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deleted263296
I'm to present a brief topic for my ICU rotation. I was trying to present on some topic that is current and relevant to ICU doctors. A lot of trials I see have generally negative results. I was just hoping for some ideas. Thanks!
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the myth of transfusion thresholds
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http://jama.jamanetwork.com/article.aspx?articleid=13832
The surgeons where right (for the wrong reasons!)......chloride kills.....
The surgeons where right (for the wrong reasons!)......chloride kills.....
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Fluid responsiveness, the uselessness of CVPs.
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http://www.nejm.org/doi/full/10.1056/NEJMoa1211801
3 weeks old from NEJM. good study atleast for UGIB. Though it excludes the heart patients which I am still transfusing if less than 10
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why?
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there are a few studies, I would have to search for them to provide you the links, that show mortality improvement with an elevated transfusion threshold in the cardiac patients. Cardiomyopathies, CABG, recent plasty patients, etc. Basis I believe was impaired peripheral O2 delivery secondary to reduced stroke volumes (CM) and the Hb levels in the 7s to 8s put higher stess on already weakened hearts. last one of those I read was a few years ago though. Would have to look to see if there is anything more recent. Our CV surgeons like their pts around 9-10 though. Obviously they are transfused at much slower infusion rates and generally get some diuresis to prevent overload but their #s are higher than the traditional "gastric ulcer with no comorbities don't transfuse unless below 7 or hemodynamiclly comprimised."
