Effects of Tranexamic Acid on Bleeding in Pediatric Surgeries: A Systematic Review and Meta-Analysis

Management of severe acute pulmonary haemorrhage in children

Pulmonary haemorrhage is a potentially life-threatening condition with a variety of causes. Quality clinical trials are insufficient in children, restricting the evidence base to observational data and adult studies. The overall management strategy should address control of symptomatic bleeding, identification of the bleeding source, and treatment of the underlying cause. Flexible bronchoscopy is an important tool used to identify the cause and site of bleeding, do interventional procedures, and directly instil medications to affected areas. Medications to control bleeding include vasoconstrictors, antifibrinolytics, and recombinant factor VIIa. Definitive treatment often requires immunomodulatory medications, bronchial artery embolisation, or surgery. In this Review, we summarise the most recent evidence pertaining to medical, interventional, and surgical treatments of pulmonary haemorrhage in children.

2024 critical review of the patient blood management (PBM) recommendations of the Spanish enhanced recovery after major surgery (via RICA)

The Spanish enhanced recovery in adult surgery strategy, the "RICA pathway", was published in 2021 and includes 19 specific recommendations and more than 20 indirect recommendations for patient blood management (PBM). After reviewing these recommendations, and in the context of the new clinical evidence available, we propose the following updates: First: Detection and treatment of any preoperative anemia status in ALL patients who are candidates for major surgery with hematinic deficiencies. Second: Universal use of tranexamic acid in major surgery, bedside monitoring of intraoperative hemoglobin levels, restrictive transfusion criteria, and monitoring of patient well-being in terms of hydration, coagulability, normothermia and analgesia. Third: Restrictive transfusion criteria, single-unit blood transfusion and diagnosis/treatment of postoperative anemia. Real, universal implementation and integration of PBM in the RICA program is urgently needed.