Management and prevention of anemia (acute bleeding excluded) in adult critical care patients - 09/10/20
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Abstract |
Objective |
Anemia is very common in critical care patients, on admission (affecting about two thirds of patients), but also during and after their stay, due to repeated blood loss, the effects of inflammation on erythropoiesis, a decreased red blood cell life span, and haemodilution. Anemia is associated with severity of illness and length of stay.
Methods |
A committee composed of 16 experts from four scientific societies, SFAR, SRLF, SFTS and SFVTT, evaluated three fields: (1) anaemia prevention, (2) transfusion strategies and (3) non-transfusion treatment of anaemia. Population, Intervention, Comparison, and Outcome (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Analysis of the literature and formulation of recommendations were then conducted according to the GRADE® methodology.
Results |
The SFAR-SRLF guideline panel provided ten statements concerning the management of anemia in adult critical care patients. Acute haemorrhage and chronic anemia were excluded from the scope of these recommendations. After two rounds of discussion and various amendments, a strong consensus was reached for ten recommendations. Three of these recommendations had a high level of evidence (GRADE 1±) and four had a low level of evidence (GRADE 2±). No GRADE recommendation could be provided for two questions in the absence of strong consensus.
Conclusions |
The experts reached a substantial consensus for several strong recommendations for optimal patient management. The experts recommended phlebotomy reduction strategies, restrictive red blood cell transfusion and a single-unit transfusion policy, the use of red blood cells regardless of storage time, treatment of anemic patients with erythropoietin, especially after trauma, in the absence of contraindications and avoidance of iron therapy (except in the context of erythropoietin therapy).
Le texte complet de cet article est disponible en PDF.Keywords : Guidelines, Anemia, Blood transfusion, Erythropoietin, Iron
Plan
☆ | French Society of Anaesthesia and Intensive Care (Société française d’anesthésie et de réanimation – SFAR) and French Intensive Care Society (Société de réanimation de langue française – SRLF) joint guidelines, in collaboration with the French Society of Blood Transfusion (Société française de transfusion sanguine – SFTS) and the French Society of Vigilance and Transfusion Therapeutics (Société française de vigilance et de thérapeutique transfusionnelle – SFVTT). |
☆☆ | Validated by the Board of Directors of SFAR on 20/06/2019 and SRLF on 26/06/2019. |
Vol 39 - N° 5
P. 655-664 - octobre 2020 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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