TY - JOUR
T1 - Patient Blood Management in the Intensive Care Unit
AU - Shander, Aryeh
AU - Javidroozi, Mazyar
AU - Lobel, Gregg
N1 - Publisher Copyright:
© 2017
PY - 2017/10
Y1 - 2017/10
N2 - Patient Blood Management underscores a fundamental shift from a product-centered approach to a patient-centric approach through timely application of evidence-based medical and surgical concepts designed to maintain hemoglobin concentration, optimize hemostasis, and minimize blood loss in an effort to improve patient outcome. In this concept, allogeneic blood transfusion is not viewed as the treatment of default for anemic patients, but one among many treatment modalities that should be weighed based on its merits—potentials risks and benefits—for the individual patient in the context of other alternatives. Patient blood management provides a multidisciplinary framework for patient-centered decision making with strategies focusing on the management of anemia, optimization of coagulation and hemostasis, and utilization of blood conservation modalities. Among the critically ill patients, Patient Blood Management can be particularly effective given the extremely high prevalence of anemia, variable and unjustified transfusion practices, high frequency of coagulation disorders, and avoidable sources of blood loss such as unnecessary diagnostic blood draws. Proper management of anemia—prevention, screening/monitoring, diagnostic workup, and treatment including hematinic agents—is the key to effective implementation of patient blood management. Blood transfusions should be used in accordance of current guidelines, which are supportive of more restrictive transfusion strategies in most critically ill patients. Emerging studies report on the success of Patient Blood Management programs in reducing transfusion utilization, reducing the burden of anemia in patients, and improving patient outcomes including shortened length of hospital stays, less frequency of complications and lower risk of mortality.
AB - Patient Blood Management underscores a fundamental shift from a product-centered approach to a patient-centric approach through timely application of evidence-based medical and surgical concepts designed to maintain hemoglobin concentration, optimize hemostasis, and minimize blood loss in an effort to improve patient outcome. In this concept, allogeneic blood transfusion is not viewed as the treatment of default for anemic patients, but one among many treatment modalities that should be weighed based on its merits—potentials risks and benefits—for the individual patient in the context of other alternatives. Patient blood management provides a multidisciplinary framework for patient-centered decision making with strategies focusing on the management of anemia, optimization of coagulation and hemostasis, and utilization of blood conservation modalities. Among the critically ill patients, Patient Blood Management can be particularly effective given the extremely high prevalence of anemia, variable and unjustified transfusion practices, high frequency of coagulation disorders, and avoidable sources of blood loss such as unnecessary diagnostic blood draws. Proper management of anemia—prevention, screening/monitoring, diagnostic workup, and treatment including hematinic agents—is the key to effective implementation of patient blood management. Blood transfusions should be used in accordance of current guidelines, which are supportive of more restrictive transfusion strategies in most critically ill patients. Emerging studies report on the success of Patient Blood Management programs in reducing transfusion utilization, reducing the burden of anemia in patients, and improving patient outcomes including shortened length of hospital stays, less frequency of complications and lower risk of mortality.
KW - Anemia
KW - Critical care
KW - Hemoglobin
KW - Hemostasis
KW - Inflammation
KW - Iron
KW - Mortality
KW - Outcomes
KW - Patient blood management
KW - Transfusion
UR - http://www.scopus.com/inward/record.url?scp=85028333557&partnerID=8YFLogxK
U2 - 10.1016/j.tmrv.2017.07.007
DO - 10.1016/j.tmrv.2017.07.007
M3 - Review article
C2 - 28811051
AN - SCOPUS:85028333557
SN - 0887-7963
VL - 31
SP - 264
EP - 271
JO - Transfusion Medicine Reviews
JF - Transfusion Medicine Reviews
IS - 4
ER -