Comportamiento de la hemoglobina en los pacientes críticos: un análisis de la práctica transfusional en una unidad de cuidados intensivos.
Durante Flórez, Roger de Jesús | 2016-06-03
Anemia in the critically ill patient is a very frequent comorbility, its etiology multifactorial and associated with negative outcomes such as prolonged hospital stay and increased mortality. Its value, representing globular mass, has been considered the element mostly used in protocols for transfusion decision making.
To describe behavior of hemoglobin levels and analyze transfusion practices in all inclusive Care Critical Care Unit in Bogota, during the follow up time: July 2008 up to December 2014
Materials and methods:
This paper is an observational analytical study with a retrospective cohort design, done in all inclusive Care Critical Care Unit in Bogotá-Colombia, where by means of a survival analysis, behavior of levels of hemoglobin were analyzed. Additionally a tree decision making model was developed in order to compare transfusion practices with the proposed practices of the available papers on the subject.
A cohort of 4764 patients was analyzed, predominantly males (54, 58%), with a media age of 65 years (RIC: 52 – 75) and a median length of stay of 6 days (RIC: 4 - 11).
The non-surgical patients predominated over the surgical ones 3328 (69, 86%), 1436 (30, 14%) respectively.
The initial hemoglobin had a median of 11gr/dl (RIC: 9, 4 – 12, 9), with a significant difference when comparing the surgical group with the non-surgical (P= 0,005). Hemoglobin was also lower in females, trauma patients and in postoperative care of major surgery. The event defined as anemia appears more frequently between the third and fourth day of hospital stay. Mortality was reported in 15.5%
Anemia in the critical care patients is a frequent event, usually observed on day third and fourth hospital stay, mainly in surgical and septic patients. It´s relationship to adverse outcomes is yet to be elucidated.
The definition of an absolute value as a starting point for red blood cell transfusion decision appears insufficient, according to the available studies and the analyzed population. There is a need for prospective studies that take into account confusion variables and benefit/risk ratios in order to orient better transfusion practices in critically ill patients