重症监护病房血小板输注实践:九一国际血小板输注调查。

IF 5.7 1区 医学 Q1 CRITICAL CARE MEDICINE
Lene Russell, Elie Azoulay, Carl Thomas Anthon, Frédéric Pène, Padmastuti Akella, Asma Mabrouki, Kathryn Puxty, Lene Bjerregaard Nielsen, Jo Bønding Andreasen, Thomas Kander, Fredrik Sjövall, Johanna Hästbacka, Christine Lodberg Hvas, Andry Van De Louw, Sanjay Chawla, Philippe R Bauer, Pedro Castro, Pedro Povoa, Luis Coelho, Sara Fernandez, Arzu Topeli, Andreas Barratt-Due, Caterina Barbaglio, Matthias Kochanek, Ignacio Martin-Loeches, Nancy Kentish-Barnes
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引用次数: 0

摘要

背景:在重症监护病房(ICU),血小板输注是很常见的,无论是作为预防出血并发症还是作为出血治疗。欧洲重症监护医学学会(European Society of Intensive Care Medicine) ICU患者指南一般建议,除非非出血患者的血小板计数低于10 × 109细胞/L,否则不建议预防性输血小板,也不建议非大量出血合并血小板减少患者输血小板的阈值。因此,输注血小板的决定往往留给治疗医生的临床评估。本研究旨在描述当前ICU医生对血小板输注的偏好。方法:采用法语和英语两种语言制作了一份包含43个项目的在线匿名调查,由九一研究网络的调查人员分发给欧洲和美国的ICU医生。该调查评估了有出血和无出血的ICU患者的血小板输注做法、当地指南的存在以及影响输注血小板决定的因素。只分析完成的调查。结果:共收到997份由ICU医师完成的问卷调查。总体而言,国家之间和国家内部的血小板输注实践存在很大的异质性。在非出血、血小板减少的ICU内科患者中,大多数会在血小板计数阈值为10 × 109细胞/L时输注预防性血小板。30%的人会在骨髓衰竭患者中改变他们的策略,或者更自由(60%;95%置信限0.54,0.66),限制性更强(31%;0.26,0.36)或寻求帮助。手术患者、手术前和出血患者首选较高的阈值。只有173人(17%;0.15,0.19)回答说,每次他们开血小板输注处方时,他们都对临床适应症有信心。至于现有的指导方针,只有123个(12%;0.10,0.15)的人回答说他们总是会读。同事的态度和部门文化是影响输血实践的重要因素。结论:ICU的血小板输注实践存在国家间和国家内部的异质性;指南通常不被使用,临床适应症也常常存在不确定性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Platelet transfusion practice in the intensive care unit: the Nine-I international platelet transfusion survey.

Background: Platelet transfusions are frequent in the Intensive Care Unit (ICU), either as prophylaxis against bleeding complications or as treatment for bleeding. The European Society of Intensive Care Medicine guidelines for ICU patients generally recommend not using prophylactic platelet transfusions unless the platelet count falls below 10 × 109 cells/L in non-bleeding patients and make no recommendation for platelet transfusion threshold in non-massively bleeding patients with thrombocytopenia. Therefore, the decision to transfuse platelets is often left to clinical assessment by the treating physician. This study aims to describe current platelet transfusion preferences among ICU physicians.

Methods: An online, anonymous survey consisting of 43 items was produced in two languages (French and English) and distributed by investigators in the Nine-I research network to ICU physicians in Europe and the United States of America. The survey evaluated platelet transfusion practices in ICU patients with and without bleeding, the presence of local guidelines, and factors influencing the decisions to transfuse platelets. Only completed surveys were analysed.

Results: We received 997 surveys completed by ICU physicians. Overall, there was large heterogeneity in platelet transfusion practices between and within countries. In non-bleeding, thrombocytopenic medical ICU patients, most would transfuse prophylactic platelets at a platelet count threshold of 10 × 109 cells/L. Thirty percent would change their strategy in patients with bone marrow failure and either be more liberal (60%; 95% Confidence Limits 0.54, 0.66), more restrictive (31%; 0.26,0.36) or seek assistance. Higher thresholds were preferred in surgical patients, prior to procedures and in patients with bleeding. Only 173 (17%; 0.15,0.19) responded that they were confident about the clinical indications every time they prescribed a platelet transfusion. As for existing guidelines, only 123 (12%; 0.10,0.15) responded that they always read them. Colleagues' attitudes and departmental culture were important influencers on transfusion practice.

Conclusion: Platelet transfusion practice in the ICU is heterogeneous, both between and within countries; guidelines are often not used, and there is often uncertainty about the clinical indication.

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来源期刊
Annals of Intensive Care
Annals of Intensive Care CRITICAL CARE MEDICINE-
CiteScore
14.20
自引率
3.70%
发文量
107
审稿时长
13 weeks
期刊介绍: Annals of Intensive Care is an online peer-reviewed journal that publishes high-quality review articles and original research papers in the field of intensive care medicine. It targets critical care providers including attending physicians, fellows, residents, nurses, and physiotherapists, who aim to enhance their knowledge and provide optimal care for their patients. The journal's articles are included in various prestigious databases such as CAS, Current contents, DOAJ, Embase, Journal Citation Reports/Science Edition, OCLC, PubMed, PubMed Central, Science Citation Index Expanded, SCOPUS, and Summon by Serial Solutions.
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