Transfusion strategies in bleeding critically ill adults: a clinical practice guideline from the European Society of Intensive Care Medicine

被引：64

作者：

Vlaar, Alexander P. J. ^{[1
]}

Dionne, Joanna C. ^{[2
,3
,4
,21
]}

de Bruin, Sanne ^{[1
]}

Wijnberge, Marije ^{[1
,5
]}

Raasveld, S. Jorinde ^{[1
]}

van Baarle, Frank E. H. P. ^{[1
]}

Antonelli, Massimo ^{[6
,7
]}

Aubron, Cecile ^{[8
]}

Duranteau, Jacques ^{[9
]}

Juffermans, Nicole P. ^{[10
,11
]}

Meier, Jens ^{[12
]}

Murphy, Gavin J. ^{[13
]}

Abbasciano, Riccardo ^{[13
]}

Muller, Marcella C. A. ^{[1
]}

Lance, Marcus ^{[14
]}

Nielsen, Nathan D. ^{[15
]}

Schochl, Herbert ^{[16
,17
]}

Hunt, Beverley J. ^{[18
]}

Cecconi, Maurizio ^{[19
,20
]}

Oczkowski, Simon ^{[2
,3
,4
]}

机构：

[1] Amsterdam UMC, Locat AMC, Dept Intens Care Med, Room C3-430,Meibergdreef 9, NL-1105 AZ Amsterdam, Netherlands

[2] McMaster Univ, Dept Med, Hamilton, ON, Canada

[3] Res Inst St Josephs Healthcare Hamilton, Guidelines Intens Care Dev & Evaluat GUIDE Grp, Hamilton, ON, Canada

[4] McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada

[5] Amsterdam UMC, Locat AMC, Dept Anaesthesiol, Amsterdam, Netherlands

[6] Fdn Policlin Univ A Gemelli IRCCS, Dept Anaesthesiol & Intens Care Med, Rome, Italy

[7] Univ Cattolica Sacro Cuore, Ist Anaesthesiol & Rianimaz, Rome, Italy

[8] Univ Bretagne Occidentale, Ctr Hosp Reg & Univ Brest, Dept Intens Care Med, Site Cavale Blanche, Brest, France

[9] Hopitaux Universitaires Paris Sud HUPS, Dept Anaesthesia & Intens Care, Le Kremlin Bicetre, France

[10] Amsterdam Univ Med Ctr, Lab Expt Intens Care & Anesthesiol, Amsterdam, Netherlands

[11] OLVG Hosp, Amsterdam, Netherlands

[12] Kepler Univ, Fac Med, Dept Anesthesiol & Crit Care Med, Linz, Austria

[13] Univ Leicester, Coll Life Sci, NIHR Leicester Biomed Res Ctr Cardiovasc Sci, Dept Cardiovasc Sci, Leicester, Leics, England

[14] Hamad Med Corp, Dept Anesthesiol, Intens Care & Perioperat Med, Doha, Qatar

[15] Univ New Mexico, Div Pulm Crit Care & Sleep Med, Sch Med, Albuquerque, NM USA

[16] AUVA Trauma Ctr Salzburg, Paracelsus Med Univ, Dept Anaesthesiol & Intens Care Med, Acad Teaching Hosp, Salzburg, Austria

[17] AUVA Trauma Res Ctr, Ludwig Boltzmann Inst Expt & Clin Traumatol, Vienna, Austria

[18] Guys & St Thomas NHS Fdn Trust, Thrombosis & Haemophilia Ctr, London, England

[19] Humanitas Clin & Res Ctr IRCCS, Dept Anaesthesia & Intens Care Med, Rozzano, MI, Italy

[20] Humanitas Univ, Via Rita Levi Montalcini, Milan, Italy

[21] McMaster Univ, Div Gastroenterol, Hamilton, ON, Canada

来源：

INTENSIVE CARE MEDICINE | 2021年 / 47卷 / 12期

关键词：

Transfusion; Coagulopathy; Critically ill; Guideline; Intensive care; Plasma; Platelets; Red blood cells; Point of care; Tranexamic acid; Bleeding; FRESH-FROZEN PLASMA; PROTHROMBIN COMPLEX CONCENTRATE; ANEURYSMAL SUBARACHNOID HEMORRHAGE; UPPER-GASTROINTESTINAL-TRACT; EARLY TRANEXAMIC ACID; RED-BLOOD-CELLS; DOUBLE-BLIND; MASSIVE TRANSFUSION; FIBRINOGEN CONCENTRATE; CARDIAC-SURGERY;

D O I：

10.1007/s00134-021-06531-x

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Purpose To develop evidence-based clinical practice recommendations regarding transfusion practices and transfusion in bleeding critically ill adults. Methods A taskforce involving 15 international experts and 2 methodologists used the GRADE approach to guideline development. The taskforce addressed three main topics: transfusion support in massively and non-massively bleeding critically ill patients (transfusion ratios, blood products, and point of care testing) and the use of tranexamic acid. The panel developed and answered structured guideline questions using population, intervention, comparison, and outcomes (PICO) format. Results The taskforce generated 26 clinical practice recommendations (2 strong recommendations, 13 conditional recommendations, 11 no recommendation), and identified 10 PICOs with insufficient evidence to make a recommendation. Conclusions This clinical practice guideline provides evidence-based recommendations for the management of massively and non-massively bleeding critically ill adult patients and identifies areas where further research is needed.

引用

页码：1368 / 1392

页数：25

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