Revealing the real risks of perioperative transfusion: rise of the machines!
Revealing the real risks of perioperative transfusion: rise of the machines!
复制标题
揭示围术期输血的真正风险：机器的崛起！
DOI：
10.1097/aln.0000000000000515
复制
发表时间：
2015
期刊：
影响因子：
8.8
通讯作者：
Pittet,Jean-Francois
中科院分区：
文献类型：
--
作者：
Simmons,JeffreyW;Pittet,Jean-Francois
Approximately 30,000,000 blood components were transfused last year in the United States. Almost half of those were transfused in the operating room or perioperatively according to the 2011 National Blood Collection and Utilization Survey Report. 1 Consequently, the anesthesiologist assumes a substantial role in mitigating adverse transfusion reactions. In fact, one adverse reaction per 414 units transfused was reported in the above survey, accounting for 50,570 total. 1 Many transfusion reactions can be identified with predictable laboratory diagnostic tests. However, when no specific test exists or concrete definitions are not established, the diagnosis is often missed or under appreciated. As a result, the transfusion reaction remains in obscurity; if proper safeguards are not implemented, the possibility of occurring again is not deterred. This is the case in Transfusion Related Acute Lung Injury (TRALI) and Transfusion Associated Circulatory Overload (TACO). In this month's edition of Anesthesiology, Kor, et al., have taken an enormous step in providing better detection of these common adverse reactions. 2, 3Why is reporting a seemingly obvious reaction that is temporally related to a visible intervention so difficult? On paper, a patient without lung injury developing acute respiratory distress within hours of receiving a blood transfusion would seem likely to raise red flags. Unfortunately, the clinical picture is often blurred with multiple confounders. Dyspnea is expected in patients presenting with preexisting cardiac conditions or underlying pulmonary disease. Isolating one culprit among multiple interventions occurring in surgical patients is often not possible or may not have clinical relevance when choosing the next therapy. Indeed, the treatment for acute respiratory failure from adult respiratory distress syndrome and circulatory overload are similar regardless of etiology. In addition, reporting depends on the specialty of the physicians and how they diagnose TRALI and TACO. 4 Personal reasons may also factor into reporting. Fear of reprisal, apathy, or unawareness of the reporting mechanisms must be taken into account. Finally, to steal a sports phrase, the concept of “no harm, no foul” may be a reason for underreporting. To address these
报告输血相关急性肺损伤的实践：临床和临床前学科的全国调查
影响因子：
2.9
作者：
A. Vlaar;K. Wortel;J. Binnekade;M. V. van Oers;E. Beckers;O. Gajic;M. Schultz;N. Juffermans
通讯作者：
N. Juffermans
影响因子：
2.9
作者：
Leahy, Michael F.;Roberts, Heather;Towler, Simon
通讯作者：
Towler, Simon
影响因子：
2.1
作者：
Leahy, M. F.;Mukhtar, S. A.
通讯作者：
Mukhtar, S. A.