“TITRe”ing the Approach to Transfusions after Cardiac Surgery  

Oleh:

Spertus, John

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: The New England Journal of Medicine (keterangan: ada di Proquest) vol. 372 no. 11 (Mar. 2015), page 1069-1070.

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Perpustakaan FK Nomor Panggil: N08.K Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Cardiac surgery is a common, high-risk procedure performed on patients who are vulnerable to ischemic complications, including myocardial infarction, sepsis, stroke, and death. These patients often have myriad coexisting conditions that further raise their risk. Given the underlying clinical circumstances warranting cardiac surgery in the first place, the goal of maximizing oxygenation by maintaining adequate hemoglobin levels seems straightforward. Anemia is readily correctable by means of transfusion, which gives clinicians an immediate sense of satisfaction as they see hemoglobin levels rise and makes clinical sense. However, previous observational studies suggest that transfusion is associated with increased rates of infection, ischemic complications, costs, and death,1 although such observational studies are prone to confounding.2 Thus, the Society of Thoracic Surgeons (STS) has made the noncommittal recommendation that “transfusion is reasonable in most postoperative patients whose hemoglobin level is less than 7 g per deciliter.”3 Given the paucity of evidence regarding the best possible transfusion levels, there is great variability in the use of transfusion after cardiac surgery. In an analysis from the STS database performed the year after the STS guidelines were published, the variability among hospitals in the use of transfusion was extraordinary, ranging from less than 5% to more than 90% among patients undergoing coronary-artery bypass graft surgery.4

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