Shah Akshay, Oczkowski Simon, Aubron Cecile, Vlaar Alexander P, Dionne Joanna C
Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
Adult Intensive Care Unit, John Radcliffe Hospital, Oxford, UK.
Transfus Med. 2020 Dec;30(6):418-432. doi: 10.1111/tme.12738. Epub 2020 Nov 18.
Anaemia and coagulopathy are common in critically ill patients and are associated with poor outcomes, including increased risk of mortality, myocardial infarction, failure to be liberated from mechanical ventilation and poor physical recovery. Transfusion of blood and blood products remains the corner stone of anaemia and coagulopathy treatment in critical care. However, determining when the benefits of transfusion outweigh the risks of anaemia may be challenging in some critically ill patients. Therefore, the European Society of Intensive Care Medicine prioritised the development of a clinical practice guideline to address anaemia and coagulopathy in non-bleeding critically ill patients. The aims of this article are to: (1) review the evolution of transfusion practice in critical care and the direction for future developments in this important area of transfusion medicine and (2) to provide a brief synopsis of the guideline development process and recommendations in a format designed for busy clinicians and blood bank staff. These clinical practice guidelines provide recommendations to clinicians on how best to manage non-bleeding critically ill patients at the bedside. More research is needed on alternative transfusion targets, use of transfusions in special populations (e.g., acute neurological injury, acute coronary syndromes), use of anaemia prevention strategies and point-of-care interventions to guide transfusion strategies.
贫血和凝血功能障碍在重症患者中很常见，并且与不良预后相关，包括死亡风险增加、心肌梗死、无法脱离机械通气以及身体恢复不佳。输血和血液制品仍然是重症监护中贫血和凝血功能障碍治疗的基石。然而，对于一些重症患者来说，确定输血的益处何时超过贫血的风险可能具有挑战性。因此，欧洲重症监护医学学会将制定一项临床实践指南作为优先事项，以解决非出血性重症患者的贫血和凝血功能障碍问题。本文的目的是：（1）回顾重症监护中输血实践的演变以及输血医学这一重要领域未来的发展方向，（2）以一种为忙碌的临床医生和血库工作人员设计的形式，简要概述指南的制定过程和建议。这些临床实践指南就如何在床边最好地管理非出血性重症患者向临床医生提供建议。关于替代输血目标、特殊人群（如急性神经损伤、急性冠状动脉综合征）输血的使用、贫血预防策略的使用以及指导输血策略的床旁干预措施，还需要更多的研究。
