Department of Medicine, National University Hospital, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074, Singapore.
Crit Care. 2010;14(1):R7. doi: 10.1186/cc8859. Epub 2010 Jan 27.
Anaemia and the associated need for packed red blood cell (PRBC) transfusions are common in patients admitted to the intensive care unit (ICU). Among many causes, blood losses from repeated diagnostic tests are contributory.
This is a before and after study in a medical ICU of a university hospital. We used a closed blood conservation device (Venous Arterial blood Management Protection, VAMP, Edwards Lifesciences, Irvine, CA, USA) to decrease PRBC transfusion requirements. We included all adult (> or =18 years) patients admitted to the ICU with indwelling arterial catheters, who were expected to stay more than 24 hours and were not admitted for active gastrointestinal or any other bleeding. We collected data for six months without VAMP (control group) immediately followed by nine months (active group) with VAMP. A restrictive transfusion strategy in which clinicians were strongly discouraged from any routine transfusions when haemoglobin (Hb) levels were above 7.5 g/dL was adopted during both periods.
Eighty (mean age 61.6 years, 49 male) and 170 patients (mean age 60.5 years, 101 male) were included in the control and active groups respectively. The groups were comparable for age, gender, Acute Physiology and Chronic Health Evaluation (APACHE) II score, need for renal replacement therapy, length of stay, and Hb levels on discharge and at transfusion. The control group had higher Hb levels on admission (12.4 +/- 2.5 vs. 11.58 +/- 2.8 gm/dL, P = 0.02). Use of a blood conservation device was significantly associated with decreased requirements for PRBC transfusion (control group 0.131 unit vs. active group 0.068 unit PRBC/patient/day, P = 0.02) on multiple linear regression analysis. The control group also had a greater decline in Hb levels (2.13 +/- 2.32 vs. 1.44 +/- 2.08 gm/dL, P = 0.02) at discharge.
The use of a blood conservation device is associated with 1) reduced PRBC transfusion requirements and 2) a smaller decrease in Hb levels in the ICU.
贫血以及由此导致的需要输注浓缩红细胞（PRBC）在入住重症监护病房（ICU）的患者中很常见。在众多原因中，反复的诊断性检查失血是一个促成因素。
这是一所大学附属医院的 ICU 中进行的一项前后对照研究。我们使用了一种封闭的血液保护装置（静脉动脉血液管理保护，VAMP，爱德华生命科学公司，加利福尼亚州欧文市）来减少 PRBC 输注需求。我们纳入了所有留置动脉导管、预计入住 ICU 时间超过 24 小时且未因活动性胃肠道出血或任何其他出血而入住的成年（≥18 岁）患者。我们在无 VAMP 时收集了 6 个月的数据（对照组），随后在使用 VAMP 时收集了 9 个月的数据（实验组）。在这两个时期均采用了一种限制性输血策略，即当血红蛋白（Hb）水平高于 7.5g/dL 时，强烈劝阻临床医生进行任何常规输血。
对照组和实验组分别纳入 80 例（平均年龄 61.6 岁，49 例男性）和 170 例（平均年龄 60.5 岁，101 例男性）患者。两组在年龄、性别、急性生理学和慢性健康评估（APACHE）II 评分、需要肾脏替代治疗、住院时间以及出院时和输血时的 Hb 水平方面均具有可比性。对照组入院时的 Hb 水平更高（12.4±2.5 vs. 11.58±2.8gm/dL，P=0.02）。多线性回归分析显示，使用血液保护装置与 PRBC 输注需求减少显著相关（对照组 0.131 单位 vs. 实验组 0.068 单位 PRBC/患者/天，P=0.02）。对照组在出院时的 Hb 水平也有更大幅度的下降（2.13±2.32 vs. 1.44±2.08gm/dL，P=0.02）。
血液保护装置的使用与 1）PRBC 输注需求减少和 2）ICU 中 Hb 水平下降幅度较小相关。
