Transfusion Thresholds in Patients With Neurological Injury: Balancing Oxygen Delivery and Risk.

IF 2.3 2区 医学 Q2 ANESTHESIOLOGY
Cara Rathmell, Susana Vacas
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引用次数: 0

Abstract

Transfusion strategies in neurocritical care require a delicate and nuanced balance between optimizing oxygen delivery to the injured brain and minimizing transfusion-associated risks. Although restrictive transfusion protocols are widely adopted in critical care, their applicability to patients with neurological injury remains the subject of debate. Anemia may exacerbate cerebral hypoxia, potentially worsening neurological outcomes, yet transfusion carries risks such as thrombosis, immune modulation, and increased intracranial pressure. Studies comparing liberal and restrictive transfusion strategies in neurocritical care have yielded mixed results, with most settling on the noninferiority of a restrictive approach while still considering a higher threshold for particular subgroups. This focused review will examine the current evidence on transfusion strategies in neurocritically ill patients and highlight key areas for future research.

神经损伤患者的输血阈值:平衡氧输送和风险。
在神经危重症护理中的输血策略需要在优化损伤脑的氧气输送和最小化输血相关风险之间取得微妙的平衡。尽管限制性输血方案在重症监护中被广泛采用,但其对神经损伤患者的适用性仍然存在争议。贫血可能加剧脑缺氧,潜在地恶化神经预后,然而输血有血栓形成、免疫调节和颅内压升高等风险。在神经危重症护理中比较自由输血和限制性输血策略的研究产生了不同的结果,大多数研究都认为限制性方法的非劣效性,同时仍然考虑到特定亚群的更高阈值。这篇重点综述将检查神经危重症患者输血策略的现有证据,并强调未来研究的关键领域。
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来源期刊
CiteScore
6.20
自引率
10.80%
发文量
119
审稿时长
>12 weeks
期刊介绍: The Journal of Neurosurgical Anesthesiology (JNA) is a peer-reviewed publication directed to an audience of neuroanesthesiologists, neurosurgeons, neurosurgical monitoring specialists, neurosurgical support staff, and Neurosurgical Intensive Care Unit personnel. The journal publishes original peer-reviewed studies in the form of Clinical Investigations, Laboratory Investigations, Clinical Reports, Review Articles, Journal Club synopses of current literature from related journals, presentation of Points of View on controversial issues, Book Reviews, Correspondence, and Abstracts from affiliated neuroanesthesiology societies. JNA is the Official Journal of the Society for Neuroscience in Anesthesiology and Critical Care, the Neuroanaesthesia and Critical Care Society of Great Britain and Ireland, the Association de Neuro-Anesthésiologie Réanimation de langue Française, the Wissenschaftlicher Arbeitskreis Neuroanästhesie der Deutschen Gesellschaft fur Anästhesiologie und Intensivmedizen, the Arbeitsgemeinschaft Deutschsprachiger Neuroanästhesisten und Neuro-Intensivmediziner, the Korean Society of Neuroanesthesia, the Japanese Society of Neuroanesthesia and Critical Care, the Neuroanesthesiology Chapter of the Colegio Mexicano de Anesthesiología, the Indian Society of Neuroanesthesiology and Critical Care, and the Thai Society for Neuroanesthesia.
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