Annales françaises d'anesthèsie et de rèanimation
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Few randomized controlled studies, the only trial design where causality can be established between an intervention and the benefits or harms thereof, have been published on the benefits and risks of a restrictive vs a liberal transfusion strategy. We review the 19 controlled studies on erythrocyte transfusion thresholds published since the eighties. These studies suggest that, overall, morbidity (including cardiac morbidity) and mortality, along with hemodynamic, respiratory and oxygen transport variables, are similar when a restrictive transfusion strategy (transfusion threshold between 7 and 8 g/dL) or a liberal strategy (transfusion threshold of 10 g/dL) are used. ⋯ In conclusion, most recommendations on transfusion practice are limited by the lack of evidence-based data and reveal our ignorance on the topic. High quality clinical trials in different patient populations must become available in order to determine optimal transfusion practices. Since then, a restrictive strategy aiming for a moderately anaemic threshold (7-8 g/dL) is appropriate under most circumstances.
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Ann Fr Anesth Reanim · Jul 2012
Multicenter Study[Use of indicators of fluid responsiveness in septic shock: a survey in public emergency departments].
Fluid therapy is one of the major elements of severe sepsis and septic shock management. A systematic initial fluid bolus is recommended before evaluation of left ventricular filling pressure by the use of indicators of fluid responsiveness, preferentially dynamic ones. A massive fluid therapy could be damaging for the patient. Dynamic indicators of fluid responsiveness are not often relevant in the emergency department. This study was aimed to evaluate the use of indicators of fluid responsiveness by emergency practitioners during septic shock management. ⋯ Emergency practitioners use preferentially less invasive and less time-consuming indicators of fluid responsiveness.
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Ann Fr Anesth Reanim · Jul 2012
Editorial Comment[Transfusion thresholds: Guidelines and real life].