{"title":"择期心脏搭桥手术患者围术期血液综合管理：保健教育和系统纠正缺铁和贫血对红细胞输注的益处","authors":"Hélène Charbonneau MD, PhD , Stéphanie Savy PhD , Nicolas Savy PhD , Marie Pasquié , Nicolas Mayeur MD, PhD , CP-PBM Study Group, Olivier Angles MD , Vincent Balech MD , Anne-Laure Berthelot MD , Madeleine Croute-Bayle MD , Isabelle Decramer MD , David Duterque MD , Valerie Julien MD , Laurent Mallet MD , Mimoun M'rini MD , Jean-François Quedreux MD , Benoit Richard MD , Laurent Sidobre MD , Laurence Taillefer MD , Adrien Thibaud MD , Giovanni Sciacca","doi":"10.1016/j.jclinane.2024.111560","DOIUrl":null,"url":null,"abstract":"<div><h3>Study objective</h3><p>The aim of this study was to investigate the efficacy of a two-step patient blood management (PBM) program in red blood cell (RBC) transfusion requirements among patients undergoing elective cardiopulmonary bypass (CPB) surgery.</p></div><div><h3>Design</h3><p>Prospective, non-randomized, two-step protocol design.</p></div><div><h3>Setting</h3><p>Cardiac surgery department of Clinique Pasteur, Toulouse, France.</p></div><div><h3>Patients</h3><p>897 patients undergoing for elective CPB surgery.</p></div><div><h3>Interventions</h3><p>We conducted a two-steps protocol: PBMe and PBMc. PBMe involved a short quality improvement program for health care workers, while PBMc introduced a systematic approach to pre- and postoperative correction of deficiencies, incorporating iron injections, oral vitamins, and erythropoiesis-stimulating agents.</p></div><div><h3>Measurements</h3><p>The PBM program's effectiveness was evaluated through comparison with a pre-PBM retrospective cohort after propensity score matching. The primary objective was the proportion of patients requiring RBC transfusions during their hospital stay. Secondary objectives were also analyzed.</p></div><div><h3>Main results</h3><p>After matching, 343 patients were included in each group. Primary outcomes were observed in 35.7% (pre-PBM), 26.7% (PBMe), and 21.1% (PBMc) of patients, resulting in a significant reduction (40.6%) in the overall RBC transfusion rate. Both the PBMe and PBMc groups exhibited significantly lower risks of RBC transfusion compared to the pre-PBM group, with adjusted odds ratios of 0.59 [95% CI 0.44–0.79] and 0.44 [95% CI 0.32–0.60], respectively. Secondary endpoints included reductions in transfusions exceeding 2 units, total RBC units transfused, administration of allogeneic blood products, and total bleeding volume recorded on Day 1. There were no significant differences noted in mortality rates or the duration of hospital stays.</p></div><div><h3>Conclusions</h3><p>This study suggests that health care education and systematic deficiency correction are associated with reduced RBC transfusion rates in elective CPB surgery. However, further randomized, controlled studies are needed to validate these findings and refine their clinical application.</p></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"98 ","pages":"Article 111560"},"PeriodicalIF":5.0000,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Comprehensive perioperative blood management in patients undergoing elective bypass cardiac surgery: Benefit effect of health care education and systematic correction of iron deficiency and anemia on red blood cell transfusion\",\"authors\":\"Hélène Charbonneau MD, PhD , Stéphanie Savy PhD , Nicolas Savy PhD , Marie Pasquié , Nicolas Mayeur MD, PhD , CP-PBM Study Group, Olivier Angles MD , Vincent Balech MD , Anne-Laure Berthelot MD , Madeleine Croute-Bayle MD , Isabelle Decramer MD , David Duterque MD , Valerie Julien MD , Laurent Mallet MD , Mimoun M'rini MD , Jean-François Quedreux MD , Benoit Richard MD , Laurent Sidobre MD , Laurence Taillefer MD , Adrien Thibaud MD , Giovanni Sciacca\",\"doi\":\"10.1016/j.jclinane.2024.111560\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Study objective</h3><p>The aim of this study was to investigate the efficacy of a two-step patient blood management (PBM) program in red blood cell (RBC) transfusion requirements among patients undergoing elective cardiopulmonary bypass (CPB) surgery.</p></div><div><h3>Design</h3><p>Prospective, non-randomized, two-step protocol design.</p></div><div><h3>Setting</h3><p>Cardiac surgery department of Clinique Pasteur, Toulouse, France.</p></div><div><h3>Patients</h3><p>897 patients undergoing for elective CPB surgery.</p></div><div><h3>Interventions</h3><p>We conducted a two-steps protocol: PBMe and PBMc. PBMe involved a short quality improvement program for health care workers, while PBMc introduced a systematic approach to pre- and postoperative correction of deficiencies, incorporating iron injections, oral vitamins, and erythropoiesis-stimulating agents.</p></div><div><h3>Measurements</h3><p>The PBM program's effectiveness was evaluated through comparison with a pre-PBM retrospective cohort after propensity score matching. The primary objective was the proportion of patients requiring RBC transfusions during their hospital stay. Secondary objectives were also analyzed.</p></div><div><h3>Main results</h3><p>After matching, 343 patients were included in each group. Primary outcomes were observed in 35.7% (pre-PBM), 26.7% (PBMe), and 21.1% (PBMc) of patients, resulting in a significant reduction (40.6%) in the overall RBC transfusion rate. Both the PBMe and PBMc groups exhibited significantly lower risks of RBC transfusion compared to the pre-PBM group, with adjusted odds ratios of 0.59 [95% CI 0.44–0.79] and 0.44 [95% CI 0.32–0.60], respectively. Secondary endpoints included reductions in transfusions exceeding 2 units, total RBC units transfused, administration of allogeneic blood products, and total bleeding volume recorded on Day 1. There were no significant differences noted in mortality rates or the duration of hospital stays.</p></div><div><h3>Conclusions</h3><p>This study suggests that health care education and systematic deficiency correction are associated with reduced RBC transfusion rates in elective CPB surgery. However, further randomized, controlled studies are needed to validate these findings and refine their clinical application.</p></div>\",\"PeriodicalId\":15506,\"journal\":{\"name\":\"Journal of Clinical Anesthesia\",\"volume\":\"98 \",\"pages\":\"Article 111560\"},\"PeriodicalIF\":5.0000,\"publicationDate\":\"2024-08-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Clinical Anesthesia\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0952818024001892\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Anesthesia","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0952818024001892","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
Comprehensive perioperative blood management in patients undergoing elective bypass cardiac surgery: Benefit effect of health care education and systematic correction of iron deficiency and anemia on red blood cell transfusion
Study objective
The aim of this study was to investigate the efficacy of a two-step patient blood management (PBM) program in red blood cell (RBC) transfusion requirements among patients undergoing elective cardiopulmonary bypass (CPB) surgery.
Cardiac surgery department of Clinique Pasteur, Toulouse, France.
Patients
897 patients undergoing for elective CPB surgery.
Interventions
We conducted a two-steps protocol: PBMe and PBMc. PBMe involved a short quality improvement program for health care workers, while PBMc introduced a systematic approach to pre- and postoperative correction of deficiencies, incorporating iron injections, oral vitamins, and erythropoiesis-stimulating agents.
Measurements
The PBM program's effectiveness was evaluated through comparison with a pre-PBM retrospective cohort after propensity score matching. The primary objective was the proportion of patients requiring RBC transfusions during their hospital stay. Secondary objectives were also analyzed.
Main results
After matching, 343 patients were included in each group. Primary outcomes were observed in 35.7% (pre-PBM), 26.7% (PBMe), and 21.1% (PBMc) of patients, resulting in a significant reduction (40.6%) in the overall RBC transfusion rate. Both the PBMe and PBMc groups exhibited significantly lower risks of RBC transfusion compared to the pre-PBM group, with adjusted odds ratios of 0.59 [95% CI 0.44–0.79] and 0.44 [95% CI 0.32–0.60], respectively. Secondary endpoints included reductions in transfusions exceeding 2 units, total RBC units transfused, administration of allogeneic blood products, and total bleeding volume recorded on Day 1. There were no significant differences noted in mortality rates or the duration of hospital stays.
Conclusions
This study suggests that health care education and systematic deficiency correction are associated with reduced RBC transfusion rates in elective CPB surgery. However, further randomized, controlled studies are needed to validate these findings and refine their clinical application.
期刊介绍：
The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained.
The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.
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