Should fresh blood be recommended for intensive care patients 英文参考文献.docVIP

Guidet Critical Care 2010,14:158 /content/14/3/158 CO MMENTA RY Should fresh blood be recommended for intensive care patients? Bertrand Guidet* 1-3 See related research by Karam et al., /content/14/2/R57 and procoagulant state [5], and an increased risk of thrombosis [6] – or related to cellular modi? cations such as a decrease of 2,3-DPG (2,3-diphosphoglycerate) [2] content, leading to an increase of hemoglobin oxygen a? nity and a decrease of RBC deformability [2]. All of Abstract Fresh blood has many potential advantages over older blood, but there is no evidence that these properties translate into clinical bene?t for intensive care patients. The observational multicenter study by Karam and colleagues provides some evidence suggesting that blood stored for less than 14 days is better than older blood in terms of new organ failure and reduction in length of stay in pediatric intensive care units. Though in favor of using young blood, this study su?ers from several limitations. As a consequence, it is ethical and certainly pertinent to conduct a randomized clinical trial in order to test the hypothesis that fresh blood might reduce mortality. The rationale is strong and the potential bene?t of fresh blood is substantial. these alterations in stored RBCs lead to a reduction of O 2 delivery. As a matter of fact, the oxygen uptake was im- proved after transfusion of fresh blood but was un- changed with older blood (28 days) in the study of Fitzgerald and colleagues [7] and tissue oxygenation was altered in trauma patients transfused with old blood [8]. Given the potential bene? cial e? ects of fresh blood and also the logistical and ? nancial impact of its recommen- dation, we need strong clinical scienti? c evidence in order to push hard to obtain fresh blood from the blood banks. e study by Karam and colleagues [1] is the ? rst prospective multicenter study of its kind (n = 296 pedia