The Experts below are selected from a list of 149604 Experts worldwide ranked by ideXlab platform
Aryeh Shander - One of the best experts on this subject based on the ideXlab platform.
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Patient Blood Management strategies in cardiac surgery
State of the Art Surgical Coronary Revascularization, 2021Co-Authors: Aryeh Shander, Victor A. FerrarisAbstract:This chapter discusses patient Blood Management strategies in cardiac surgery, including sections on the burden of anaemia in cardiac surgery, Blood transfusion in cardiac surgery, patient Blood Management in cardiac surgery (Management of anaemia, optimization of haemostasis, autotransfusion techniques, and other supportive measures), and outcomes of patient Blood Management programmes.
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Patient Blood Management during the COVID-19 pandemic: a narrative review.
Anaesthesia, 2020Co-Authors: D. M. Baron, Manuel Munoz, Andrew A. Klein, Aryeh Shander, Mazyar Javidroozi, Susan M Goobie, M. Franchini, Sigismond Lasocki, Giancarlo M. Liumbruno, Donat R. SpahnAbstract:As COVID-19 disease escalates globally, optimising patient outcome during this catastrophic healthcare crisis is the number one priority. The principles of patient Blood Management are fundamental strategies to improve patient outcomes and should be given high priority in this crisis situation. The aim of this expert review is to provide clinicians and healthcare authorities with information regarding how to apply established principles of patient Blood Management during the COVID-19 pandemic. In particular, this review considers the impact of the COVID-19 pandemic on Blood supply and specifies important aspects of donor Management. We discuss how preventative and control measures implemented during the COVID-19 crisis could affect the prevalence of anaemia, and highlight issues regarding the diagnosis and treatment of anaemia in patients requiring elective or emergency surgery. In addition, we review aspects related to patient Blood Management of critically ill patients with known or suspected COVID-19, and discuss important alterations of the coagulation system in patients hospitalised due to COVID-19. Finally, we address special considerations pertaining to supply-demand and cost-benefit issues of patient Blood Management during the COVID-19 pandemic.
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society for the advancement of Blood Management administrative and clinical standards for patient Blood Management programs 4th edition pediatric version
Pediatric Anesthesia, 2019Co-Authors: Susan M Goobie, Trudi Gallagher, Irwin Gross, Aryeh ShanderAbstract:Patient Blood Management is the timely application of evidence-based medical and surgical concepts designed to maintain hemoglobin concentration, optimize hemostasis, and minimize Blood loss to improve patient outcomes. Conceptually similar to a "bundle" strategy, it is designed to improve clinical care using comprehensive evidence-based treatment strategies to manage patients with potential or ongoing critical bleeding, bleeding diathesis, critical anemia, and/ or a coagulopathy. Patient Blood Management includes multimodal strategies to screen, diagnose and properly treat anemia, coagulopathies and minimize bleeding, using goal-directed therapy and leverages a patient's physiologic ability to adapt to anemia while definitive treatment is undertaken. Allogeneic Blood component transfusion is one traditional therapeutic modality out of many for managing Blood loss and anemia and, while it may be the best choice in certain situations, other effective and more appropriate options are available and should be used in conjunction or alone. Therefore, comprehensive Patient Blood Management is the new standard of care to prevent and manage anemia and optimize hemostasis and has been recommended by the World Health Organization, the American Society of Anesthesiologists, the European Society of Anaesthesiology and the Australian National Blood Authority. While there is a plethora of expert consensus and good practice guidelines published for Blood component transfusion from multiple professional organizations and societies, there remains a need for more comprehensive and broader standards of patient medical Management to proactively reduce the risk of exposure to allogeneic transfusions. In 2010, the Society for Advancement of Blood Management published the first comprehensive standards to address the administrative and clinical components of an effective, patient-centered Patient Blood Management program. Recognizing the need to reduce inappropriate transfusions, some professional organizations have placed their emphasis on transfusion guidelines. In contrast, the focus of the Society for Advancement of Blood Management Standard is on the centrality of the patient and the full spectrum of therapeutic strategies needed to improve clinical outcomes in patients at risk for Blood loss or anemia, thereby reducing avoidable transfusions as well. The Standards are meant not to replace, but to complement transfusion guidelines by more completely addressing the need for a multi-modal clinical approach with the goal to improve patient outcomes. Compared to adult programs, Pediatric Patient Blood Management programs are currently not commonly accepted as standard of care for pediatric patients. This is partly due to the fact that, until recently, there was a paucity of robust evidence-based literature and expert consensus guidelines on pediatric PBM. Managing pediatric bleeding and Blood product transfusion presents a unique set of challenges. The main goal of transfusion is to correct or avoid imminent inadequate oxygen carrying capacity caused by inadequate red Blood cell mass. Determining when, what, and how much to transfuse can be difficult. Neonates, infants, children, and adolescents each have specific considerations based on age, weight, physiology, and pharmacology. In this edition of Pediatric Anaesthesia we provide, in abbreviated format, the 4th edition of the Administrative and Clinical Standards for Patient Blood Management; Pediatric Version, first published in 2010 with the addition of a new Pediatric section in 2016. These Standards provide guidance for implementing a comprehensive Pediatric Patient Blood Management program at both pediatric and adult medical institutions. While every hospital may not be equipped to have a dedicated Pediatric Patient Blood Management program, this document highlights important universal clinical strategies that can be implemented to optimize pediatric bleeding Management and minimize allogeneic Blood product exposure through the use of multi-modal therapeutic strategies that have their central emphasis on the patient rather than the transfusion. Important strategies include: treatment of preoperative anemia, standardized transfusion algorithms, the use of restrictive transfusion thresholds, goal-directed therapy based on point of care and viscoelastic testing, antifibrinolytics, and avoidance of hemodilution and hypothermia as supported by evidence. For the full version, please go to https://www.sabm.org/publications.
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Patient Blood Management in the Intensive Care Unit
Transfusion medicine reviews, 2017Co-Authors: Aryeh Shander, Mazyar Javidroozi, Gregg LobelAbstract:Patient Blood Management underscores a fundamental shift from a product-centered approach to a patient-centric approach through timely application of evidence-based medical and surgical concepts designed to maintain hemoglobin concentration, optimize hemostasis, and minimize Blood loss in an effort to improve patient outcome. In this concept, allogeneic Blood transfusion is not viewed as the treatment of default for anemic patients, but one among many treatment modalities that should be weighed based on its merits-potentials risks and benefits-for the individual patient in the context of other alternatives. Patient Blood Management provides a multidisciplinary framework for patient-centered decision making with strategies focusing on the Management of anemia, optimization of coagulation and hemostasis, and utilization of Blood conservation modalities. Among the critically ill patients, Patient Blood Management can be particularly effective given the extremely high prevalence of anemia, variable and unjustified transfusion practices, high frequency of coagulation disorders, and avoidable sources of Blood loss such as unnecessary diagnostic Blood draws. Proper Management of anemia-prevention, screening/monitoring, diagnostic workup, and treatment including hematinic agents-is the key to effective implementation of patient Blood Management. Blood transfusions should be used in accordance of current guidelines, which are supportive of more restrictive transfusion strategies in most critically ill patients. Emerging studies report on the success of Patient Blood Management programs in reducing transfusion utilization, reducing the burden of anemia in patients, and improving patient outcomes including shortened length of hospital stays, less frequency of complications and lower risk of mortality.
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“Simplified International Recommendations for the Implementation of Patient Blood Management” (SIR4PBM)
Perioperative medicine (London England), 2017Co-Authors: Patrick Meybohm, Manuel Munoz, Donat R. Spahn, Andrew A. Klein, Aryeh Shander, Toby Richards, Michael F. Murphy, Lawrence T. Goodnough, Bernd Froessler, Kai ZacharowskiAbstract:More than 30% of the world’s population are anemic with serious medical and economic consequences. Red Blood cell transfusion is the mainstay to correct anemia, but it is also one of the top five overused procedures and carries its own risk and cost burden. Patient Blood Management (PBM) is a patient-centered and multidisciplinary approach to manage anemia, minimize iatrogenic Blood loss, and harness tolerance to anemia in an effort to improve patient outcome. Despite resolution 63.12 of the World Health Organization in 2010 endorsing PBM and current guidelines which include evidence-based recommendations on the use of diagnostic/therapeutic resources to provide better health care, many hospitals have yet to implement PBM in routine clinical practice. A number of experienced clinicians developed the following “Simplified International Recommendations for Patient Blood Management.” We propose a series of simple, cost-effective, best-practice, feasible, and evidence-based measures that will enable any hospital to reduce both anemia prevalence on the day of intervention/surgery and anemia-related unnecessary transfusion in surgical and medical patients, including obstetrics and gynecology.
Donat R. Spahn - One of the best experts on this subject based on the ideXlab platform.
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building a patient Blood Management program in a large volume tertiary hospital setting problems and solutions
Turkish Journal of Thoracic and Cardiovascular Surgery, 2020Co-Authors: Serdar Gunaydin, Donat R. Spahn, Kanat Ozisik, Asli Demir, Goktan Askin, Dogan Emre Sert, Hale Bozkurt, Ali şampiyon, Dilek Kazanci, Arnel Boke KilicliAbstract:Successful implementation of a patient Blood Management program necessitates the collaboration of a strong organization and a multidisciplinary approach. We organized a meeting with broad participation in our center to establish a consensus for implementation of a specific patient Blood Management program. International and domestic experiences were shared, the importance of coordination and execution of different pillars in patient Blood Management were discussed, and the problems about the Blood transfusion system were also investigated with the proposal for solutions. The data obtained from this meeting are presented to be a guide for similar large-volume tertiary hospitals for integration of a patient Blood Management protocol.
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Patient Blood Management during the COVID-19 pandemic: a narrative review.
Anaesthesia, 2020Co-Authors: D. M. Baron, Manuel Munoz, Andrew A. Klein, Aryeh Shander, Mazyar Javidroozi, Susan M Goobie, M. Franchini, Sigismond Lasocki, Giancarlo M. Liumbruno, Donat R. SpahnAbstract:As COVID-19 disease escalates globally, optimising patient outcome during this catastrophic healthcare crisis is the number one priority. The principles of patient Blood Management are fundamental strategies to improve patient outcomes and should be given high priority in this crisis situation. The aim of this expert review is to provide clinicians and healthcare authorities with information regarding how to apply established principles of patient Blood Management during the COVID-19 pandemic. In particular, this review considers the impact of the COVID-19 pandemic on Blood supply and specifies important aspects of donor Management. We discuss how preventative and control measures implemented during the COVID-19 crisis could affect the prevalence of anaemia, and highlight issues regarding the diagnosis and treatment of anaemia in patients requiring elective or emergency surgery. In addition, we review aspects related to patient Blood Management of critically ill patients with known or suspected COVID-19, and discuss important alterations of the coagulation system in patients hospitalised due to COVID-19. Finally, we address special considerations pertaining to supply-demand and cost-benefit issues of patient Blood Management during the COVID-19 pandemic.
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Patient Blood Management: Effectiveness and Future Potential.
Anesthesiology, 2020Co-Authors: Donat R. Spahn, Manuel Munoz, Andrew A. Klein, Jerrold H. Levy, Kai ZacharowskiAbstract:Patient Blood Management is a highly successful and cost-effective concept that improves patient outcome by correction of anemia with hematinic medication and reduction of Blood loss perioperatively by meticulous surgical techniques and individualized coagulation Management.
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Patient Blood Management in der Herzchirurgie
Zeitschrift für Herz- Thorax- und Gefäßchirurgie, 2017Co-Authors: Patrick Meybohm, Donat R. Spahn, Ralf Michael Muellenbach, Harald Keller, Stephan Fichtlscherer, Nestoras Papadopoulos, Andreas Greinacher, Kai ZacharowskiAbstract:Patient Blood Management (PBM) ist ein patientenzentriertes und multidisziplinares Konzept mit der Zielsetzung, eine Anamie zu vermeiden oder zu therapieren, die Hamostase zu optimieren, den iatrogenen Blutverlust zu minimieren und die Toleranz einer Anamie medizinisch sinnvoll auszunutzen. Der vorliegende CME-Beitrag geht auf besondere Herausforderungen im Bereich der Herzchirurgie ein, u. a. auf das Management der praoperativen Anamie, das praoperative Management von oralen Antikoagulanzien und Thrombozytenaggregationshemmern, das Management der intra- und der postoperativen Koagulopathie, die Vermeidung unnotiger Blutverluste sowie vermeidbare Transfusionen allogener Blutprodukte.
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“Simplified International Recommendations for the Implementation of Patient Blood Management” (SIR4PBM)
Perioperative medicine (London England), 2017Co-Authors: Patrick Meybohm, Manuel Munoz, Donat R. Spahn, Andrew A. Klein, Aryeh Shander, Toby Richards, Michael F. Murphy, Lawrence T. Goodnough, Bernd Froessler, Kai ZacharowskiAbstract:More than 30% of the world’s population are anemic with serious medical and economic consequences. Red Blood cell transfusion is the mainstay to correct anemia, but it is also one of the top five overused procedures and carries its own risk and cost burden. Patient Blood Management (PBM) is a patient-centered and multidisciplinary approach to manage anemia, minimize iatrogenic Blood loss, and harness tolerance to anemia in an effort to improve patient outcome. Despite resolution 63.12 of the World Health Organization in 2010 endorsing PBM and current guidelines which include evidence-based recommendations on the use of diagnostic/therapeutic resources to provide better health care, many hospitals have yet to implement PBM in routine clinical practice. A number of experienced clinicians developed the following “Simplified International Recommendations for Patient Blood Management.” We propose a series of simple, cost-effective, best-practice, feasible, and evidence-based measures that will enable any hospital to reduce both anemia prevalence on the day of intervention/surgery and anemia-related unnecessary transfusion in surgical and medical patients, including obstetrics and gynecology.
Kai Zacharowski - One of the best experts on this subject based on the ideXlab platform.
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Patient Blood Management: Effectiveness and Future Potential.
Anesthesiology, 2020Co-Authors: Donat R. Spahn, Manuel Munoz, Andrew A. Klein, Jerrold H. Levy, Kai ZacharowskiAbstract:Patient Blood Management is a highly successful and cost-effective concept that improves patient outcome by correction of anemia with hematinic medication and reduction of Blood loss perioperatively by meticulous surgical techniques and individualized coagulation Management.
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Patient Blood Management in Critically Ill
Hematologic Challenges in the Critically Ill, 2018Co-Authors: Suma Choorapoikayil, Kai Zacharowski, Christoph Füllenbach, Patrick MeybohmAbstract:Anaemia is much more prevalent than commonly thought and is an independent risk factor for morbidity and mortality. For a long time, transfusion with allogeneic Blood components has been considered the only method to correct and reverse anaemia especially in hospitalized and intensive care units (ICU) till the notion that transfusion might represent an additional independent risk factor for morbidity and mortality creating uncertainty among clinicians regarding an appropriate transfusion practice. Patient Blood Management (PBM) evolved from the urgent need for an adequate anaemia Management and offers more than 100 measures to optimize patient’s own Blood. In general, PBM consist of three pillars: first, a comprehensive anaemia Management; second, the minimization of iatrogenic (avoidable) Blood loss; and third, the establishment of a rational Management of haemotherapy that could include transfusions.
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Patient Blood Management improves outcome in oncologic surgery.
World journal of surgical oncology, 2018Co-Authors: Vivienne Keding, Kai Zacharowski, Patrick Meybohm, Wolf O. Bechstein, Andreas A. SchnitzbauerAbstract:Background Patient Blood Management (PBM) is a systematic quality improving clinical model to reduce anemia and avoid transfusions in all kinds of clinical settings. Here, we investigated the potential of PBM in oncologic surgery and hypothesized that PBM improves 2-year overall survival (OS).
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Patient Blood Management in der Herzchirurgie
Zeitschrift für Herz- Thorax- und Gefäßchirurgie, 2017Co-Authors: Patrick Meybohm, Donat R. Spahn, Ralf Michael Muellenbach, Harald Keller, Stephan Fichtlscherer, Nestoras Papadopoulos, Andreas Greinacher, Kai ZacharowskiAbstract:Patient Blood Management (PBM) ist ein patientenzentriertes und multidisziplinares Konzept mit der Zielsetzung, eine Anamie zu vermeiden oder zu therapieren, die Hamostase zu optimieren, den iatrogenen Blutverlust zu minimieren und die Toleranz einer Anamie medizinisch sinnvoll auszunutzen. Der vorliegende CME-Beitrag geht auf besondere Herausforderungen im Bereich der Herzchirurgie ein, u. a. auf das Management der praoperativen Anamie, das praoperative Management von oralen Antikoagulanzien und Thrombozytenaggregationshemmern, das Management der intra- und der postoperativen Koagulopathie, die Vermeidung unnotiger Blutverluste sowie vermeidbare Transfusionen allogener Blutprodukte.
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“Simplified International Recommendations for the Implementation of Patient Blood Management” (SIR4PBM)
Perioperative medicine (London England), 2017Co-Authors: Patrick Meybohm, Manuel Munoz, Donat R. Spahn, Andrew A. Klein, Aryeh Shander, Toby Richards, Michael F. Murphy, Lawrence T. Goodnough, Bernd Froessler, Kai ZacharowskiAbstract:More than 30% of the world’s population are anemic with serious medical and economic consequences. Red Blood cell transfusion is the mainstay to correct anemia, but it is also one of the top five overused procedures and carries its own risk and cost burden. Patient Blood Management (PBM) is a patient-centered and multidisciplinary approach to manage anemia, minimize iatrogenic Blood loss, and harness tolerance to anemia in an effort to improve patient outcome. Despite resolution 63.12 of the World Health Organization in 2010 endorsing PBM and current guidelines which include evidence-based recommendations on the use of diagnostic/therapeutic resources to provide better health care, many hospitals have yet to implement PBM in routine clinical practice. A number of experienced clinicians developed the following “Simplified International Recommendations for Patient Blood Management.” We propose a series of simple, cost-effective, best-practice, feasible, and evidence-based measures that will enable any hospital to reduce both anemia prevalence on the day of intervention/surgery and anemia-related unnecessary transfusion in surgical and medical patients, including obstetrics and gynecology.
Andrew A. Klein - One of the best experts on this subject based on the ideXlab platform.
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Patient Blood Management during the COVID-19 pandemic: a narrative review.
Anaesthesia, 2020Co-Authors: D. M. Baron, Manuel Munoz, Andrew A. Klein, Aryeh Shander, Mazyar Javidroozi, Susan M Goobie, M. Franchini, Sigismond Lasocki, Giancarlo M. Liumbruno, Donat R. SpahnAbstract:As COVID-19 disease escalates globally, optimising patient outcome during this catastrophic healthcare crisis is the number one priority. The principles of patient Blood Management are fundamental strategies to improve patient outcomes and should be given high priority in this crisis situation. The aim of this expert review is to provide clinicians and healthcare authorities with information regarding how to apply established principles of patient Blood Management during the COVID-19 pandemic. In particular, this review considers the impact of the COVID-19 pandemic on Blood supply and specifies important aspects of donor Management. We discuss how preventative and control measures implemented during the COVID-19 crisis could affect the prevalence of anaemia, and highlight issues regarding the diagnosis and treatment of anaemia in patients requiring elective or emergency surgery. In addition, we review aspects related to patient Blood Management of critically ill patients with known or suspected COVID-19, and discuss important alterations of the coagulation system in patients hospitalised due to COVID-19. Finally, we address special considerations pertaining to supply-demand and cost-benefit issues of patient Blood Management during the COVID-19 pandemic.
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Patient Blood Management: Effectiveness and Future Potential.
Anesthesiology, 2020Co-Authors: Donat R. Spahn, Manuel Munoz, Andrew A. Klein, Jerrold H. Levy, Kai ZacharowskiAbstract:Patient Blood Management is a highly successful and cost-effective concept that improves patient outcome by correction of anemia with hematinic medication and reduction of Blood loss perioperatively by meticulous surgical techniques and individualized coagulation Management.
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Development and feasibility of a Patient Blood Management implementation programme in vascular surgery
Vascular medicine (London England), 2019Co-Authors: Marisa Chau, Andrew A. Klein, Divisha Gohil, Nick Schofield, Sandaruwani Abeysiri, Toby RichardsAbstract:Vascular surgery is the largest (non-cardiac) user of Blood transfusion which is associated with increased risk to patients. Patient Blood Management (PBM) is a quality improvement programme in tra...
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“Simplified International Recommendations for the Implementation of Patient Blood Management” (SIR4PBM)
Perioperative medicine (London England), 2017Co-Authors: Patrick Meybohm, Manuel Munoz, Donat R. Spahn, Andrew A. Klein, Aryeh Shander, Toby Richards, Michael F. Murphy, Lawrence T. Goodnough, Bernd Froessler, Kai ZacharowskiAbstract:More than 30% of the world’s population are anemic with serious medical and economic consequences. Red Blood cell transfusion is the mainstay to correct anemia, but it is also one of the top five overused procedures and carries its own risk and cost burden. Patient Blood Management (PBM) is a patient-centered and multidisciplinary approach to manage anemia, minimize iatrogenic Blood loss, and harness tolerance to anemia in an effort to improve patient outcome. Despite resolution 63.12 of the World Health Organization in 2010 endorsing PBM and current guidelines which include evidence-based recommendations on the use of diagnostic/therapeutic resources to provide better health care, many hospitals have yet to implement PBM in routine clinical practice. A number of experienced clinicians developed the following “Simplified International Recommendations for Patient Blood Management.” We propose a series of simple, cost-effective, best-practice, feasible, and evidence-based measures that will enable any hospital to reduce both anemia prevalence on the day of intervention/surgery and anemia-related unnecessary transfusion in surgical and medical patients, including obstetrics and gynecology.
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Patient Blood Management
2015Co-Authors: Donat R. Spahn, Manuel Munoz, Andrew A. Klein, Jerrold H. Levy, Kai ZacharowskiAbstract:Bluttransfusionen werden traditionell als lebensrettende Masnahme propagiert. Tatsachlich zeigt aber die Studienlage, dass Transfusionen mengenabhangig mit einer signifikanten Erhohung von Morbiditat und Mortalitat assoziiert sind. Neben den Erklarungsmodellen der Grundlagenforschung legen v. a. die Ergebnisse randomisierter kontrollierter Studien nahe, dass hier von einem kausalen Zusammenhang auszugehen ist. Daher relativiert der Stand der Wissenschaft das Bild von der lebensrettenden Bluttransfusion und weist deutlich auf die lebensbedrohende und krankheitsfordernde Wirkung dieser Intervention hin. Deshalb, und weil Transfusionen mit deutlich hoheren Kosten verbunden sind, als bisher angenommen, sind bei Anamie und Blutungen neue Behandlungsansatze im Sinne des „patient Blood Management“ (PBM) dringend indiziert. Patient Blood Management senkt die Transfusionsrate dramatisch durch Anamiekorrektur mithilfe stimulierter Erythropoese, Minimierung perioperativer Blutverluste und Erhohung der physiologischen Anamietoleranz. In einer Resolution der World Health Assembly ist PBM nun als Behandlungsstandard gefordert. Durch Reduktion des uberhohten Blutverbrauchs in Osterreich, Deutschland und der Schweiz konnen Morbiditat und Mortalitat deutlich reduziert werden.
Susan M Goobie - One of the best experts on this subject based on the ideXlab platform.
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Patient Blood Management during the COVID-19 pandemic: a narrative review.
Anaesthesia, 2020Co-Authors: D. M. Baron, Manuel Munoz, Andrew A. Klein, Aryeh Shander, Mazyar Javidroozi, Susan M Goobie, M. Franchini, Sigismond Lasocki, Giancarlo M. Liumbruno, Donat R. SpahnAbstract:As COVID-19 disease escalates globally, optimising patient outcome during this catastrophic healthcare crisis is the number one priority. The principles of patient Blood Management are fundamental strategies to improve patient outcomes and should be given high priority in this crisis situation. The aim of this expert review is to provide clinicians and healthcare authorities with information regarding how to apply established principles of patient Blood Management during the COVID-19 pandemic. In particular, this review considers the impact of the COVID-19 pandemic on Blood supply and specifies important aspects of donor Management. We discuss how preventative and control measures implemented during the COVID-19 crisis could affect the prevalence of anaemia, and highlight issues regarding the diagnosis and treatment of anaemia in patients requiring elective or emergency surgery. In addition, we review aspects related to patient Blood Management of critically ill patients with known or suspected COVID-19, and discuss important alterations of the coagulation system in patients hospitalised due to COVID-19. Finally, we address special considerations pertaining to supply-demand and cost-benefit issues of patient Blood Management during the COVID-19 pandemic.
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society for the advancement of Blood Management administrative and clinical standards for patient Blood Management programs 4th edition pediatric version
Pediatric Anesthesia, 2019Co-Authors: Susan M Goobie, Trudi Gallagher, Irwin Gross, Aryeh ShanderAbstract:Patient Blood Management is the timely application of evidence-based medical and surgical concepts designed to maintain hemoglobin concentration, optimize hemostasis, and minimize Blood loss to improve patient outcomes. Conceptually similar to a "bundle" strategy, it is designed to improve clinical care using comprehensive evidence-based treatment strategies to manage patients with potential or ongoing critical bleeding, bleeding diathesis, critical anemia, and/ or a coagulopathy. Patient Blood Management includes multimodal strategies to screen, diagnose and properly treat anemia, coagulopathies and minimize bleeding, using goal-directed therapy and leverages a patient's physiologic ability to adapt to anemia while definitive treatment is undertaken. Allogeneic Blood component transfusion is one traditional therapeutic modality out of many for managing Blood loss and anemia and, while it may be the best choice in certain situations, other effective and more appropriate options are available and should be used in conjunction or alone. Therefore, comprehensive Patient Blood Management is the new standard of care to prevent and manage anemia and optimize hemostasis and has been recommended by the World Health Organization, the American Society of Anesthesiologists, the European Society of Anaesthesiology and the Australian National Blood Authority. While there is a plethora of expert consensus and good practice guidelines published for Blood component transfusion from multiple professional organizations and societies, there remains a need for more comprehensive and broader standards of patient medical Management to proactively reduce the risk of exposure to allogeneic transfusions. In 2010, the Society for Advancement of Blood Management published the first comprehensive standards to address the administrative and clinical components of an effective, patient-centered Patient Blood Management program. Recognizing the need to reduce inappropriate transfusions, some professional organizations have placed their emphasis on transfusion guidelines. In contrast, the focus of the Society for Advancement of Blood Management Standard is on the centrality of the patient and the full spectrum of therapeutic strategies needed to improve clinical outcomes in patients at risk for Blood loss or anemia, thereby reducing avoidable transfusions as well. The Standards are meant not to replace, but to complement transfusion guidelines by more completely addressing the need for a multi-modal clinical approach with the goal to improve patient outcomes. Compared to adult programs, Pediatric Patient Blood Management programs are currently not commonly accepted as standard of care for pediatric patients. This is partly due to the fact that, until recently, there was a paucity of robust evidence-based literature and expert consensus guidelines on pediatric PBM. Managing pediatric bleeding and Blood product transfusion presents a unique set of challenges. The main goal of transfusion is to correct or avoid imminent inadequate oxygen carrying capacity caused by inadequate red Blood cell mass. Determining when, what, and how much to transfuse can be difficult. Neonates, infants, children, and adolescents each have specific considerations based on age, weight, physiology, and pharmacology. In this edition of Pediatric Anaesthesia we provide, in abbreviated format, the 4th edition of the Administrative and Clinical Standards for Patient Blood Management; Pediatric Version, first published in 2010 with the addition of a new Pediatric section in 2016. These Standards provide guidance for implementing a comprehensive Pediatric Patient Blood Management program at both pediatric and adult medical institutions. While every hospital may not be equipped to have a dedicated Pediatric Patient Blood Management program, this document highlights important universal clinical strategies that can be implemented to optimize pediatric bleeding Management and minimize allogeneic Blood product exposure through the use of multi-modal therapeutic strategies that have their central emphasis on the patient rather than the transfusion. Important strategies include: treatment of preoperative anemia, standardized transfusion algorithms, the use of restrictive transfusion thresholds, goal-directed therapy based on point of care and viscoelastic testing, antifibrinolytics, and avoidance of hemodilution and hypothermia as supported by evidence. For the full version, please go to https://www.sabm.org/publications.
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Patient Blood Management in Pediatric Cardiac Surgery: A Review
Anesthesia and analgesia, 2018Co-Authors: Jill M. Cholette, Victor A. Ferraris, Susan M Goobie, David Faraoni, Nabil HassanAbstract:Efforts to reduce Blood product transfusions and adopt Blood conservation strategies for infants and children undergoing cardiac surgical procedures are ongoing. Children typically receive red Blood cell and coagulant Blood products perioperatively for many reasons, including developmental alterations of their hemostatic system, and hemodilution and hypothermia with cardiopulmonary bypass that incites inflammation and coagulopathy and requires systemic anticoagulation. The complexity of their surgical procedures, complex cardiopulmonary interactions, and risk for inadequate oxygen delivery and postoperative bleeding further contribute to Blood product utilization in this vulnerable population. Despite these challenges, safe conservative Blood Management practices spanning the pre-, intra-, and postoperative periods are being developed and are associated with reduced Blood product transfusions. This review summarizes the available evidence regarding anemia Management and Blood transfusion practices in the perioperative care of these critically ill children. The evidence suggests that adoption of a comprehensive Blood Management approach decreases Blood transfusions, but the impact on clinical outcomes is less well studied and represents an area that deserves further investigation.