{"id":20756,"date":"2021-12-25T05:33:00","date_gmt":"2021-12-24T21:33:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=20756"},"modified":"2021-12-25T05:45:06","modified_gmt":"2021-12-24T21:45:06","slug":"intensive-care-med%e5%8f%91%e8%a1%a8%e6%8c%87%e5%8d%97-%e6%88%90%e5%b9%b4%e5%8d%b1%e9%87%8d%e7%97%85%e6%82%a3%e8%80%85%e5%87%ba%e8%a1%80%e6%97%b6%e7%9a%84%e8%be%93%e8%a1%80%e7%ad%96%e7%95%a5","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=20756","title":{"rendered":"[Intensive Care Med\u53d1\u8868\u6307\u5357]: \u6210\u5e74\u5371\u91cd\u75c5\u60a3\u8005\u51fa\u8840\u65f6\u7684\u8f93\u8840\u7b56\u7565"},"content":{"rendered":"\n

Transfusion strategies in bleeding critically ill adults: a clinical practice guideline from the European Society of Intensive Care Medicine<\/h1>\n\n\n\n

Alexander P. J. Vlaar,\u00a0Joanna C. Dionne,\u00a0Sanne de Bruin,\u00a0et al<\/h3>\n\n\n\n

Intensive Care Medicine<\/em><\/a>\u00a0 2021; 47<\/strong>:\u00a01368-1392<\/h3>\n\n\n\n

Transfusion support in massively bleeding, critically ill adults<\/p>\n\n\n\n

Part 1: massively bleeding patients<\/strong><\/h2>\n\n\n\n

1. Transfusion ratios<\/h3>\n\n\n\n

We suggest <\/strong>use of high-ratio transfusion strategies (at least one unit plasma per two units of packed red blood cells) vs. low-ratio transfusion strategies in critically ill patients with massive bleeding due to trauma (Conditional recommendation, low certainty of evidence).<\/p>\n\n\n\n

We make no recommendation<\/strong> regarding the use of fixed high-ratio transfusion strategies in critically ill patients with non-traumatic massive bleeding (No recommendation, very low certainty evidence).<\/p>\n\n\n\n

2. Platelets<\/h3>\n\n\n\n

We make no recommendation<\/strong> regarding the use of cryopreserved or cold-stored platelets in bleeding patients with massive or non-massive hemorrhage (No recommendation, very low certainty of evidence).<\/p>\n\n\n\n

3. Prothrombin complex concentrate (PCC) and plasma<\/h3>\n\n\n\n

We make no recommendation<\/strong> for the use of PCC versus plasma alone in massively bleeding patients due to very low certainty of evidence from observational studies only (No recommendation, very low certainty of evidence)<\/p>\n\n\n\n

4. Fibrinogen<\/h3>\n\n\n\n

We make no recommendation<\/strong> regarding the use of early empiric fibrinogen replacement in critically ill patients with massive hemorrhage due to trauma (No recommendation, low certainty evidence).<\/p>\n\n\n\n

5. Point of care testing<\/h3>\n\n\n\n

We suggest<\/strong> for either for viscoelastic or conventional coagulation assays to guide transfusions in massively bleeding trauma critically ill patients (Conditional recommendation, low quality of evidence)<\/p>\n\n\n\n

Part 2: transfusion support in non<\/strong>\u2011massively bleeding critically ill adults<\/strong><\/h2>\n\n\n\n

1. RBC transfusion<\/h3>\n\n\n\n

In patients with non-massive bleeding after vascular surgery, we suggest<\/strong> restrictive (7.5\u20138 g\/ d\/L) red blood cell transfusion threshold (Conditional recommendation, low certainty).<\/p>\n\n\n\n

In patients with non-massive postpartum hemorrhage, we suggest<\/strong> restrictive transfusion, guided by presence of shock and symptoms potentially attributable to anemia (e.g. dyspnea, syncope, tachycardia, angina, neurological symptoms) or hemoglobin < 6 g\/dL, rather than at a liberal target hemoglobin of 9 g\/dL (Conditional recommendation, low certainty).<\/p>\n\n\n\n

In patients with non-massive gastrointestinal bleeding, we suggest<\/strong> restrictive (7 g\/dL) transfusion vs. liberal (9 g\/dL) red blood cell transfusion threshold (Conditional recommendation, moderate certainty).<\/p>\n\n\n\n

2. Platelets<\/h3>\n\n\n\n

We make no recommendation<\/strong> for the use of a restrictive vs a liberal platelet transfusion threshold in non-massively bleeding patients with thrombocytopenia (No recommendation, very low certainty evidence)<\/p>\n\n\n\n

We suggest<\/strong> using a restrictive platelet transfusion strategy (no transfusion) in patients with intracranial hemorrhage (spontaneous or traumatic intracerebral hemorrhage) who are on antiplatelet therapy (Conditional recommendation, moderate certainty evidence).<\/p>\n\n\n\n

We make no recommendation<\/strong> for the use of a restrictive (no transfusion) vs liberal platelet transfusion strategy in critically ill patients with non-massive bleeding who are on antiplatelet therapy (No recommendation, very low certainty of evidence)<\/p>\n\n\n\n

3. Fibrinogen<\/h3>\n\n\n\n

We suggest<\/strong> the empiric use of fibrinogen concentrate in critically ill patients with non-massive bleeding after cardiac surgery, using either fixed dose (2\u20134 g) or titrated to FIBTEM clot firmness, to maintain a fibrinogen level over 1.5 g\/dL necessary for clot formation and platelet aggregation, after giving the empiric fibrinogen dose if available (Conditional recommendation, low certainty of evidence).<\/p>\n\n\n\n

We make no recommendation<\/strong> regarding the empiric use of fibrinogen concentrate in other critically ill patients with non-massive bleeding (No recommendation, low certainty of evidence)<\/p>\n\n\n\n

4. Plasma<\/h3>\n\n\n\n

We make no recommendation<\/strong> for a restrictive plasma versus a liberal plasma transfusion strategy for non-massively bleeding patients with or without coagulopathy (No recommendation, low certainty evidence)<\/p>\n\n\n\n

5. Point of care vs. conventional coagulation testing<\/h3>\n\n\n\n

We suggest<\/strong> either viscoelastic testing or conventional coagulation testing to guide transfusions in massive and non-massively bleeding cirrhotic patients, liver transplant patients or critically ill trauma patients (Conditional recommendation, low certainty evidence).<\/p>\n\n\n\n

We suggest<\/strong> either viscoelastic testing or conventional coagulation testing to guide transfusions in bleeding cardiac surgery patients (Conditional recommendation, very low certainty of evidence).<\/p>\n\n\n\n

We suggest<\/strong> using either viscoelastic testing or conventional coagulation testing to guide transfusion in extra corporeal membrane oxygenation (ECMO) patients with non-massive bleeding (Conditional recommendation, very low certainty evidence).<\/p>\n\n\n\n

Part 3. Tranexamic acid (TXA) in bleeding critically ill adults<\/strong><\/h2>\n\n\n\n

1. TXA in patients with traumatic intracranial hemorrhage<\/h3>\n\n\n\n

We recommend<\/strong> the use of early (< 3 h from trauma) TXA in critically ill patients with bleeding or suspected bleeding due to trauma (Strong recommendation, high certainty).<\/p>\n\n\n\n

We suggest<\/strong> the use of TXA in critically ill patients with acute traumatic brain injury and bleeding due to trauma (Conditional recommendation, moderate certainty).<\/p>\n\n\n\n

We make no recommendation<\/strong> regarding the use of TXA in critically ill patients with subarachnoid hemorrhage (No recommendation, low certainty evidence).<\/p>\n\n\n\n

2. TXA in patients with non\u2011traumatic intracranial hemorrhage.<\/h3>\n\n\n\n

We make no recommendation<\/strong> regarding the use of TXA in critically ill patients non-traumatic intracranial hemorrhage (No recommendation, moderate certainty).<\/p>\n\n\n\n

We suggest<\/strong> not using high-dose IV TXA in critically ill patients with gastrointestinal bleeding (Conditional recommendation, high certainty evidence).<\/p>\n\n\n\n

We make no recommendation<\/strong> regarding the use of low-dose IV TXA or enteral TXA in critically ill patients with gastrointestinal bleeding (No recommendation, moderate certainty evidence)<\/p>\n\n\n\n

We suggest<\/strong> the early use of TXA in critically ill patients with postpartum hemorrhage (Conditional recommendation, high certainty).<\/p>\n\n\n\n

We\u00a0recommend<\/strong>\u00a0the use of TXA in critically ill patients with bleeding post-cardiac surgery (Strong recommendation, high certainty).<\/p>\n\n\n\n

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Transfusion strategies in bleeding critically ill adult […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[25,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/20756"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=20756"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/20756\/revisions"}],"predecessor-version":[{"id":20757,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/20756\/revisions\/20757"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=20756"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=20756"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=20756"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}