Transfusión sanguínea / Blood transfusion

Mayo 2, 2016. No. 2314

Impacto de la edad de la sangre de banco sobre la mortalidad del traumatizado. Revisión sistemática Impact of the age of stored blood on trauma patient mortality: a systematic review. Sowers N1, Froese PC1, Erdogan M1, Green RS1. Can J Surg. 2015 Oct;58(5):335-42. Abstract BACKGROUND: The impact of the age of stored red blood cells on mortality in patients sustaining traumatic injuries requiring transfusion of bloodproducts is unknown. The objective of this systematic review was to identify and describe the available literature on the use of older versus newerblood in trauma patient populations. METHODS: We searched PubMed, Embase, Lilac and the Cochrane Database for published studies comparing the transfusion of newer versus older red blood cells in adult patients sustaining traumatic injuries. Studies included for review reported on trauma patients receiving transfusions of packed red blood cells, identified the age of stored blood that was transfused and reported patient mortality as an end point. We extracted data using a standardized form and assessed study quality using the Newcastle-Ottawa Scale. RESULTS: Seven studies were identified (6780 patients) from 3936 initial search results. Four studies reported that transfusion of older blood was independently associated with increased mortality in trauma patients, while 3 studies did not observe any increase in patient mortality with the use of older versus newer blood. Three studies associated the transfusion of older blood with adverse patient outcomes, including longer stay in the intensive care unit, complicated sepsis, pneumonia and renal dysfunction. Studies varied considerably in design, volumes of blood transfused and definitions applied for old and new blood. CONCLUSION: The impact of the age of stored packed red blood cells on mortality in trauma patients is inconclusive. Future investigations are warranted. PDF   Transfusión perioperatoria de sangre. Lo que no conocemos Perioperative Red Blood Cell Transfusion: What We Do Not Know. Lei C, Xiong LZ1. Chin Med J (Engl). 2015 Sep 5;128(17):2383-6. doi: 10.4103/0366-6999.163384. Abstract OBJECTIVE: Blood transfusion saves lives but may also increase the risk of injury. The objective of this review was to evaluate the possible adverse effects related to transfusion of red blood cell (RBC) concentrates stored for prolonged periods. DATA SOURCES: The data used in this review were mainly from PubMed articles published in English up to February 2015. STUDY SELECTION: Clinical and basic research articles were selected according to their relevance to this topic. RESULTS: The ex vivo changes to RBC that occur during storage are collectively called storage lesion. It is still inconclusive if transfusion of RBC with storage lesion has clinical relevance. Multiple ongoing prospective randomized controlled trials are aimed to clarify this clinical issue. It was observed that the adverse events related to stored RBC transfusion were prominent in certain patient populations, including trauma, critical care, pediatric, and cardiac surgery patients, which leads to the investigation of underlying mechanisms. It is demonstrated that free hemoglobin toxicity, decreasing of nitric oxide bioavailability, and free iron-induced increasing of inflammation may play an important role in this process. CONCLUSION: It is still unclear whether transfusion of older RBC has adverse effects, and if so, which factors determine such clinical effects. However, considering the magnitude of transfusion and the widespread medical significance, potential preventive strategies should be considered, especially for the susceptible recipients. PDF Aun hay espacios disponibles para el curso Committee for European Education in Anaesthesiology (CEEA) Colegio de Anestesiólogos de León AC MÓDULO V: Sistema nervioso, fisiología, anestesia locoregional y dolor. Reconocimientos de: CEEA, CLASA, Consejo Nacional Mexicano de Anestesiología.   En la Ciudad de Léon, Guanajuato. México del 6 al 8 de Mayo, 2016. Informes en el tel (477) 716 06 16 y con el Dr. Enrique Hernández kikinhedz@gmail.com

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Sepsis

Abril 20, 2016. No. 2302

Diseño de ensayos fase 3 en sepsis: aplicación de las experiencias adquiridas a partir de ensayos de cuidados críticos en la insuficiencia cardíaca aguda. Designing phase 3 sepsis trials: application of learned experiences from critical care trials in acute heart failure. Mebazaa A1, Laterre PF2, Russell JA3, Bergmann A4, Gattinoni L5, Gayat E6, Harhay MO7, Hartmann O4, Hein F4, Kjolbye AL8, Legrand M9, Lewis RJ10,Marshall JC11, Marx G12, Radermacher P13, Schroedter M4, Scigalla P4, Stough WG14, Struck J4, Van den Berghe G15, Yilmaz MB16, Angus DC17. J Intensive Care. 2016 Mar 31;4:24. doi: 10.1186/s40560-016-0151-6. eCollection 2016. Abstract Substantial attention and resources have been directed to improving outcomes of patients with critical illnesses, in particular sepsis, but all recent clinical trials testing various interventions or strategies have failed to detect a robust benefit on mortality. Acute heart failure is also a critical illness, and although the underlying etiologies differ, acute heart failure and sepsis are critical care illnesses that have a high mortality in which clinical trials have been difficult to conduct and have not yielded effective treatments. Both conditions represent a syndrome that is often difficult to define with a wide variation in patient characteristics, presentation, and standard management across institutions. Referring to past experiences and lessons learned in acute heart failure may be informative and help frame research in the area of sepsis. Academic heart failure investigators and industry have worked closely with regulators for many years to transition acute heart failure trials away from relying on dyspnea assessments and all-cause mortality as the primary measures of efficacy, and recent trials have been designed to assess novel clinical composite endpoints assessing organ dysfunction and mortality while still assessing all-cause mortality as a separate measure of safety. Applying the lessons learned in acute heart failure trials to severe sepsis and septic shock trials might be useful to advance the field. Novel endpoints beyond all-cause mortality should be considered for future sepsis trials. KEYWORDS: Clinical trials as topic; Heart failure; Mortality; Multiple organ failure; Sepsis PDF Committee for European Education in Anaesthesiology (CEEA) Colegio de Anestesiólogos de León AC MÓDULO V: Sistema nervioso, fisiología, anestesia locoregional y dolor. Reconocimientos de: CEEA, CLASA, Consejo Nacional Mexicano de Anestesiología.   En la Ciudad de Léon, Guanajuato. México del 6 al 8 de Mayo, 2016. Informes en el tel (477) 716 06 16 y con el Dr. Enrique Hernández kikinhedz@gmail.com

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

Dexmedetomidina

Abril 22, 2016. No. 2304

Dexmedetomidina-fentanil comparados con midazolam-fentanil en sedación consciente en pacientes programados para cirugía de los discos lumbares Dexmedetomidine-fentanyl Compared With Midazolam-fentanyl for Conscious Sedation in Patients Undergoing Lumbar Disc Surgery. Peng K1, Liu HY1, Liu SL1, Ji FH2. Clin Ther. 2016 Jan 1;38(1):192-201.e2. doi: 10.1016/j.clinthera.2015.11.016. Epub 2015 Dec 14. Abstract PURPOSE: Patients undergoing awake lumbar disc surgery need adequate sedation and analgesia. This study investigated whether use of a dexmedetomidine-fentanyl (DF) regimen could be superior to midazolam-fentanyl (MF) for these patients. METHODS: Sixty patients scheduled for elective lumbar laminotomy and discectomy were randomly assigned to receive either DF or MF for conscious sedation. Patient-controlled intravenous analgesia with fentanyl was used for postoperative pain management. Hemodynamic and respiratory changes, sedation scores, pain scores, fentanyl consumption, patient satisfaction, postoperative hospital stay, and adverse events were assessed. FINDINGS: The patient and surgical characteristics, sedation levels, and pain scores were similar in the 2 groups. Compared with the MF group, heart rate was lower in the DF group at six time points from skin incision to 15 minutes in the postanesthesia care unit (PACU), they are skin incision, 15 min after the beginning of surgery, 30 min after the beginning of surgery, skin closure, entering PACU, and 15 min in PACU (P = 0.016, 0.002, 0.000, 0.000, 0.000, and 0.001, respectively), whereas pulse oxygen saturation was higher at 3 time points from 15 minutes after the beginning of surgery to skin closure (P = 0.022, 0.026, and 0.025, respectively). The intraoperative, postoperative, and total consumption of fentanyl were lower in the DF group (total: mean difference = -69.3 µg; 95% CI, = -114.3 to -24.4; P = 0.003). No significant differences were found for adverse events, postoperative hospital stay, or satisfaction between the 2 groups. IMPLICATIONS: Although awake lumbar disc surgery can be performed successfully under sedation with either MF or DF combination, the latter may be a better alternative because of less consumption of opioid analgesics. ChiCTR.org identifier: ChiCTR-TRC-13003645. KEYWORDS: analgesia; dexmedetomidine; discectomy; laminotomy; midazolam; sedation PDF Committee for European Education in Anaesthesiology (CEEA) Colegio de Anestesiólogos de León AC MÓDULO V: Sistema nervioso, fisiología, anestesia locoregional y dolor. Reconocimientos de: CEEA, CLASA, Consejo Nacional Mexicano de Anestesiología.   En la Ciudad de Léon, Guanajuato. México del 6 al 8 de Mayo, 2016. Informes en el tel (477) 716 06 16 y con el Dr. Enrique Hernández kikinhedz@gmail.com

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015