Patient Blood Management auf der Intensivstation – Transfusionspolitik im Rahmen einer individuellen Hämotherapie

Patient Blood Management (PBM) im intensivmedizinischen Bereich zielt darauf ab, patienteneigene Ressourcen zu stärken sowie blutsparende Maßnahmen in Diagnostik und Therapie, ein optimiertes Gerinnungsmanagement und eine restriktive Transfusionspolitik im Rahmen einer individuellen Hämotherapie zu etablieren. Behandlungsergebnisse können somit nachhaltig verbessert werden. Ein klinikinternes praktikables PBM-Konzept sollte in enger Kooperation von Anästhesiologen, Chirurgen, Intensivmedizinern, Internisten, Labor- und Transfusionsmedizinern ausgearbeitet werden.

Effective patient blood management in intensive care aims to conserve patients' own resources and to focus on blood-conserving measures, an optimal management of coagulopathy and a restrictive transfusion policy. In this respect, quality of patient care can be improved. A customized, practical concept should be agreed upon in an interdisciplinary capacity involving anesthesiologists, surgeons, intensivists and internists as well as laboratory and transfusion specialists.

Key words

Patient blood management - intensive care - blood transfusion - blood-conserving measures

• Literatur

• 1 Vincent JL, Baron JF, Reinhart K et al. Investigators ABC. Anemia and blood transfusion in critically ill patients. Jama 2002; 288: 1499-1507
• 2 Rodriguez RM, Corwin HL, Gettinger A et al. Nutritional deficiencies and blunted erythropoietin response as causes of the anemia of critical illness. J Crit Care 2001; 16: 36-41
• 3 Chant C, Wilson G, Friedrich JO. Anemia, transfusion, and phlebotomy practices in critically ill patients with prolonged ICU length of stay: a cohort study. Critical care 2006; 10
• 4 Shander A, Fink A, Javidroozi M et al. Appropriateness of allogeneic red blood cell transfusion: the international consensus conference on transfusion outcomes. Ann Intern Med 2011; 25: 232-246
• 5 McEvoy M, Shander A. Anemia, Bleeding, and Blood Transfusion in the Intensive Care Unit: Causes, Risks, Costs, and New Strategies. Am J Crit Care 2013; 22 (Suppl. 01) 1-13
• 6 Shah DM, Gottlieb ME, Rahm RL et al. Failure of red blood cell transfusion to increase oxygen transport or mixed venous PO2 in injured patients. J Trauma 1983; 22: 741-746
• 7 Acheson AG, Brookes MJ, Spahn DR. Effects of allogeneic red blood cell transfusions on clinical outcomes in patients undergoing colorectal cancer surgery: a systematic review and meta-analysis. Ann Surg 2012; 256: 235-244
• 8 Cata JP, Wang H, Gottumukkala V et al. Inflammatory response, immunosuppression, and cancer recurrence after perioperative blood transfusions. Br J Anaesth 2013; 110: 690-701
• 9 Vamvakas EC, Blajchman MA. Transfusion-related mortality: the ongoing risks of allogeneic blood transfusion and the available strategies for their prevention. Blood 2009; 113: 3406-3417
• 10 Rohde JM, Dimcheff DE, Blumberg N et al. Health care-associated infection after red blood cell transfusion: a systematic review and meta-analysis. JAMA 2014; 311: 1317-1326
• 11 Marik PE, Corwin HL. Efficacy of red blood cell transfusion in the critically ill: a systematic review of the literature. Crit Care Med 2008; 36: 2667-2674
• 12 Corwin HL, Parsonnet KC, Gettinger A. RBC transfusion in the ICU. Is there a reason?. Chest 1995; 108: 767-771
• 13 Wang TJ, Mort EA, Nordberg P et al. A utilization management intervention to reduce unnecessary testing in the coronary care unit. Arch Intern Med 2002; 162: 1885-1890
• 14 Sanchez-Giron F, Alvarez-Mora F. Reduction of blood loss from laboratory testing in hospitalized adult patients using small-volume (pediatric) tubes. Arch Pathol Lab Med 2008; 132: 1916-1919
• 15 Kodali BS. Capnography outside the operating rooms. Anesthesiology 2013; 118: 192-201
• 16 Wu MY, Hsu YH, Bai CH et al. Regional citrate versus heparin anticoagulation for continuous renal replacement therapy: a metaanalysis of randomized controlled trials. Am J Kidney Dis 2012; 59: 810-818
• 17 Dietrich W, Faraoni D, von Heymann C et al. ESA guidelines on the management of severe perioperative bleeding: Comments on behalf of the Subcommittee on Transfusion and Haemostasis of the European Association of Cardiothoracic Anaesthesiologists. Eur J Anaesthesiol 2014; 31: 239-241
• 18 CRASH-2 trial collaborators. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. The Lancet 2010; 376: 23-32
• 19 Weber CF, Gorlinger K, Meininger D, Herrmann E, Bingold T, Moritz A, Cohn LH, Zacharowski K. Point-of-care testing: a prospective, randomized clinical trial of efficacy in coagulopathic cardiac surgery patients. Anesthesiology 2012; 117: 531-547
• 20 Holst LB, Haase N, Wetterslev J et al. Lower versus Higher Hemoglobin Threshold for Transfusion in Septic Shock. N Engl J Med 2014; 371: 1381-1391
• 21 Walsh TS, Boyd JA, Watson D et al. Restrictive versus liberal transfusion strategies for older mechanically ventilated critically ill patients: a randomized pilot trial. Crit Care Med 2013; 41: 2354-2363
• 22 Goodnough LT, Levy JH, Murphy MF. Concepts of blood transfusion in adults. Lancet 2013; 381: 1845-1854
• 23 Bundesärztekammer VuwB Hrsg. Querschnitts-Leitlinien zur Therapie mit Blutkomponenten und Plasmaderivaten. Köln: Deutscher Ärzte-Verlag; 2009