the literature, with extraction of the recommendations from the existing evidences because of the need for its improvement and the management standardization. From the results we found, we wrote a multidisciplinary consensus document. We begin with the agreement in the definitions of massive haemorrhage and massive transfusion, and we do structured recommendations on their general management (clinical assessment of bleeding, hypothermia management, fluid therapy, hypotensive resuscitation and damage control surgery), blood volume monitoring, blood products transfusion (red blood cells, fresh frozen plasma, platelets and their best transfusion ratio), and administration of hemostatic components (prothrombin complex, fibrinogen, factor VIIa, antifibrinolytic agents).
Subject(s)
Hemorrhage , Antifibrinolytic Agents/therapeutic use , Consensus , Hemorrhage/drug therapy , Humans , Resuscitation/adverse effects , Transfusion ReactionABSTRACT
La hemorragia masiva es una entidad frecuente que se asocia a una elevada morbimortalidad. Ante la necesidad de la implementación y estandarización de su manejo, se realizó una revisión sistemática de la literatura, con extracción de recomendaciones en base a las evidencias existentes. A partir de las mismas se redactó un documento de consenso multidisciplinar. Desde las definiciones de hemorragia masiva y transfusión masiva, se establecen recomendaciones de actuación estructuradas en las medidas generales de manejo de las mismas (valoración clínica de la hemorragia, manejo de la hipotermia, reposición de la volemia, reanimación hipotensiva y cirugía de contención de daños), monitorización de la volemia, administración de hemocomponentes (concentrado de hematíes, plasma fresco, plaquetas, y óptima relación de administración entre ellos), y de hemostáticos (complejo protrombínico, fibrinógeno, factor VIIa, antifibrinolíticos) (AU)
Massive haemorrhage is common and often associated with high morbidity and mortality. We perform a systematic review of the literature, with extraction of the recommendations from the existing evidences because of the need for its improvement and the management standardization. From the results we found, we wrote a multidisciplinary consensus document. We begin with the agreement in the definitions of massive haemorrhage and massive transfusion, and we do structured recommendations on their general management (clinical assessment of bleeding, hypothermia management, fluid therapy, hypotensive resuscitation and damage control surgery), blood volume monitoring, blood products transfusion (red blood cells, fresh frozen plasma, platelets and their best transfusion ratio), and administration of hemostatic components (prothrombin complex, fibrinogen, factor VIIa, antifibrinolytic agents) (AU)
Subject(s)
Humans , Shock, Hemorrhagic/diagnosis , Shock, Hemorrhagic/therapy , Hemorrhage/therapy , Indicators of Morbidity and Mortality , Critical Care/methods , Intensive Care Units/statistics & numerical data , Blood Transfusion , Blood Component Transfusion , Anticoagulants/therapeutic useABSTRACT
Massive haemorrhage is common and often associated with high morbidity and mortality. We perform a systematic review of the literature, with extraction of the recommendations from the existing evidences because of the need for its improvement and the management standardization. From the results we found, we wrote a multidisciplinary consensus document. We begin with the agreement in the definitions of massive haemorrhage and massive transfusion, and we do structured recommendations on their general management (clinical assessment of bleeding, hypothermia management, fluid therapy, hypotensive resuscitation and damage control surgery), blood volume monitoring, blood products transfusion (red blood cells, fresh frozen plasma, platelets and their best transfusion ratio), and administration of hemostatic components (prothrombin complex, fibrinogen, factor VIIa, antifibrinolytic agents).
Subject(s)
Blood Transfusion , Hemorrhage/therapy , Hemostatic Techniques , Antifibrinolytic Agents/therapeutic use , Brain Injuries, Traumatic/complications , Brain Injuries, Traumatic/therapy , Colloids/administration & dosage , Colloids/therapeutic use , Contraindications , Crystalloid Solutions , Emergencies , Fluid Therapy , Hemorrhage/diagnosis , Hemorrhage/drug therapy , Hemostatics/therapeutic use , Humans , Hypotension/etiology , Hypotension/therapy , Hypothermia/etiology , Hypothermia/therapy , Isotonic Solutions/administration & dosage , Isotonic Solutions/therapeutic use , Plasma Substitutes/therapeutic use , Resuscitation/methods , Shock, Hemorrhagic/drug therapy , Shock, Hemorrhagic/therapy , Triage , Wounds and Injuries/complications , Wounds and Injuries/therapyABSTRACT
La transfusión de sangre alogénica (TSA) no es inocua, y como consecuencia han surgido múltiples alternativas a la misma (ATSA). Existe variabilidad respecto a las indicaciones y buen uso de las ATSA. Dependiendo de la especialidad de los médicos que tratan a los pacientes, el grado de anemia, la política transfusional, la disponibilidad de las ATSA y el criterio personal, estas se usan de forma variable. Puesto que las ATSA tampoco son inocuas y pueden no cumplir criterios de coste-efectividad, la variabilidad en su uso es inaceptable. Las sociedades españolas de Anestesiología y Reanimación (SEDAR), Hematología y Hemoterapia(SEHH), Farmacia Hospitalaria (SEFH), Medicina Intensiva y Unidades Coronarias(SEMICYUC), Trombosis y Hemostasia (SETH) y Transfusiones Sanguíneas (SETS) han elaborado un documento de consenso para el buen uso de la ATSA. Un panel de expertos de las 6sociedades ha llevado a cabo una revisión sistemática de la literatura médica y elaborado el 2013. Documento Sevilla de Consenso sobre Alternativas a la Transfusión de Sangre Alogénica. Solo se contempla las ATSA dirigidas a disminuir la transfusión de concentrado de hematíes. Se definen las ATSA como toda medida farmacológica y no farmacológica encaminada a disminuir la transfusión de concentrado de hematíes, preservando siempre la seguridad del paciente. La cuestión principal que se plantea en cada ítem se formula, en forma positiva o negativa, como: La ATSA en cuestión reduce/no reduce la tasa transfusional». Para formular el grado de recomendación se ha usado la metodología Grades of Recommendation Assessment, Development and Evaluation (GRADE) (AU)
Since allogeneic blood transfusion (ABT) is not harmless, multiple alternatives to ABT (AABT) have emerged, though there is great variability in their indications and appropriate use. This variability results from the interaction of a number of factors, including the specialty of the physician, knowledge and preferences, the degree of anemia, transfusion policy, and AABT availability. Since AABTs are not harmless and may not meet cost-effectiveness criteria, such variability is unacceptable. The Spanish Societies of Anesthesiology (SEDAR), Hematology and Hemotherapy (SEHH), Hospital Pharmacy (SEFH), Critical Care Medicine (SEMICYUC), Thrombosis and Hemostasis (SETH)and Blood Transfusion (SETS) have developed a Consensus Document for the proper use of AABTs. A panel of experts convened by these 6 Societies have conducted a systematic review of the medical literature and have developed the 2013 Seville Consensus Document on Alternatives to Allogeneic Blood Transfusion, which only considers those AABT aimed at decreasing the transfusion of packed red cells. AABTs are defined as any pharmacological or non-pharmacological measure aimed at decreasing the transfusion of red blood cell concentrates, while preserving patient safety. For each AABT, the main question formulated, positively or negatively, is: Does this particular AABT reduce the transfusion rate or not? All the recommendations on the use of AABTs were formulated according to the Grades of Recommendation Assessment, Development and Evaluation(GRADE) methodology (AU)
Subject(s)
Humans , Blood Transfusion, Autologous , Blood Transfusion/methods , Blood Substitutes/therapeutic use , Anemia/therapy , Glycated Hemoglobin/therapeutic use , Fibrinogen/therapeutic use , Practice Patterns, Physicians'ABSTRACT
La transfusión de sangre alogénica (TSA) no es inocua, y como consecuencia han surgido múltiples alternativas a la misma (ATSA). Existe variabilidad respecto a las indicaciones y buen uso de las ATSA. Dependiendo de la especialidad de los médicos que tratan a los pacientes, el grado de anemia, la política transfusional, la disponibilidad de las ATSA y el criterio personal, estas se usan de forma variable. Puesto que las ATSA tampoco son inocuas y pueden no cumplir criterios de coste-efectividad, la variabilidad en su uso es inaceptable. Las sociedades españolas de Anestesiología y Reanimación (SEDAR), Hematología y Hemoterapia (SEHH), Farmacia Hospitalaria (SEFH), Medicina Intensiva y Unidades Coronarias (SEMICYUC), Trombosis y Hemostasia (SETH) y Transfusiones Sanguíneas (SETS) han elaborado un documento de consenso para el buen uso de la ATSA. Un panel de expertos de las 6 sociedades ha llevado a cabo una revisión sistemática de la literatura médica y elaborado el 2013. Documento Sevilla de Consenso sobre Alternativas a la Transfusión de Sangre Alogénica. Solo se contempla las ATSA dirigidas a disminuir la transfusión de concentrado de hematíes. Se definen las ATSA como toda medida farmacológica y no farmacológica encaminada a disminuir la transfusión de concentrado de hematíes, preservando siempre la seguridad del paciente. La cuestión principal que se plantea en cada ítem se formula, en forma positiva o negativa, como: «La ATSA en cuestión reduce/no reduce la tasa transfusional». Para formular el grado de recomendación se ha usado la metodología Grades of Recommendation Assessment, Development and Evaluation (GRADE) (AU)
Since allogeneic blood transfusion (ABT) is not harmless, multiple alternatives to ABT (AABT) have emerged, though there is great variability in their indications and appropriate use. This variability results from the interaction of a number of factors, including the specialty of the physician, knowledge and preferences, the degree of anemia, transfusion policy, and AABT availability. Since AABTs are not harmless and may not meet cost-effectiveness criteria, such variability is unacceptable. The Spanish Societies of Anesthesiology (SEDAR), Hematology and Hemotherapy (SEHH), Hospital Pharmacy (SEFH), Critical Care Medicine (SEMICYUC), Thrombosis and Hemostasis (SETH) and Blood Transfusion (SETS) have developed a Consensus Document for the proper use of AABTs. A panel of experts convened by these 6 Societies have conducted a systematic review of the medical literature and have developed the 2013 Seville Consensus Document on Alternatives to Allogeneic Blood Transfusion, which only considers those AABT aimed at decreasing the transfusion of packed red cells. AABTs are defined as any pharmacological or non-pharmacological measure aimed at decreasing the transfusion of red blood cell concentrates, while preserving patient safety. For each AABT, the main question formulated, positively or negatively, is: "Does this particular AABT reduce the transfusion rate or not?" All the recommendations on the use of AABTs were formulated according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) methodology (AU)
Subject(s)
Humans , Male , Female , Transplantation, Homologous/instrumentation , Transplantation, Homologous/methods , Transplantation, Homologous , Cost-Benefit Analysis/organization & administration , Cost-Benefit Analysis/standards , Cost-Benefit Analysis , Evaluation of the Efficacy-Effectiveness of Interventions , Anesthesiology/methods , Transplantation, Homologous/standards , Transplantation, Homologous/trends , 50303 , Anesthesiology/organization & administration , Anesthesiology/standards , Erythrocyte Transfusion/trends , Erythrocyte TransfusionABSTRACT
Since allogeneic blood transfusion (ABT) is not harmless, multiple alternatives to ABT (AABT) have emerged, though there is great variability in their indications and appropriate use. This variability results from the interaction of a number of factors, including the specialty of the physician, knowledge and preferences, the degree of anemia, transfusion policy, and AABT availability. Since AABTs are not harmless and may not meet cost-effectiveness criteria, such variability is unacceptable. The Spanish Societies of Anesthesiology (SEDAR), Hematology and Hemotherapy (SEHH), Hospital Pharmacy (SEFH), Critical Care Medicine (SEMICYUC), Thrombosis and Hemostasis (SETH) and Blood Transfusion (SETS) have developed a Consensus Document for the proper use of AABTs. A panel of experts convened by these 6 Societies have conducted a systematic review of the medical literature and have developed the 2013 Seville Consensus Document on Alternatives to Allogeneic Blood Transfusion, which only considers those AABT aimed at decreasing the transfusion of packed red cells. AABTs are defined as any pharmacological or non-pharmacological measure aimed at decreasing the transfusion of red blood cell concentrates, while preserving patient safety. For each AABT, the main question formulated, positively or negatively, is: « Does this particular AABT reduce the transfusion rate or not?¼ All the recommendations on the use of AABTs were formulated according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) methodology.
Subject(s)
Blood Transfusion/standards , Complementary Therapies , Humans , Patient Safety , Surgical Procedures, OperativeABSTRACT
Since allogeneic blood transfusion (ABT) is not harmless, multiple alternatives to ABT (AABT) have emerged, though there is great variability in their indications and appropriate use. This variability results from the interaction of a number of factors, including the specialty of the physician, knowledge and preferences, the degree of anemia, transfusion policy, and AABT availability. Since AABTs are not harmless and may not meet cost-effectiveness criteria, such variability is unacceptable. The Spanish Societies of Anesthesiology (SEDAR), Hematology and Hemotherapy (SEHH), Hospital Pharmacy (SEFH), Critical Care Medicine (SEMICYUC), Thrombosis and Hemostasis (SETH) and Blood Transfusion (SETS) have developed a Consensus Document for the proper use of AABTs. A panel of experts convened by these 6 Societies have conducted a systematic review of the medical literature and have developed the 2013 Seville Consensus Document on Alternatives to Allogeneic Blood Transfusion, which only considers those AABT aimed at decreasing the transfusion of packed red cells. AABTs are defined as any pharmacological or non-pharmacological measure aimed at decreasing the transfusion of red blood cell concentrates, while preserving patient safety. For each AABT, the main question formulated, positively or negatively, is: "Does this particular AABT reduce the transfusion rate or not?" All the recommendations on the use of AABTs were formulated according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) methodology.
Subject(s)
Bloodless Medical and Surgical Procedures/standards , Humans , Practice Guidelines as TopicABSTRACT
Objetivo. Comparar la morbilidad y la mortalidad de los pacientes de cirugía cardíaca de acuerdo a la edad inferior o superior a 75 años. Diseño. Estudio descriptivo retrospectivo. Pacientes. Dos mil cuatrocientos setenta pacientes consecutivos ingresados en el postoperatorio inmediato tras cirugía cardíaca en nuestra Unidad de Medicina Intensiva entre noviembre de 2000 y diciembre de 2005. De ellos, 1.983 eran menores de 75 años y 497 mayores de 75 años. Se han incluido todos los pacientes con cirugía, tanto programada como urgente y emergente. Principales variables de interés. Factores de riesgo cardiovascular (diabetes mellitus, hipertensión arterial y dislipidemia), European System for Cardiac Operative Risk Evaluation (EuroSCORE) y EuroSCORE logístico, estancia, mortalidad, complicaciones durante la estancia en la Unidad de Cuidados Intensivos (UCI). Resultados. La mortalidad hospitalaria de los pacientes mayores de 74 años fue significativamente superior (9,2% frente a 4,3%, p < 0,05). La morbilidad de los pacientes mayores de 74 también fue superior (EuroSCORE 8,2 ± 2,7 frente a 4,9 ± 3,3, p < 0,001). Tanto la estancia en la UCI como la estancia hospitalaria fueron significativamente superiores en los pacientes mayores de 74 años. Conclusiones. En nuestra serie tanto la morbilidad como la mortalidad de los mayores de 74 es superior, lo que conlleva peores resultados en la cirugía cardíaca de estos pacientes
Objective. To compare morbidity and mortality of cardiac surgery patients according to age below or above 75 years. Design. Descriptive retrospective study. Patients. A total of 2,470 consecutive patients admitted to our Intensive Medicine Unit between November 2000 and December 2005 who were in the immediate postoperative period after cardiac surgery. Of these patients, 1,983 were younger than 75 years and 497 were older than 75 years. Main variables of interest. Cardiovascular risk factors (diabetes mellitus, arterial hypertension and dyslipidemia), EuroSCORE (European System for Cardiac Operative Risk Evaluation) and logistic EuroSCORE, length of stay, mortality, complications during Intensive Care Unit (ICU) stay. Results. In-hospital mortality of patients older than 74 years was significantly higher (9.2% versus 4.2%, p < 0.05). The morbidity of patients over 74 years of age was also significantly higher (EuroSCORE 8.2 ± 2.7 versus 4.9 ± 3.3, p < 0.001). Both ICU stay and hospital stay were significantly higher in those over 74 years of age. Conclusions. In our series both morbidity and mortality were higher in those older than 74 years of age group, which entails worse results in cardiac surgery of these patients
Subject(s)
Humans , Male , Female , Aged , Cardiac Surgical Procedures/statistics & numerical data , Heart Diseases/surgery , Heart Diseases/epidemiology , Retrospective Studies , Thoracotomy , Extracorporeal Circulation , Postoperative Care/methods , Postoperative Complications/epidemiology , MortalityABSTRACT
OBJECTIVE: To compare morbidity and mortality of cardiac surgery patients according to age below or above 75 years. DESIGN: Descriptive retrospective study. PATIENTS: A total of 2,470 consecutive patients admitted to our Intensive Medicine Unit between November 2000 and December 2005 who were in the immediate postoperative period after cardiac surgery. Of these patients, 1,983 were younger than 75 years and 497 were older than 75 years. MAIN VARIABLES OF INTEREST: Cardiovascular risk factors (diabetes mellitus, arterial hypertension and dyslipidemia), EuroSCORE (European System for Cardiac Operative Risk Evaluation) and logistic EuroSCORE, length of stay, mortality, complications during Intensive Care Unit (ICU) stay. RESULTS: In-hospital mortality of patients older than 74 years was significantly higher (9.2% versus 4.2%, p < 0.05). The morbidity of patients over 74 years of age was also significantly higher (EuroSCORE 8.2 +/- 2.7 versus 4.9 +/- 3.3, p < 0.001). Both ICU stay and hospital stay were significantly higher in those over 74 years of age. CONCLUSIONS: In our series both morbidity and mortality were higher in those older than 74 years of age group, which entails worse results in cardiac surgery of these patients.
Subject(s)
Cardiac Surgical Procedures/adverse effects , Age Factors , Aged , Female , Humans , Male , Middle Aged , Postoperative Complications/epidemiology , Retrospective Studies , Risk FactorsSubject(s)
Streptococcal Infections , Streptococcus pyogenes , Fasciitis/microbiology , Humans , Necrosis/microbiology , Penicillin Resistance , Streptococcal Infections/diagnosis , Streptococcal Infections/drug therapy , Streptococcal Infections/physiopathology , Streptococcus pyogenes/drug effects , Streptococcus pyogenes/pathogenicity , VirulenceSubject(s)
Ciprofloxacin/adverse effects , Critical Care , Delirium/chemically induced , Hallucinations/chemically induced , Adult , Ciprofloxacin/therapeutic use , Clindamycin/therapeutic use , Drug Therapy, Combination/therapeutic use , Humans , Male , Shock, Septic/drug therapy , Tremor/chemically inducedABSTRACT
We report the case of a female patient who developed a clinical picture characterized by hemodynamic deterioration, bradycardia and asystole due to pulmonary hyperinsufflation (documented by X-ray examination) during the immediate postoperative phase of a right pneumonectomy. Occlusion of the respiratory limb of the respirator was followed by a positive pressure at the end of the respiration (PEEP) suggesting the presence of an intrinsic PEEP independent of the respirator. Application of a PEEP to the respirator induced a radiologic improvement. The mechanisms by which an intrinsic PEEP may develop are discussed.
Subject(s)
Bradycardia/etiology , Heart Arrest/etiology , Pneumonectomy , Postoperative Complications/physiopathology , Pulmonary Ventilation , Respiration, Artificial/adverse effects , Adenocarcinoma/surgery , Aged , Bradycardia/physiopathology , Female , Heart Arrest/physiopathology , Humans , Lung Neoplasms/surgery , Pulmonary Edema/etiology , Pulmonary Edema/physiopathologyABSTRACT
The clinical and bacteriological characteristics of eight cases with purulent pericarditis observed over the last five years are studied. The route of the infection and dissemination in the majority of the cases (75 percent) was through pleuropulmonary lesions in the form of pneumonia and/or empyema, attributing the remaining cases to a subhepatic abscess and a pericardial infection after a thoracic surgical operation. In seven patients the diagnosis of the disease was established while they were alive. The more orientative clinical data were the pericardial pain (50 percent), pericardial friction murmur (25 percent), and signs of cardiac tamponade (62.5 percent). The observation of the above mentioned clinical signs together with the presence of cardiomegaly and electrocardiographic alterations suggestive of pericarditis, obliged the practice of a pericardial puncture, which confirmed the diagnosis of a purulent pericarditis by the macro and microscopic characteristics of the fluid. Staphylococcus and pneumoncoccus were isolated in two cases, respectively; other Gram-negative bacillus (E. coli and Pseudomonas aeruginosa) were isolated in the remaining cases. All patients were treated with the appropriate antibiotic according to the isolated germ; surgical drainage was carried out in six cases, and a pericardiectomy in one. Two patients died, one as a consequence of a septic myocardiopathy and the other in which the diagnosis of purulent pericarditis was not clinically suspected. During the follow-up period one case presented a constrictive pericarditis, which was corrected by a pericardiectomy.
