Summary


Objective: Review the literature regarding the use of recombinant human erythropoietin (rHuEPO) to prevent red blood cell (RBC) transfusion in critically ill patients.



Data sources:  A computerized search of MEDLINE and EMBASE from 1966 through June 2003 was conducted using the terms erythropoietin, anemia, hemoglobin, critical care, intensive care, surgery, trauma, burn, and transfusion. References of selected articles were reviewed. A manual search of critical care, surgery, trauma, burn, hematology, and pharmacy journals was conducted to identify relevant abstracts.



Results:  Six randomized studies have evaluated exogenous administration of erythropoietin to prevent RBC transfusions in critically ill patients. Studies vary with respect to rHuEPO dosage regimens, dose of concurrently administered iron, patient characteristics, and transfusion thresholds. Administration of rHuEPO rapidly produces erythropoiesis to reduce the need for RBC transfusions. The largest study conducted to date used weekly rHuEPO administration and found a modest decrease in transfusion requirements although the time to first transfusion was delayed. Reduced intensive care unit (ICU) length of stay (LOS) was shown in only one study of surgical/trauma patients. Reduced LOS after ICU discharge was found in another study of severely ill patients (APACHE II score >22). Other clinical outcomes were not altered by rHuEPO use. No adverse events were associated with rHuEPO use although studies were not designed to evaluate safety.



Conclusions:  rHuEPO reduces the need for transfusions. A cost-effectiveness analysis of rHuEPO for this indication is needed. Defining an optimal dosage regimen, identifying patients most likely to respond to rHuEPO, and determining risk factors for ICU associated anaemia would provide information for appropriate rHuEPO utilization.

Use of exogenous erythropoietin in critically ill patients

SUMMARy

Anemia is one of the most commonly encountered abnormal laboratory findings in intensive care unit (ICU) patients, and many ICU patients will receive a blood transfusion during their ICU stay. However, the determinants of when and to whom transfusions should be given are not clear cut and have been the subject of considerable debate in recent years. Transfusion practice may vary considerably between institutions and across countries. The ABC (anemia and blood transfusion in critical care) study reported increased ICU and hospital mortality rates in patients who had received a transfusion. On the other hand, low hemoglobin levels are still associated with increased mortality and morbidity. The “traditional” transfusion trigger of 10 g/dL certainly no longer applies to all, but may well be relevant in certain groups, e.g., patients with cardiac disease. Transfusions should certainly be more restrictive than before, but applying this policy across the board cannot be recommended; each patient must be assessed individually on the basis of past and present clinical history, and in light of oxygenation and hemodynamic parameters. Clearly, further study is needed before we are able to determine the best transfusion strategies for our ICU patients.

ABC Study: The Results and Clinical Application

Resume En neurochirurgie, la question des seuils transfusionnels pour l’hemoglobine reste debattue. Concernant le cerveau, les donnees actuelles sont encore incompletes, justifiant la poursuite de travaux experimentaux et cliniques. Les avis d’experts actuels decoulent de ces donnees assez pauvres mais devraient evoluer avec les etudes cliniques en cours. Pour le rachis la situation est plus simple, et les enjeux transfusionnels s’apparentent a ceux de l’orthopedie et de la traumatologie. En ce qui concerne l’hemostase, des recommandations standardisees existent en fonction des resultats des tests ou des traitements anticoagulants suivis par le patient.

Transfusion en neurochirurgie

Although nosocomial infection rates are prospectively collected and widely known, little is known about compliance rates to preventive measures that are assumed to be implemented for nosocomial infection control. Monitoring and improving compliance rates to preventive measures can help maintain nosocomial infection rates within acceptable ranges and even prevent outbreaks.

/pdf/quality-improvement-tools-pdca-cycle-enhances-compliance-to-33ku3pxqk3.pdf

Quality improvement tools (PDCA cycle) enhances compliance to nosocomial infection preventive measures: experience of a medical-surgical ICU

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Quality improvement tools (PDCA cycle) enhances compliance to nosocomial infection preventive measures: experience of a medical-surgical ICU