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Schorr CA, Zanotti S, Dellinger RP. Severe sepsis and septic shock: management and performance improvement. Virulence 2014; 5:190-9. [PMID: 24335487 PMCID: PMC3916373 DOI: 10.4161/viru.27409] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 11/22/2013] [Accepted: 12/02/2013] [Indexed: 12/18/2022] Open
Abstract
Morbidity and mortality from sepsis remains unacceptably high. Large variability in clinical practice, plus the increasing awareness that certain processes of care associated with improved critical care outcomes, has led to the development of clinical practice guidelines in a variety of areas related to infection and sepsis. The Surviving Sepsis Guidelines for Management of Severe Sepsis and Septic Shock were first published in 2004, revised in 2008, and recently revised again and published in 2013. The first part of this manuscript is a summary of the 2013 guidelines with some editorial comment. The second part of the manuscript characterizes hospital based sepsis performance improvement programs and highlights the sepsis bundles from the Surviving Sepsis Campaign as a key component of such a program.
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Affiliation(s)
- Christa A Schorr
- Division of Critical Care Medicine; Department of Medicine; Cooper University Hospital; Camden, NJ USA
| | - Sergio Zanotti
- Division of Critical Care Medicine; Department of Medicine; Cooper University Hospital; Camden, NJ USA
| | - R Phillip Dellinger
- Division of Critical Care Medicine; Department of Medicine; Cooper University Hospital; Camden, NJ USA
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Labarinas S, Arni D, Karam O. Plasma in the PICU: why and when should we transfuse? Ann Intensive Care 2013; 3:16. [PMID: 23725411 PMCID: PMC3698065 DOI: 10.1186/2110-5820-3-16] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 05/07/2013] [Indexed: 11/10/2022] Open
Abstract
Whereas red blood cell transfusions have been used since the 19th century, plasma has only been available since 1941. It was originally mainly used as volume replacement, mostly during World War II and the Korean War. Over the years, its indication has shifted to correct coagulation factors deficiencies or to prevent bleeding. Currently, it remains a frequent treatment in the intensive care unit, both for critically ill adults and children. However, observational studies have shown that plasma transfusion fail to correct mildly abnormal coagulation tests. Furthermore, recent epidemiological studies have shown that plasma transfusions are associated with an increased morbidity and mortality in critically ill patients. Therefore, plasma, as any other treatment, has to be used when the benefits outweigh the risks. Based on observational data, most experts suggest limiting its use either to massively bleeding patients or bleeding patients who have documented abnormal coagulation tests, and refraining for transfusing plasma to nonbleeding patients whatever their coagulation tests. In this paper, we will review current evidence on plasma transfusions and discuss its indications.
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Affiliation(s)
- Sonia Labarinas
- Pediatric Critical Care Unit, Geneva University Hospital, 6 rue Willy Donzé, Geneva 1211, Switzerland.
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53
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Bansal D, Oberoi S, Marwaha RK, Singhi SC. Approach to a child with bleeding in the emergency room. Indian J Pediatr 2013; 80:411-20. [PMID: 23269640 DOI: 10.1007/s12098-012-0918-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 10/26/2012] [Indexed: 10/27/2022]
Abstract
A bleeding child is a cause of great concern and often, panic, for parents and pediatricians alike. Causes of bleeding could be trivial or secondary to an underlying bleeding disorder or a potentially serious systemic illness. Based on etiology, they can be categorized into disorders affecting platelets or the coagulation cascade and can be inherited or acquired. A systematic approach with relevant clinical history and examination along with appropriate laboratory investigations aid in reaching the diagnosis promptly. Indication and administration of blood products including fresh frozen plasma, cryoprecipitate, random donor and single donor apheresis platelets is elaborated. Management of hemophilia, Von Willebrand disease, disseminated intravascular coagulation and bleeding in cyanotic congenital heart disease, among other causes is outlined. Role of antifibrinolytic therapy, desmopressin and recombinant factor VIIa is briefly described. The review outlines the approach to a bleeding child in the emergency room. Practical points in history, examination, investigations and management are discussed. Management in resource constraint setting of developing countries is addressed.
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Affiliation(s)
- Deepak Bansal
- Hematology -Oncology Unit, Department of Pediatrics, Advanced Pediatric Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Spahn DR, Bouillon B, Cerny V, Coats TJ, Duranteau J, Fernández-Mondéjar E, Filipescu D, Hunt BJ, Komadina R, Nardi G, Neugebauer E, Ozier Y, Riddez L, Schultz A, Vincent JL, Rossaint R. Management of bleeding and coagulopathy following major trauma: an updated European guideline. Crit Care 2013; 17:R76. [PMID: 23601765 PMCID: PMC4056078 DOI: 10.1186/cc12685] [Citation(s) in RCA: 692] [Impact Index Per Article: 62.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Revised: 03/26/2013] [Accepted: 04/02/2013] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Evidence-based recommendations are needed to guide the acute management of the bleeding trauma patient. When these recommendations are implemented patient outcomes may be improved. METHODS The multidisciplinary Task Force for Advanced Bleeding Care in Trauma was formed in 2005 with the aim of developing a guideline for the management of bleeding following severe injury. This document represents an updated version of the guideline published by the group in 2007 and updated in 2010. Recommendations were formulated using a nominal group process, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) hierarchy of evidence and based on a systematic review of published literature. RESULTS Key changes encompassed in this version of the guideline include new recommendations on the appropriate use of vasopressors and inotropic agents, and reflect an awareness of the growing number of patients in the population at large treated with antiplatelet agents and/or oral anticoagulants. The current guideline also includes recommendations and a discussion of thromboprophylactic strategies for all patients following traumatic injury. The most significant addition is a new section that discusses the need for every institution to develop, implement and adhere to an evidence-based clinical protocol to manage traumatically injured patients. The remaining recommendations have been re-evaluated and graded based on literature published since the last edition of the guideline. Consideration was also given to changes in clinical practice that have taken place during this time period as a result of both new evidence and changes in the general availability of relevant agents and technologies. CONCLUSIONS A comprehensive, multidisciplinary approach to trauma care and mechanisms with which to ensure that established protocols are consistently implemented will ensure a uniform and high standard of care across Europe and beyond.
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Affiliation(s)
- Donat R Spahn
- Institute of Anaesthesiology, University Hospital Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - Bertil Bouillon
- Department of Trauma and Orthopaedic Surgery, University of Witten/Herdecke, Cologne-Merheim Medical Centre, Ostmerheimerstrasse 200, D-51109 Cologne, Germany
| | - Vladimir Cerny
- Faculty of Medicine in Hradec Králové, Department of Anaesthesiology and Intensive Care Medicine, University Hospital Hradec Králové, CZ-50005 Hradec Králové, Czech Republic
- Dalhousie University, Department of Anesthesia, Pain Management and Perioperative Medicine, Halifax, NS B3H 4R2, Canada
| | - Timothy J Coats
- Accident and Emergency Department, University of Leicester, Infirmary Square, Leicester LE1 5WW, UK
| | - Jacques Duranteau
- Department of Anaesthesia and Intensive Care, University of Paris XI, Faculté de Médecine Paris-Sud, 63 rue Gabriel Péri, F-94276 Le Kremlin-Bicêtre, France
| | - Enrique Fernández-Mondéjar
- Department of Emergency and Critical Care Medicine, University Hospital Virgen de las Nieves, ctra de Jaén s/n, E-18013 Granada, Spain
| | - Daniela Filipescu
- Department of Cardiac Anaesthesia and Intensive Care, C. C. Iliescu Emergency Institute of Cardiovascular Diseases, Sos Fundeni 256-258, RO-022328 Bucharest, Romania
| | - Beverley J Hunt
- Guy's and St Thomas' Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Radko Komadina
- Department of Traumatology, General and Teaching Hospital Celje, SI-3000 Celje, Slovenia
| | - Giuseppe Nardi
- Shock and Trauma Centre, S. Camillo Hospital, Viale Gianicolense 87, I-00152 Rome, Italy
| | - Edmund Neugebauer
- Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Campus Cologne, Ostmerheimerstrasse 200, D-51109 Cologne, Germany
| | - Yves Ozier
- Division of Anaesthesia, Intensive Care and Emergency Medicine, Brest University Hospital, Boulevard Tanguy Prigent, F-29200 Brest, France
| | - Louis Riddez
- Department of Surgery and Trauma, Karolinska University Hospital, S-171 76 Solna, Sweden
| | - Arthur Schultz
- Ludwig-Boltzmann-Institute for Experimental and Clinical Traumatology, Lorenz Boehler Trauma Centre, Donaueschingenstrasse 13, A-1200 Vienna, Austria
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, B-1070 Brussels, Belgium
| | - Rolf Rossaint
- Department of Anaesthesiology, University Hospital Aachen, RWTH Aachen University, Pauwelsstrasse 30, D-52074 Aachen, Germany
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Papa F, Rongioletti M, Ventura MD, Di Turi F, Cortesi M, Pasqualetti P, Majolini MB, Collegiani V, Cicchese M, Notarmuzi ML, Agostino R, Liumbruno GM. Blood cell counting in neonates: a comparison between a low volume micromethod and the standard laboratory method. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2011; 9:400-6. [PMID: 21839016 PMCID: PMC3200409 DOI: 10.2450/2011.0082-10] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Accepted: 11/25/2010] [Indexed: 11/21/2022]
Abstract
BACKGROUND Iatrogenic anaemia caused by repeated blood sampling to monitor laboratory parameters can contribute, particularly in neonates, to the need for transfusion. "Point of care" laboratory equipment uses smaller amounts of blood for analytic determinations and could, therefore, help to prevent secondary anaemia. In this study we compared the results of haematological parameters measured using a standard laboratory method and using a "point of care" micromethod, with the aim of validating the use of this latter method in clinical practice in neonatology. MATERIALS AND METHODS One hundred and fifty venous or capillary blood samples were taken from full-term or premature neonates 2-4 hours or 48 hours after birth. Each sample was processed by a standard haematology analyser and another micromethod instrument. Bland-Altman plots were constructed for each parameter and intra-class coefficients of correlation were calculated in order to evaluate the concordance between the two analysers. RESULTS The concordance between the data obtained with the two analysers, expressed as the intra-class correlation, was 0.98 for white blood cell count, 0.97 for haemoglobin concentration, 0.96 for haematocrit, 0.95 for mean red cell volume and 0.98 for platelet count. The micromethod produced overestimated mean values for the leucocyte count (+1.27; p<0.001), haematocrit (+1.80; p<0.001) and platelet count (+13.55; p<0.001). CONCLUSIONS Overall, the concordance between the values obtained with the two analysers was high for each of the parameters taken into consideration. In the case of haemoglobin and leucocytes, give the high intra-class correlation and lack of systematic overestimation of one method over another, the micromethod guarantees a correct evaluation; however, despite the high intra-class correlations for platelet counts, the systemic error seems to suggest that the micromethod cannot guarantee an appropriate evaluation of this parameter.
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Affiliation(s)
- Fabrizio Papa
- Clinical Pathology Unit, “San Giovanni Calibita” Fatebenefratelli Hospital, Rome
| | - Mauro Rongioletti
- Clinical Pathology Unit, “San Giovanni Calibita” Fatebenefratelli Hospital, Rome
| | - Marco Della Ventura
- Immunohaematology and Transfusion Medicine Unit, “San Giovanni Calibita” Fatebenefratelli Hospital, Rome
| | - Francesco Di Turi
- Neonatology Unit, “San Giovanni Calibita” Fatebenefratelli Hospital, Rome
| | - Maurizio Cortesi
- Clinical Pathology Unit, “San Giovanni Calibita” Fatebenefratelli Hospital, Rome
| | | | | | - Valeria Collegiani
- Clinical Pathology Unit, “San Giovanni Calibita” Fatebenefratelli Hospital, Rome
| | - Marika Cicchese
- Neonatology Unit, “San Giovanni Calibita” Fatebenefratelli Hospital, Rome
| | | | - Rocco Agostino
- Neonatology Unit, “San Giovanni Calibita” Fatebenefratelli Hospital, Rome
| | - Giancarlo Maria Liumbruno
- Immunohaematology and Transfusion Medicine Unit, “San Giovanni Calibita” Fatebenefratelli Hospital, Rome
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Abstract
As screening for transfusion-associated infections has improved, noninfectious complications of transfusion now cause the majority of morbidity and mortality associated with transfusion in the United States. For example, transfusion-related acute lung injury, transfusion-associated circulatory overload, and hemolytic transfusion-reactions are the first, second, and third leading causes of death from transfusion, respectively. These complications and others are reviewed, and several controversial methods for prevention of noninfectious complications of transfusion are discussed, including universal leukoreduction of erythrocyte units, use of male-only plasma, and restriction of erythrocyte storage age.
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Affiliation(s)
- Brian M Gilliss
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, California 94143-0624, USA
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57
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Liumbruno GM, Bennardello F, Lattanzio A, Piccoli P, Rossetti G. Recommendations for the transfusion management of patients in the peri-operative period. III. The post-operative period. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2011; 9:320-35. [PMID: 21627922 PMCID: PMC3136601 DOI: 10.2450/2011.0076-10] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Giancarlo Maria Liumbruno
- Units of Immunohaematology, Transfusion Medicine and Clinical Pathology, San Giovanni Calibita Fatebenefratelli Hospital, Rome.
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Liumbruno GM, Bennardello F, Lattanzio A, Piccoli P, Rossetti G. Recommendations for the transfusion management of patients in the peri-operative period. II. The intra-operative period. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2011; 9:189-217. [PMID: 21527082 PMCID: PMC3096863 DOI: 10.2450/2011.0075-10] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Transfusion therapy in the peri-operative period. BLOOD TRANSFUSION 2011; 9:1-3. [PMID: 21235850 DOI: 10.2450/2010.0068-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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60
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Liumbruno GM, Bennardello F, Lattanzio A, Piccoli P, Rossetti G. Recommendations for the transfusion management of patients in the peri-operative period. I. The pre-operative period. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2011; 9:19-40. [PMID: 21235852 PMCID: PMC3021395 DOI: 10.2450/2010.0074-10] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Giancarlo Maria Liumbruno
- Units of Immunohaematology, Transfusion Medicine and Clinical Pathology, San Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
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