Critical Care / ICU

Abstract

Although potentially life-saving in hemorrhaging trauma patients, autologous salvage of enteric-contaminated blood for reinfusion has been considered contraindicated. With considerable literature support for its use and ethics committee approval, Bowley and colleagues from Johannesburg, Republic of South Africa, conducted a prospective randomized controlled trial investigating intraoperative blood salvage (IBS) as a means of reducing allogeneic blood transfusion in penetrating abdominal trauma.

Abstract

CONTEXT:

Anemia is common in the critically ill and results in a large number of red blood cell transfusions. Recent data have shown that red blood cell transfusions in critically ill patients can be decreased with recombinant human erythropoietin (rHuEPO) therapy during their intensive care unit stay.

OBJECTIVE:

To assess the efficacy of rHuEPO therapy in decreasing the occurrence of red blood cell transfusions in patients admitted to a long-term acute care facility (LTAC).

DESIGN:

Summary This multicenter randomized controlled trial investigated the use of recombinant human erythropoietin (rHuEPO) in patients who, following their acute critical illness, are discharged from the intensive care unit (ICU) and, because of their chronic critical illness, are admitted to a long-term acute care facility (LTAC).

Summary

Summary This retrospective trauma registry study found that, compared with external pelvic fixation (EPF), the non-invasive pelvic orthotic device (POD) resulted in significantly reduced transfusions, hospital length of stay and ventilator associated pneumonia (VAP) and a non-significant decrease in mortality. Patients admitted to a single trauma center over a 10-year period with pelvic fractures after blunt trauma were identified (n=3,359). Of 241 patients with anterior-posterior compression fractures II or III, 186 underwent external stabilization for their complex pelvic ring fractures.

Summary Thomas and Martinez present and discuss the results of a pilot blood management program in their intensive care unit (ICU). They report that their transfusion rate (average of 17.8%) during the pilot program was considerably lower than that reported elsewhere in the literature. Strategies employed to minimize transfusion included reducing the amount and frequency of blood and laboratory testing, vigilance in monitoring and managing bleeding and judicious fluid management.

Summary Work by Cabrales and colleagues and others has suggested that the beneficial effects of transfusion may relate more to maintaining microcirculatory function (functional capillary density) via blood viscosity and mechanotransduction than oxygen carrying capacity. In the current study using the hamster chamber window model, Cabrales et al compared the effects on the microcirculation and tissue of carbon monoxide (CO) saturated red blood cells (RBCs) versus unsaturated RBCs in hemorrhagic shock resuscitation.

Summary Unexpectedly, this prospective multicenter randomized controlled trial found that, compared with placebo, epoetin alfa did not reduce transfusion in critically ill surgical, medical and trauma intensive care unit patients. However, the hemoglobin rise and absolute hemoglobin concentration was significantly higher in the epoetin group at day 29. The most important finding in this study, according to the investigators, was that mortality was reduced in the epoetin group, particularly in trauma patients.