Tromboelastometría como guía de administración de hemoderivados en cirugía cardiaca / Thromboelastometry as guidance for blood management in patients undergoing cardiac surgery

Objetivo. La tromboelastometría evalúa la coagulación analizando la viscoelasticidad de una muestra de sangre. Nuestro objetivo principal fue evaluar los resultados de su uso como guía de administración de hemoderivados en cirugía cardiaca y, secundariamente, las complicaciones postoperatorias y el tiempo de hospitalización en UCI. Material y método. Estudio analítico, de intervención, cuasiexperimental, comparativo, no aleatorizado, prospectivo, con un grupo control retrospectivo. Se incluyeron 80 pacientes reintervenidos de cualquier cirugía cardiaca, o cirugías por endocarditis o del arco aórtico. En 31 pacientes los hemoderivados intraoperatorios se administraron según pautas clínicas tradicionales (grupo A). Los 49 pacientes restantes recibieron hemoderivados siguiendo algoritmos basados en el análisis tromboelastométrico (grupo B). El objetivo principal fue la administración de hemoderivados y los objetivos secundarios fueron: estancia en UCI y complicaciones postoperatorias. Resultados. Hubo una importante disminución en la administración de plasma fresco congelado en el grupo B respecto al A (p<0,001), así como una disminución en la transfusión intraoperatoria de sangre: 3,9 concentrados de hematíes de media por paciente en el grupo A frente a 2,67 en el grupo B (p=0,125). Se incrementó la administración de fibrinógeno, con una p<0,019. Se encontró una menor tasa de complicaciones respiratorias (p=0,019) en el grupo B y una reducción significativa de las estancias mayores de 7 días en el grupo B respecto al A (p=0,031). Conclusiones. La tromboelastometría condujo a una importante disminución en la utilización de plasma fresco congelado, contribuyendo muy probablemente al descenso en la incidencia de complicaciones respiratorias y en la menor estancia en UCI (AU)

Objective. Thromboelastometry is a viscoelastometric method for haemostasis testing in a whole blood sample. The aim of this study was to assess the results of using thromboelastometry as guidance for blood management in cardiac surgery, postoperative adverse events and ICU stay. Material and method. Analytical and comparative non-randomised quasi-experimental prospective study with a retrospective control group. The inclusion criteria for the 80 patients were: patients undergoing cardiac surgery who had had prior cardiac surgery, endocarditis surgery or aortic arch surgery. Thirty-one patients were treated following routine transfusion practice during surgery (group A). The other 49 patients were treated with thromboelastometrically guided transfusion algorithms (group B). The main objective was blood products transfused, and postoperative adverse events and ICU stay were the secondary objectives. Results. Statistical analysis showed lower transfusion rates of fresh-frozen plasma in group B compared to group A (P<.001), as well as red blood cell transfusion during surgery with an average transfusion rate of 3.9 units in group A in comparison to 2.67 units in group B (P=.125). Moreover, fibrinogen infusion was increased in group B compared to group A (P=.019). In addition, a lower rate of respiratory adverse events was found in group B (P=.019). There was a significant decrease in ICU stays over 7 days in group B compared to group A (P=.031). Conclusions. Using thromboelastometry guidance for blood management led to a meaningful reduction of fresh frozen plasma transfusion during surgery. This probably resulted in a reduction in respiratory adverse events after surgery and length of ICU stay in our patients (AU)

Thromboelastometry as guidance for blood management in patients undergoing cardiac surgery. / Tromboelastometría como guía de administración de hemoderivados en cirugía cardiaca.

OBJECTIVE: Thromboelastometry is a viscoelastometric method for haemostasis testing in a whole blood sample. The aim of this study was to assess the results of using thromboelastometry as guidance for blood management in cardiac surgery, postoperative adverse events and ICU stay. MATERIAL AND METHOD: Analytical and comparative non-randomised quasi-experimental prospective study with a retrospective control group. The inclusion criteria for the 80 patients were: patients undergoing cardiac surgery who had had prior cardiac surgery, endocarditis surgery or aortic arch surgery. Thirty-one patients were treated following routine transfusion practice during surgery (group A). The other 49 patients were treated with thromboelastometrically guided transfusion algorithms (group B). The main objective was blood products transfused, and postoperative adverse events and ICU stay were the secondary objectives. RESULTS: Statistical analysis showed lower transfusion rates of fresh-frozen plasma in group B compared to group A (P<.001), as well as red blood cell transfusion during surgery with an average transfusion rate of 3.9 units in group A in comparison to 2.67 units in group B (P=.125). Moreover, fibrinogen infusion was increased in group B compared to group A (P=.019). In addition, a lower rate of respiratory adverse events was found in group B (P=.019). There was a significant decrease in ICU stays over 7 days in group B compared to group A (P=.031). CONCLUSIONS: Using thromboelastometry guidance for blood management led to a meaningful reduction of fresh frozen plasma transfusion during surgery. This probably resulted in a reduction in respiratory adverse events after surgery and length of ICU stay in our patients.

Actualización de las técnicas laringoscópicas en anestesiología y reanimación / Updating of the laryngoscopy methods in anaesthesia

Los autores realizan una revisión y actualización de los dispositivos que a lo largo de los años han permitido la intubación endotraqueal. Junto a modificaciones puramente anecdóticas se han desarrollado innumerables modificaciones de la pala del laringoscopio o de sus articulaciones, algunas de las cuales han supuesto un importante avance en la laringoscopia. Se describen laringoscopios rígidos, fibrolaringoscopios rígidos, fibrolaringoscopia flexible, dispositivos supraglóticos, estiletes fibro-ópticos y accesorios que facilitan la intubación endotraqueal. Se hace mención de todos y cada uno de dichos dispositivos y accesorios, así como de su utilidad y experiencia clínica

The authors have performed a review of the devices that over the years have allowed the intubation of the trachea. Apart from anecdotal modifications, many modifications of the laryngoscopeblade or of its articulations have been developed, many of them have resulted in an important advance in the laryngoscopy. Rigid laringoscopes, rigid fibre optic laryngoscopes, flexible fibre optic intubation, supraglotic devices, fibre optic stylets and accesories are reviewed. Mention is made of all these devices and accesories, as well as their utility and clinical experience