在短缺危机期间，作为一种血液保护策略的超限制输血方案的安全性和可行性。

Safety and Feasibility of Ultra-Restrictive Transfusion Protocol as a Blood-Preservation Strategy During Shortage Crises.

机构信息

Division of Trauma and Critical Care Surgery, Department of Surgery, Brown University, Providence, RI.

出版信息

R I Med J (2013). 2022 Sep 1;105(7):49-54.

Abstract

BACKGROUND

We hypothesized that implementation of new ultra-restrictive transfusion protocol in adult surgical intensive care units (SICU) was safe and feasible during pandemic-associated shortage crises.

METHODS

Retrospective analysis two months pre- and post-implementation of ultra-restrictive transfusion protocol in March 2020 with hemoglobin cutoff of 6 g/dL (6.5 g/dL if ≥ 65 years old) for patients without COVID, active bleeding, or myocardial ischemia.

RESULTS

We identified 16/93 and 27/168 patients PRE and POST meeting standard transfusion threshold (7 g/dL); within POST, 12 patients met ultra-restrictive cutoffs. There was no significant difference between PRE and POST in the rate of mortality, ischemic complications, or the number of transfusions per patient, however, the overall incidence of transfusion was lower in the POST group (7.1 vs 17.2%, p = 0.02). Patients received a mean (SD) of 4(3.8) and 2.4(1.5) PRBC transfusions pre- and post-implementation. Odds ratio of mortality in POST group was 0.62 (95%CI: 0.08-5.12) adjusted for age, sex, and SOFA score.

CONCLUSIONS

Implementation of an ultra-restrictive transfusion protocol was feasible and effective as a blood- preservation strategy.

摘要

背景

我们假设在与大流行相关的资源短缺危机期间，在成人外科重症监护病房（SICU）实施新的超限制输血方案是安全且可行的。

方法

回顾性分析 2020 年 3 月实施超限制输血方案（血红蛋白切点为 6g/dL，年龄≥65 岁者为 6.5g/dL）前两个月和实施后两个月无 COVID、活动性出血或心肌缺血的患者。

结果

我们分别识别出符合标准输血阈值（7g/dL）的 PRE 和 POST 组的 16/93 和 27/168 例患者；在 POST 组中，有 12 例患者符合超限制切点。两组间死亡率、缺血性并发症发生率或患者每例输血次数均无显著差异，但 POST 组的总体输血发生率较低（7.1%比 17.2%，p=0.02）。患者分别接受了 PRE 和 POST 组的 4（3.8）和 2.4（1.5）单位红细胞输注。校正年龄、性别和 SOFA 评分后，POST 组的死亡率比值比为 0.62（95%CI：0.08-5.12）。