Blood Loss Kinetics During the First 12 Hours After On-Pump Cardiac Surgical Procedures
| Autor: | Norddine Zeroual, Cinderella Blin, Pascal Colson, Emmanuelle Aubry, Marine Saour, Philippe Gaudard |
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| Rok vydání: | 2021 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine Time Factors Blood management Anemia medicine.medical_treatment Blood volume Postoperative Hemorrhage 030204 cardiovascular system & hematology law.invention 03 medical and health sciences 0302 clinical medicine Blood loss 030202 anesthesiology law medicine Humans Blood Transfusion Prospective Studies Cardiac Surgical Procedures Aged Volume of distribution Receiver operating characteristic business.industry Incidence Middle Aged medicine.disease Intensive care unit 3. Good health Chest tube ROC Curve Anesthesia Female Surgery France Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | The Annals of Thoracic Surgery. 111:1308-1315 |
| ISSN: | 0003-4975 |
| Popis: | Anemia and coagulation management and a restrictive transfusion strategy are key points of blood management in patients undergoing cardiac surgical procedures. However, little consideration has been given to the kinetics of postoperative bleeding. This prospective observational study investigated bleeding kinetics from chest tubes to assess whether it was possible to predict, within the early postoperative hours, major bleeding at 12 postoperative hours.Adult cardiac surgical patients who were admitted consecutively to the postoperative intensive care unit in a tertiary academic hospital from January to June 2016 were included. Blood volume was collected from the chest drains, and major bleeding was defined as bleeding exceeding the 90th percentile of the volume distribution at 12 postoperative hours. Receiver operating characteristics curve analysis was performed with hourly bleeding thresholds to determine the best predictor of major bleeding.In 292 patients, bleeding at 12 postoperative hours ranged from 60 to 2190 mL (median, 350 mL), and 30 patients had major bleeding, with a threshold of 675 mL. Bleeding volume declined logarithmically, 54% [IQR, 45% to 63%] within the first 4 hours. Patients with major bleeding had a higher bleeding volume every hour (P.004). A good predictive value was observed within the first 2 hours (2.73 mL/kg; receiver operating characteristics area under the curve, 0.87 ± 0.04 [IQR, 0.79 to 0.94]; P.001).The hourly rate of chest tube blood loss seems to be relevant to predict, within the first postoperative hours after cardiac surgical procedures, major bleeding at 12 postoperative hours. Early detection of blood loss may help to improve a patient's blood conservation strategy because it may prompt preemptive treatments. |
| Databáze: | OpenAIRE |
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