red blood cell transfusion in patients with subarachnoid hemorrhage a multidisciplinary north american survey蛛网膜下腔出血患者的红细胞输血北美一个和多个学科相关的调查.pdfVIP

Kramer et al. Critical Care 2011, 15:R30 /content/15/1/R30 RESEARCH Open Access Red blood cell transfusion in patients with subarachnoid hemorrhage: a multidisciplinary North American survey 1* 2 3 4 5 6 Andreas H Kramer , Michael N Diringer , Jose I Suarez , Andrew M Naidech , Loch R Macdonald , Peter D Le Roux Abstract Introduction: Anemia is associated with poor outcomes in patients with aneurysmal subarachnoid hemorrhage (SAH). It remains unclear whether this association can be modified with more aggressive use of red blood cell (RBC) transfusions. The degree to which restrictive thresholds have been adopted in neurocritical care patients remains unknown. Methods: We performed a survey of North American academic neurointensivists, vascular neurosurgeons and multidisciplinary intensivists who regularly care for patients with SAH to determine hemoglobin (Hb) concentrations which commonly trigger a decision to initiate transfusion. We also assessed minimum and maximum acceptable Hb goals in the context of a clinical trial and how decision-making is influenced by advanced neurological monitoring, clinician characteristics and patient-specific factors. Results: The survey was sent to 531 clinicians, of whom 282 (53%) responded. In a hypothetical patient with high- grade SAH (WFNS 4), the mean Hb concentration at which clinicians administered RBCs was 8.19 g/dL (95% CI, 8.07 to 8.30 g/dL). Transfusion practices were comparatively more restrictive in patients with low-grade SAH (mean Hb 7.85 g/dL (95% CI, 7.73 to 7.97 g/dL)) (P 0.0001) and more liberal in patients with delayed cerebral ischemia (DCI) (mean Hb 8.58 g/dL (95% CI, 8.45 to 8.72 g/dL)) (P 0.0001). In ea