RÉSUMÉ
INTRODUCTION: Preoperative anemia affects approximately one third of surgical patients. It increases the risk of blood transfusion and influences short- and medium-term functional outcomes, increases comorbidities, complications and costs. The "Patient Blood Management" (PBM) programs, for integrated and multidisciplinary management of patients, are considered as paradigms of quality care and have as one of the fundamental objectives to correct perioperative anemia. PBM has been incorporated into the schemes for intensified recovery of surgical patients: the recent Enhanced Recovery After Surgery 2021 pathway (in Spanish RICA 2021) includes almost 30 indirect recommendations for PBM. OBJECTIVE: To make a consensus document with RAND/UCLA Delphi methodology to increase the penetration and priority of the RICA 2021 recommendations on PBM in daily clinical practice. MATERIAL AND METHODS: A coordinating group composed of 6 specialists from Hematology-Hemotherapy, Anesthesiology and Internal Medicine with expertise in anemia and PBM was formed. A survey was elaborated using Delphi RAND/UCLA methodology to reach a consensus on the key areas and priority professional actions to be developed at the present time to improve the management of perioperative anemia. The survey questions were extracted from the PBM recommendations contained in the RICA 2021 pathway. The development of the electronic survey (Google Platform) and the management of the responses was the responsibility of an expert in quality of care and clinical safety. Participants were selected by invitation from speakers at AWGE-GIEMSA scientific meetings and national representatives of PBM-related working groups (Seville Document, SEDAR HTF section and RICA 2021 pathway participants). In the first round of the survey, the anonymized online questionnaire had 28 questions: 20 of them were about PBM concepts included in ERAS guidelines (2 about general PBM organization, 10 on diagnosis and treatment of preoperative anemia, 3 on management of postoperative anemia, 5 on transfusion criteria) and 8 on pending aspects of research. Responses were organized according to a 10-point Likter scale (0: strongly disagree to 10: strongly agree). Any additional contributions that the participants considered appropriate were allowed. They were considered consensual because all the questions obtained an average score of more than 9 points, except one (question 14). The second round of the survey consisted of 37 questions, resulting from the reformulation of the questions of the first round and the incorporation of the participants' comments. It consisted of 2 questions about general organization of PBM programme, 15 questions on the diagnosis and treatment of preoperative anemia; 3 on the management of postoperative anemia, 6 on transfusional criteria and finally 11 questions on aspects pending od future investigations. Statistical treatment: tabulation of mean, median and interquartiles 25-75 of the value of each survey question (Tables 1, 2 and 3). RESULTS: Except for one, all the recommendations were accepted. Except for three, all above 8, and most with an average score of 9 or higher. They are grouped into: 1.- "It is important and necessary to detect and etiologically diagnose any preoperative anemia state in ALL patients who are candidates for surgical procedures with potential bleeding risk, including pregnant patients". 2.- "The preoperative treatment of anemia should be initiated sufficiently in advance and with all the necessary hematinic contributions to correct this condition". 3.- "There is NO justification for transfusing any unit of packed red blood cells preoperatively in stable patients with moderate anemia Hb 8-10g/dL who are candidates for potentially bleeding surgery that cannot be delayed." 4.- "It is recommended to universalize restrictive criteria for red blood cell transfusion in surgical and obstetric patients." 5.- "Postoperative anemia should be treated to improve postoperative results and accelerate postoperative recovery in the short and medium term". CONCLUSIONS: There was a large consensus, with maximum acceptance,strong level of evidence and high recommendation in most of the questions asked. Our work helps to identify initiatives and performances who can be suitables for the implementation of PBM programs at each hospital and for all patients.
Sujet(s)
Anémie , Méthode Delphi , Interventions chirurgicales non urgentes , Humains , Anémie/thérapie , Transfusion sanguine , Soins périopératoires/méthodes , Soins périopératoires/normes , Complications postopératoires/thérapie , Complications postopératoires/épidémiologie , Récupération améliorée après chirurgie/normesRÉSUMÉ
INTRODUCTION: The implementing of the WHO Surgical Safety Checklist (SSC) has helped to improve patient safety. The aim of this study was to assess the level of compliance of the SSC, and incorporating the non-compliances as «triggers¼ in the Global Trigger Tool (GTT). SETTING: Acute Geriatric Hospital (200 beds). Retrospective study, study period: 2011-2014. The SSC formulary and the methodology of the GTT were used for the analysis of electronic medical records and the compliance with the SSC. The NCCP MERP categories were used to assess the severity of the harm. RESULTS: Out of all the electronic medical records (EMR), a total of 227 (23.6%) discharged patients (1.7% of interventions in the four year study period) were analysed. All (100%) of the EMR included the SSC, with 94.4% of the items being completed, and 28.2% of SSC had all items completed in the 3 phases of the process. Surgical adverse events decreased from 16.3% in 2011 to 9.4% in 2014 (P=.2838, not significant), and compliance with all items of SSC was increased from 18.6% to 39.1% (P=.0246, significant). CONCLUSIONS: The GTT systematises and evaluates, at low cost, the triggers and incidents/ AEs found in the EMR in order to assess the compliance with the SSC and consider non-compliance of SSC as «triggers¼ for further analysis. This strategy has never been referred to in the GTT or in the SCC formulary.
Sujet(s)
Liste de contrôle , Adhésion aux directives , Soins préopératoires/normes , Services de santé pour personnes âgées , Hôpitaux spécialisés , Humains , Études rétrospectivesRÉSUMÉ
Introducción. La implantación del listado de verificación quirúrgica (LVQ) por la OMS ha permitido mejorar la seguridad de los pacientes. El objetivo ha sido evaluar el grado de cumplimiento del LVQ incorporando los no cumplimientos como triggers o pistas en la herramienta Global Trigger Tool (GTT). Material y métodos. Ámbito: hospital geriátrico de agudos con 200 camas. Estudio retrospectivo. Periodo de estudio: 2011-2014. Se utilizó el formulario del LVQ y la metodología del GTT para el análisis de historias clínicas y el cumplimiento del LVQ desde el año 2011 hasta el año 2014. Para el grado del daño se usaron las categorías del National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP). Resultados. Se analizaron 227 historias de pacientes dados de alta (23,6%) de todas las historias electrónicas (1,7% de las intervenciones en los 4 años). El 100% de las historias contenían el LVQ, el 94,4% de los ítems estaban cubiertos y 28,2% de los LVQ tenían todos los ítems cumplimentados en las 3 fases del proceso. Los efectos adversos quirúrgicos disminuyeron del 16,3% en el año 2011 al 9,4% en el año 2014 (p=0,2838, no significativo) y el cumplimiento de todos los ítems del LVQ aumentó del 18,6 al 39,1% (p=0,0246, significativo). Conclusiones. La herramienta GTT permite sistematizar con un menor coste de tiempo la búsqueda de historias clínicas al azar para evaluar el cumplimiento del LVQ y considerar a los no cumplimientos del LVQ como triggers para su análisis posterior. Esta estrategia no ha sido nunca contemplada en el GTT ni en la sistemática del LVQ (AU)
Introduction. The implementing of the WHO Surgical Safety Checklist (SSC) has helped to improve patient safety. The aim of this study was to assess the level of compliance of the SSC, and incorporating the non-compliances as «triggers» in the Global Trigger Tool (GTT). Material and methods. Setting: Acute Geriatric Hospital (200 beds). Retrospective study, study period: 2011-2014. The SSC formulary and the methodology of the GTT were used for the analysis of electronic medical records and the compliance with the SSC. The NCCP MERP categories were used to assess the severity of the harm. Results. Out of all the electronic medical records (EMR), a total of 227 (23.6%) discharged patients (1.7% of interventions in the four year study period) were analysed. All (100%) of the EMR included the SSC, with 94.4% of the items being completed, and 28.2% of SSC had all items completed in the 3 phases of the process. Surgical adverse events decreased from 16.3% in 2011 to 9.4% in 2014 (P=.2838, not significant), and compliance with all items of SSC was increased from 18.6% to 39.1% (P=.0246, significant). Conclusions. The GTT systematises and evaluates, at low cost, the triggers and incidents/ AEs found in the EMR in order to assess the compliance with the SSC and consider non-compliance of SSC as «triggers» for further analysis. This strategy has never been referred to in the GTT or in the SCC formulary (AU)
Sujet(s)
Humains , Mâle , Femelle , Sécurité des patients/législation et jurisprudence , Sécurité des patients/normes , Qualité des soins de santé/organisation et administration , Qualité des soins de santé/normes , Formulaires comme sujet/normes , /normes , Qualité des soins de santé , Études rétrospectives , Dossiers médicaux/législation et jurisprudence , Dossiers médicaux/normes , Contrôle des formulaires et des dossiers/normes , 28599RÉSUMÉ
Esta Guía de Práctica Clínica responde a preguntas clínicas sobre seguridad en la elección de fluido (cristaloide, coloide o Hidroxietilalmidón 130) en pacientes que precisan restauración volémica en el periodo perioperatorio de cirugía no cardiaca. A partir del resumen de la evidencia, se elaboraron las recomendaciones siguiendo la metodología GRADE. En esta población se sugiere la fluidoterapia basada en la administración de cristaloides, (recomendación débil, calidad de la evidencia baja). En las situaciones en las que la restauración volémica no se alcance sólo con cristaloides, se sugiere utilizar coloides sintéticos (Hidroxietilalmidón 130 o gelatina fluida modificada) en lugar de Albúmina 5% (recomendación débil, calidad de la evidencia baja). La elección y dosificación de coloide deberán basarse en las características del producto, comorbilidad del paciente y experiencia del anestesiólogo (AU)
The present Clinical practice guide responds to the clinical questions about security in the choice of fluid (crystalloid, colloid or hydroxyethyl starch 130) in patients who require volume replacement during perioperative period of non-cardiac surgeries. From the evidence summary, recommendations were made following the GRADE methodology. In this population fluid therapy based on crystalloids is suggested (weak recommendation, low quality evidence). In the events where volume replacement is not reached with crystalloids, the use of synthetic colloids (hydroxyethyl starch 130 or modified fluid gelatin) is suggested instead of 5% albumin (weak recommendation, low quality evidence). The choice and dosage of the colloid should be based in the product characteristics, patient comorbidity and anesthesiologist's experience (AU)
Sujet(s)
Humains , Mâle , Femelle , Chirurgie thoracique/méthodes , Colloïdes/administration et posologie , Traitement par apport liquidien/méthodes , Préparations pharmaceutiques/administration et posologie , Maladies transmissibles/anatomopathologie , Maladies transmissibles/transmission , Anesthésiques intraveineux/administration et posologie , Anesthésiques intraveineux/métabolisme , Polygéline/métabolisme , Espagne/ethnologie , Chirurgie thoracique/normes , Colloïdes/métabolisme , Traitement par apport liquidien , Préparations pharmaceutiques/métabolisme , Maladies transmissibles/génétique , Maladies transmissibles/métabolisme , Anesthésiques intraveineux/ressources et distribution , Anesthésiques intraveineux/toxicité , PolygélineRÉSUMÉ
The present Clinical practice guide responds to the clinical questions about security in the choice of fluid (crystalloid, colloid or hydroxyethyl starch 130) in patients who require volume replacement during perioperative period of non-cardiac surgeries. From the evidence summary, recommendations were made following the GRADE methodology. In this population fluid therapy based on crystalloids is suggested (weak recommendation, low quality evidence). In the events where volume replacement is not reached with crystalloids, the use of synthetic colloids (hydroxyethyl starch 130 or modified fluid gelatin) is suggested instead of 5% albumin (weak recommendation, low quality evidence). The choice and dosage of the colloid should be based in the product characteristics, patient comorbidity and anesthesiologist's experience.
Sujet(s)
Soins périopératoires , Adulte , Colloïdes/usage thérapeutique , Traitement par apport liquidien , Humains , Hydroxyéthylamidons/usage thérapeutiqueSujet(s)
Hydroxyéthylamidons/effets indésirables , Substituts du plasma/effets indésirables , Insuffisance rénale/induit chimiquement , Europe , Traitement par apport liquidien/effets indésirables , Traitement par apport liquidien/méthodes , Humains , Appréciation des risques/méthodes , Sepsie/traitement médicamenteux , Solutions , Royaume-UniRÉSUMÉ
As allogeneic blood transfusion (ABT) is not harmless, multiple alternatives to TSA (AABT) have emerged, but there is a huge variability with respect to their indications and appropriate use. This variability results from the interplay of a number of factors, which include physicians specialty, knowledge and preferences, degree of anaemia, transfusion policy, and AABT availability. Since the ABBT are not harmless and may not meet costeffectiveness criteria, such avariability is unacceptable. The Spanish Societies of Anaesthesiology (SEDAR), Haematology and Haemotherapy (SEHH), Hospital Pharmacy (SEFH), Critical Care Medicine (SEMICYUC), Thrombosis and Haemostasis (SETH) and Blood Transfusion (SETS) have developed a Consensus Document for the proper use of AABTs. A panel of experts convened by these six Societies have conducted a systematic review of the medical literature and developed the «2013. Seville Document of Consensus on Alternatives to Allogeneic Blood Transfusion¼, which only considers those AABT aimed to decrease the transfusion of packed red cells. The AABTs are defined as any pharmacological and non-pharmacological measure aimed to decrease the transfusion of of red blood cell concentrates, while preserving the patient safety. For each AABT, the main question is formulated, positively or negatively, as: «Does or does not this particular AABT reduce the transfusion rate?¼ All the recommendations on the use of AABTs were formulated according to the GRADE (Grades of Recommendation Assessment, Development and Evaluation) methodology.
La transfusión de sangre alogénica (TSA) no es inocua, y como consecuencia han surgido múltiples alternativas a la TSA (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, grado de anemia, política transfusional, disponibilidad de las ATSA y criterio personal, las ATSA 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 seis sociedades han 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 Alogénica¼. 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 Transfusional¼. Para formular el grado de recomendación se ha usado la metodología GRADE (Grades of Recommendation Assessment, Development and Evaluation).
Sujet(s)
Procédures médicales et chirurgicales sans transfusion/normes , Réaction transfusionnelle , Perte sanguine peropératoire , Substituts sanguins/effets indésirables , Substituts sanguins/usage thérapeutique , Procédures médicales et chirurgicales sans transfusion/effets indésirables , Transfusion d'érythrocytes/effets indésirables , Humains , Récupération de sang périopératoire/normes , ThromboélastographieRÉSUMÉ
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)
Sujet(s)
Humains , Transfusion sanguine autologue , Transfusion sanguine/méthodes , Substituts sanguins/usage thérapeutique , Anémie/thérapie , Hémoglobine glyquée/usage thérapeutique , Fibrinogène/usage thérapeutique , Types de pratiques des médecinsRÉSUMÉ
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)
Sujet(s)
Humains , Mâle , Femelle , Transplantation homologue/instrumentation , Transplantation homologue/méthodes , Transplantation homologue , Analyse coût-bénéfice/organisation et administration , Analyse coût-bénéfice/normes , Analyse coût-bénéfice , Évaluation de l'Efficacité-Efficience des Interventions , Anesthésiologie/méthodes , Transplantation homologue/normes , Transplantation homologue/tendances , 50303 , Anesthésiologie/organisation et administration , Anesthésiologie/normes , Transfusion d'érythrocytes/tendances , Transfusion d'érythrocytesRÉSUMÉ
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.
Sujet(s)
Transfusion sanguine/normes , Thérapies complémentaires , Humains , Sécurité des patients , Procédures de chirurgie opératoireRÉSUMÉ
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.
Sujet(s)
Procédures médicales et chirurgicales sans transfusion/normes , Humains , Guides de bonnes pratiques cliniques comme sujetRÉSUMÉ
BACKGROUND: This study was conducted to determine whether an alveolar recruitment strategy (ARS) applied during two-lung ventilation (TLV) just before starting one-lung ventilation (OLV) improves ventilatory efficiency. METHODS: Subjects were randomly allocated to two groups: (i) control group: ventilation with tidal volume (VT) of 8 or 6 ml kg(-1) for TLV and OLV, respectively, and (ii) ARS group: same ventilatory pattern with ARS consisting of 10 consecutive breaths at a plateau pressure of 40 and 20 cm H(2)O PEEP applied immediately before and after OLV. Volumetric capnography and arterial blood samples were recorded 5 min (baseline) and 20 min into TLV, at 20 and 40 min during OLV, and finally 10 min after re-establishing TLV. RESULTS: Twenty subjects were included in each group. In all subjects, the airway component of dead space remained constant during the study. Compared with baseline, the alveolar dead space ratio (VD(alv)/VT(alv)) increased throughout the protocol in the control but decreased in the ARS group. Differences in VD(alv)/VT(alv) between groups were significant (P<0.001). Except for baseline, all values in kPa (sd) were higher in the ARS than in the control group (P<0.001), respectively [70 (7) and 55 (9); 33 (9) and 24 (10); 33 (8) and 22 (10); 70 (7) and 55 (10)]. CONCLUSIONS: Recruitment of both lungs before instituting OLV not only decreased alveolar dead space but also improved arterial oxygenation and the efficiency of ventilation.
Sujet(s)
Ventilation à pression positive , Alvéoles pulmonaires/physiopathologie , Procédures de chirurgie thoracique/méthodes , Adulte , Sujet âgé , Capnographie/méthodes , Dioxyde de carbone/sang , Femelle , Humains , Soins peropératoires/méthodes , Mâle , Adulte d'âge moyen , Surveillance peropératoire/méthodes , Oxygène/sang , Consommation d'oxygène/physiologie , Pression partielle , Ventilation à pression positive/méthodes , Mécanique respiratoire/physiologie , Volume courant , Jeune adulteRÉSUMÉ
INTRODUCTION: It has been suggested that for adequate maintenance of tacrolimus levels, the total daily dosage should be increased when switching from the conventional twice-daily regimen tacrolimus (CT) to once-daily sustained-release tacrolimus (SR-T). OBJECTIVE: To evaluate the safety and efficacy of a 25% increase in daily dosage when switching heart transplant (HT) patients from CT to SR-T. METHODS: We switched 75 HT patients including 72% males and an overall mean age of 55.6 years from CT to SR-T using a 25% increase in daily dosage. We screened for adverse events by measurements of lipids, creatinine, glycemia, and tacrolimus in blood samples taken at 1, 3, 7, and 12 weeks after the conversion, as well as by repeated echocardiography and routine clinical examinations. RESULTS: Just two patients (2.7%) were returned to CT because of failure of SR-T to attain therapeutic levels. In the remainder of subjects, tacrolimus levels remained stable, with trough values of 8.7±3.2, 8.7±2.9, 8.3±2.6, and 7.5±2.0 mg/dL, respectively. Twenty-three patients (31%) required no dosage change in the first 3 months, but 44 (33%) required one or two changes. No departure from therapeutic levels was associated with rejection; there was no case of severe intercurrent infection. We did not observe significant changes in glycemia, creatinine, lipid profile, or blood pressure. CONCLUSIONS: Administration of SR-T at a dosage 25% higher than the daily dosage of CT was safe. It ensured adequate tacrolimus levels in one-third of patients. Nevertheless, strict analytical surveillance is necessary during the initial months to allow dosage adjustments and to detect the minority of patients for whom SR-T does not achieve therapeutic tacrolimus levels.
Sujet(s)
Transplantation cardiaque , Immunosuppresseurs/administration et posologie , Tacrolimus/administration et posologie , Préparations à action retardée , Échocardiographie , Femelle , Humains , Immunosuppresseurs/effets indésirables , Mâle , Adulte d'âge moyen , Tacrolimus/effets indésirablesRÉSUMÉ
No disponible
Sujet(s)
Humains , Anesthésiologie/organisation et administration , Anesthésiologie/normes , Satisfaction des patients/économie , /législation et jurisprudence , /tendances , Qualité des soins de santé/organisation et administration , Qualité des soins de santé/normes , Anesthésiologie/économie , Anesthésiologie/législation et jurisprudence , Acceptation des soins par les patients , 24419RÉSUMÉ
OBJECTIVE: To analyze the effectiveness, safety, and performance of anesthetist-led preanesthetic interviews in which specifically trained nurses exercise defined roles under supervision. MATERIAL AND METHODS: This descriptive study analyzed preanesthetic interviews performed by a team of anesthesiologists and nurses in surgically treated patients over a 1-year period. We assessed the impact of those interviews on the rate of procedures canceled due to errors in presurgical assessment. Study variables were the percentage of procedures canceled due to failure of presurgical assessment and the difference in the cancellation rate according to whether the interviews were undertaken by anesthesiologists or nurses, number of preanesthetic assessments made by nurses; number of consultations made by nurses to anesthesiologists, number of patients referred for a second interview with an anesthesiologist after assessment by a nurse, rate of substitution by nurses of anesthesiologists, and time dedicated daily by anesthesiologists responding to nurses' consultations. The results were analyzed using descriptive statistics. RESULTS: A total of 7343 preoperative assessments were performed. Of those, 28.6% were undertaken by nurses. Surgery was canceled because of errors in presurgical assessment in 78 cases (1.06%), corresponding to 1.0% of the preoperative evaluations performed by anesthesiologists and 0.7% of those performed by nurses. In 317 (18.2%) nurse-led preoperative assessments the anesthesiologist was consulted, and in another 121 cases (6.9%) a second preanesthetic interview was required. The rate of substitution of anesthesiologists by nursing staff was 26.5% and the time anesthesiologists dedicated daily to consultation during nurse-led assessments was 17.7 minutes. CONCLUSIONS: The involvement of nurses in preanesthesia assessments of surgical patients is a clinically safe and effective initiative.
Sujet(s)
Anesthésie , Infirmières anesthésistes , Soins préopératoires , Humains , Diagnostic infirmier , Enquêtes et questionnairesRÉSUMÉ
OBJETIVO: Analizar la eficacia, seguridad y rendimientode una consulta preanestésica, liderada por anestesiólogos,en la que participa, por delegación de funciones, supervisaday previo entrenamiento específico enfermería.MATERIAL Y MÉTODOS: Estudio descriptivo de las evaluacionespreanestésicas de pacientes sometidos a intervencionesquirúrgicas durante el período de un año porun equipo compuesto por anestesiólogos (CAnest) y enfermería(CEnfAnest) y su impacto sobre el índice de suspensionesquirúrgicas por fallo del Circuito Preoperatorio(CP). Variables del estudio: Porcentaje de suspensionesquirúrgicas por fallo del CP; relación de las mismas conCAnest y CEnfAnest. Número de evaluaciones preanestésicasrealizadas por enfermería, número de consultas desdeCEnfAnest a CAnest, número de pacientes derivadoscomo segunda visita a CAnest tras visita en CEnfAnest,índice de sustitución (IS) de CEnfAnest, tiempo del anestesiólogodedicado diariamente a las consultas de CEnfAnest(TAnest). Estudio estadístico: estadística descriptiva.RESULTADOS: Total de evaluaciones preoperatorias:7.343. El 28,6% de las mismas fueron realizadas porCEnfAnest. Suspensiones quirúrgicas por fallo del CP:78 casos (1,06%); correspondieron al 1% de las evaluacionespreoperatorias realizadas en CAnest y al 0,7% delas realizadas en CEnfAnest. En 317 (18,2%) evaluacionespreoperatorias de CEnfAnest se consultó al anestesiólogoy en otros 121 casos (6,9%) se requirió nuevavisita preanestésica. El IS de CEnfAnest fue del 26,5%;el TAnest de 17,7 minutos.CONCLUSIONES: La participación de enfermería en lasvaloraciones preanestésicas de los pacientes quirúrgicoses una iniciativa eficaz y segura desde el punto de vistaclínico
OBJETIVE: To analyze the effectiveness, safety, and performance of anesthetist-led preanesthetic interviews in which specifically trained nurses exercise defined roles under supervision. MATERIAL AND METHODS: This descriptive study analyzed preanesthetic interviews performed by a team of anesthesiologists and nurses in surgically treated patients over a 1-year period. We assessed the impact of those interviews on the rate of procedures canceled due to errors in presurgical assessment. Study variables were the percentage of procedures canceled due to failure of presurgical assessment and the difference in the cancellation rate according to whether the interviews were undertaken by anesthesiologists or nurses, number of preanesthetic assessments made by nurses; number of consultations made by nurses to anesthesiologists, number of patients referred for a second interview with an anesthesiologist after assessment by a nurse, rate of substitution by nurses of anesthesiologists, and time dedicated daily by anesthesiologists responding to nurses consultations. The results were analyzed using descriptive statistics. RESULTS: A total of 7343 preoperative assessments were performed. Of those, 28.6% were undertaken by nurses. Surgery was canceled because of errors in presurgical assessment in 78 cases (1.06%), corresponding to 1.0% of the preoperative evaluations performed by anesthesiologists and 0.7% of those performed by nurses. In 317 (18.2%) nurse-led preoperative assessments the anesthesiologist was consulted, and in another 121 cases (6.9%) a second preanesthetic interview was required. The rate of substitution of anesthesiologists by nursing staff was 26.5% and the time anesthesiologists dedicated daily to consultation during nurse-led assessments was 17.7 minutes. CONCLUSIONS: The involvement of nurses in preanesthesia assessments of surgical patients is a clinically safe and effective initiative
Sujet(s)
Humains , Soins préopératoires/méthodes , Anesthésie/soins infirmiers , Soins infirmiers/tendances , Épidémiologie Descriptive , Service hospitalier d'anesthésieRÉSUMÉ
OBJECTIVES: To determine the availability of intravascular fluid volume replacement solutions in Spanish hospitals, to survey the extent of use of colloids by anesthesiologists, to ascertain the possible adverse effects they seek to prevent when using each solution, and to assess their level of knowledge about the subject. MATERIAL AND METHODS: A questionnaire was administered over a period of 6 months (July 2004-January 2005). The questionnaire was available online at www.encuestacoloides.com. The address was distributed by e-mail to anesthesiologists of all the Spanish autonomous communities and published in the Revista Española de Anestesiología y Reanimación. RESULTS: One hundred forty-two anesthesiologists responded. Crystalloids and colloids were widely available in most hospitals. Hydroxyethyl starch (HES) solutions were the colloids most often used (73%), followed by gelatins (28%). Dextran solutions, on the other hand, were no longer being used. The reasons the respondents gave for using these solutions were related to the time they remained in the vascular system, their greater effect of volume expansion, and the preservation of hemostasis. The most-feared complication was anaphylactic reaction to gelatins and there were concerns about the dose limit for infusion of HES solutions and about hemodynamic instability caused by dextran solutions. Fifty-four percent felt that scientific meetings provide little information about colloids and volume replacement. CONCLUSIONS: There is widespread use of colloids other than dextran along with crystalloids for plasma volume replacement. Spanish anesthesiologists are clear about important concepts related to colloid use. However, a high percentage have doubts about certain fundamental issues. Continuing professional development opportunities related to intravascular fluid replacement therapy should be increased.
Sujet(s)
Anesthésiologie , Attitude du personnel soignant , Colloïdes/administration et posologie , Traitement par apport liquidien/psychologie , Hypovolémie/thérapie , Complications peropératoires/thérapie , Solution isotonique/administration et posologie , Médecins/psychologie , Complications postopératoires/thérapie , Albumines/administration et posologie , Albumines/effets indésirables , Anaphylaxie/étiologie , Colloïdes/effets indésirables , Cristalloïdes , Collecte de données , Dextrane/administration et posologie , Dextrane/effets indésirables , Gélatine/administration et posologie , Gélatine/effets indésirables , Hôpitaux/statistiques et données numériques , Hydroxyéthylamidons/administration et posologie , Hydroxyéthylamidons/effets indésirables , Solution isotonique/effets indésirables , Maladies du rein/induit chimiquement , EspagneRÉSUMÉ
OBJETIVOS: Determinar la disponibilidad de sueros enlos centros hospitalarios españoles, conocer la utilizaciónde los coloides por los anestesiólogos, los posibles efectosadversos que evitan la utilización de cada uno de ellos yla disponibilidad de información sobre el tema.MATERIAL Y MÉTODOS: Encuesta realizada on-linedurante 6 meses (Julio 2004-Enero 2005) en la dirección:www.encuestacoloides.com difundida por vía e-mail y enla Revista Española de Anestesiología y Reanimacióndirigida a anestesiólogos de todas las ComunidadesAutónomas españolas.RESULTADOS: Contestada por 142 anestesiólogos. Seencontró una amplia disponibilidad de cristaloides-coloidesen la mayoría de hospitales. Los hidroxietilalmidones(HEA) son los coloides más utilizados (73%), seguidosde las gelatinas (28%), mientras que los dextranosestán en desuso. Los motivos de esta utilización por losencuestados vienen determinados por el tiempo de permanenciaen el espacio intravascular, la mayor expansiónvolémica y la preservación de la hemostasia. El efectosecundario más temido es el riesgo de reacciónanafiláctica de las gelatinas, el límite de volumen ainfundir de los almidones y la alteración de la hemostasiapor los dextranos. El 54% opina que en las reunionescientíficas se aborda escasamente la información relacionadacon coloides y reposición volémica.CONCLUSIONES: Existe un amplio uso de coloides asociadosa cristaloides en la reposición volémica, a excepciónde los dextranos. Los anestesiólogos españoles tienenclaros algunos conceptos importantes del uso de loscoloides, sin embargo un alto porcentaje tiene dudassobre determinados aspectos básicos. Sería deseableincrementar la formación continuada en fluidoterapia
OBJECTIVES: To determine the availability ofintravascular fluid volume replacement solutions inSpanish hospitals, to survey the extent of use ofcolloids by anesthesiologists, to ascertain the possibleadverse effects they seek to prevent when using eachsolution, and to assess their level of knowledge aboutthe subject.MATERIAL AND METHODS: A questionnaire wasadministered over a period of 6 months (July 2004-January 2005). The questionnaire was available onlineat www.encuestacoloides.com. The address wasdistributed by e-mail to anesthesiologists of all theSpanish autonomous communities and published in theRevista Española de Anestesiología y Reanimación.RESULTS: One hundred forty-two anesthesiologistsresponded. Crystalloids and colloids were widely availablein most hospitals. Hydroxyethyl starch (HES) solutionswere the colloids most often used (73%), followed bygelatins (28%). Dextran solutions, on the other hand, wereno longer being used. The reasons the respondents gave forusing these solutions were related to the time theyremained in the vascular system, their greater effect ofvolume expansion, and the preservation of hemostasis. Themost-feared complication was anaphylactic reaction togelatins and there were concerns about the dose limit forinfusion of HES solutions and about hemodynamicinstability caused by dextran solutions. Fifty-four percentfelt that scientific meetings provide little informationabout colloids and volume replacement.CONCLUSIONS: There is widespread use of colloidsother than dextran along with crystalloids for plasmavolume replacement. Spanish anesthesiologists are clearabout important concepts related to colloid use.However, a high percentage have doubts about certainfundamental issues. Continuing professionaldevelopment opportunities related to intravascular fluidreplacement therapy should be increased