RESUMO
Objetivo: relatar a vivência de uma equipe interdisciplinar na implantação da técnica de Recuperação Intraoperatória de Sangue em um serviço público de atendimento ao trauma. Método: estudo descritivo, do tipo relato de experiência, desenvolvido no Instituto Dr. José Frota, Fortaleza, Ceará, Brasil. Resultados: a técnica foi implantada no segundo semestre de 2015 no hospital de trauma, e a vivência permitiu listar as atividades da implantação da técnica, como a disponibilização do equipamento, materiais e profissional capacitado; aulas e palestras direcionadas ao corpo clínico e residentes de anestesiologia; identificação de cirurgias com benefício potencial; abordagem direta da enfermagem aos cirurgiões no centro cirúrgico; divulgação sistemática da disponibilidade do método e dos resultados obtidos no hospital, com o apoio da chefia cirúrgica; criação de estratégia de comunicação na interface entre enfermeiros, cirurgiões e anestesistas; e ampliação da equipe de enfermeiros para o atendimento 24 horas. Conclusão: a implantação da técnica de Recuperação Intraoperatória de Sangue no hospital de trauma permitiu identificar critérios para sua utilização e disponibilizar a estratégia de conservação de sangue para todos os procedimentos com benefício potencial, ampliando o uso de forma sistemática. (AU)
Objective: To report the experience of an interdisciplinary team in the implementation of the Intraoperative Blood Recovery technique in a public trauma care service. Methods: Descriptive study, of the experience report type, developed at Instituto Dr. José Frota, Fortaleza, Ceará, Brazil. Results: The technique was implemented in the second half of 2015 at the trauma hospital, and the experience allowed listing the activities of the technique's implementation, such as the availability of equipment, materials and trained professionals; classes and lectures aimed at clinical staff and anesthesiology residents; identification of surgeries with potential benefit; direct nursing approach to surgeons in the operating room; systematic dissemination of the availability of the method and the results obtained in the hospital, with the support of the surgical leadership; creation of a communication strategy at the interface between nurses, surgeons and anesthetists; and expansion of the team of nurses to provide 24-hour care. Conclusion: The implementation of the Intraoperative Blood Recovery technique in the trauma hospital allowed identifying criteria for its use and making this blood conservation strategy available for all procedures with potential benefit, expanding its use in a systematic way. (AU)
Objetivo: Reportar la experiencia de un equipo interdisciplinario en la implementación de la técnica de Recuperación Sanguínea Intraoperatoria en un servicio público de atención traumatológica. Métodos: Estudio descriptivo, del tipo informe de experiencia, desarrollado en el Instituto Dr. José Frota, Fortaleza, Ceará, Brasil. Resultados: La técnica fue implementada en el segundo semestre de 2015 en el hospital de trauma, y la experiencia permitió enumerar las actividades de implementación de la técnica, como la disponibilidad de equipos, materiales y profesionales capacitados; clases y conferencias dirigidas al personal clínico y residentes de anestesiología; identificación de cirugías con beneficio potencial; abordaje directo de enfermería a los cirujanos en el quirófano; difusión sistemática de la disponibilidad del método y los resultados obtenidos en el hospital, con el apoyo del liderazgo quirúrgico; creación de una estrategia de comunicación en la interfaz entre enfermeras, cirujanos y anestesistas; y ampliación del equipo de enfermeras para brindar atención las 24 horas. Conclusión: A implantação da técnica de RIOS no hospital de trauma permitiu identificar criterios para su utilización y disponibilidad es una estrategia de conservación de sangue para todos los procedimientos con beneficio potencial, ampliando o uso de forma sistemática. (AU)
Assuntos
Recuperação de Sangue Operatório , Transfusão de Sangue Autóloga , Cuidados de EnfermagemRESUMO
Objective To prospectively compare the clinical and laboratorial aspects of patients undergoing spine deformity surgery, using the acute normovolemic hemodilution technique with tranexamic acid, versus a control group with tranexamic acid alone, and to evaluate the influence of hemodilution in intraoperative bleeding and the need for homologous transfusion. Materials and Methods Comparative prospective study with patients aged between 12 and 65 years undergoing spine deformity surgery with the acute normovolemic hemodilution technique associated with tranexamic acid versus a control group to which only tranexamic acid (15 mg/kg) was administered. Laboratorial exams were performed and analyzed in three different moments. Results A total of 30 patients were included in the present study: 17 in the hemodilution group, and 13 in the control group. The mean duration of the surgery in the hemodilution group was longer. The number of levels submitted to surgery ranged from 7 to 16 in the hemodilution group, and from 4 to 13 in the control group. Osteotomy, predominantly of the posterior kind, was performed in 20 patients. There was more intraoperative bleeding in the control group. All patients were stable during the procedures. Only 6 participants needed homologous blood transfusion, mostly from the control group ( p > 0.05). Conclusion There was no significant difference between the two groups regarding the need for blood transfusion and intraoperative bleeding. The severity of the deformity was the main determinant for homologous blood transfusion.
RESUMO
Abstract Objective To prospectively compare the clinical and laboratorial aspects of patients undergoing spine deformity surgery, using the acute normovolemic hemodilution technique with tranexamic acid, versus a control group with tranexamic acid alone, and to evaluate the influence of hemodilution in intraoperative bleeding and the need for homologous transfusion. Materials and Methods Comparative prospective study with patients aged between 12 and 65 years undergoing spine deformity surgery with the acute normovolemic hemodilution technique associated with tranexamic acid versus a control group to which only tranexamic acid (15 mg/kg) was administered. Laboratorial exams were performed and analyzed in three different moments. Results A total of 30 patients were included in the present study: 17 in the hemodilution group, and 13 in the control group. The mean duration of the surgery in the hemodilution group was longer. The number of levels submitted to surgery ranged from 7 to 16 in the hemodilution group, and from 4 to 13 in the control group. Osteotomy, predominantly of the posterior kind, was performed in 20 patients. There was more intraoperative bleeding in the control group. All patients were stable during the procedures. Only 6 participants needed homologous blood transfusion, mostly from the control group (p > 0.05). Conclusion There was no significant difference between the two groups regarding the need for blood transfusion and intraoperative bleeding. The severity of the deformity was the main determinant for homologous blood transfusion.
Resumo Objetivo Comparar de modo prospectivo os parâmetros clínicos e laboratoriais dos pacientes submetidos a hemodiluição normovolêmica aguda associada ao ácido tranexâmico com um grupo de controle que recebeu apenas ácido tranexâmico, durante cirurgia de correção de deformidades da coluna, e avaliar a influência da técnica de hemodiluição no sangramento perioperatório e a necessidade de transfusão de sangue homólogo. Materiais e Métodos Estudo prospectivo comparativo, com pacientes entre 12 e 65 anos submetidos a cirurgia para correção de deformidades da coluna vertebral, com a técnica de hemodiluição normovolêmica aguda associada ao ácido tranexâmico, versus grupo de controle com ácido tranexâmico isolado na dose de 15 mg/kg. Exames laboratoriais foram feitos e analisados em três momentos de avaliação diferentes. Resultados Participaram deste estudo 30 pacientes: 17 no grupo de hemodiluição e 13 no grupo de controle. O tempo médio de cirurgia foi maior para o grupo de hemodiluição. O número de níveis operados variou entre 7 e 16 no grupo de hemodiluição, e entre 4 e 13 no grupo de controle. Fez-se osteotomia, predominantemente posterior, em 20 pacientes. O valor médio de sangramento intraoperatório foi maior no grupo de controle. Os parâmetros clínicos se mantiveram estáveis durante todos os procedimentos. Apenas 6 pacientes necessitaram de transfusão sanguínea homóloga, a maioria dos quais pertencia ao grupo de controle (p > 0,05). Conclusão Não houve diferença significativa entre os dois grupos quanto à necessidade de transfusão e sangramento intraoperatório. A gravidade da deformidade foi o principal fator determinante da transfusão.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Escoliose , Coluna Vertebral , Transfusão de Sangue Autóloga , Hemodiluição/métodos , HemorragiaRESUMO
La hemorragia obstétrica representa un desafío para el equipo médico, aportando con importante morbilidad y mortalidad a las pacientes embarazadas.El manejo adecuado, precoz y expedito beneficia el logro de resultados favorables para la madre e hijo; es por esto que debemos reconocer activamente aquellas pacientes en riesgo de presentar un sangrado obstétrico significativo.Presentamos el primer caso reportado en Chile de una paciente embarazada con mala inserción placentaria, sometida a cesárea y decómo se realizó el manejo del sangrado intraoperatorio, con énfasis en el uso de Cell Saver como técnica ahorradora de sangre.(AU)
Obstetric hemorrhage is a challenge for the medical team, contributing with significant morbidity and mortality to the pregnant patient.An appropriate, early, and expeditious management eases the achievement of favourable results for mother and son. We must recognizeactively those patients at risk of a significant obstetric bleeding.We present the first case report in Chile of a pregnant patient with abnormal placentation, undergoing a caesarean section and howbleeding was handled during the surgery, with emphasis on the use of a Cell Saver device as a blood-saving technique.(AU)
Assuntos
Humanos , Feminino , Gravidez , Cesárea , Hemorragia , Placenta Acreta , Transfusão de Sangue , Chile , ObstetríciaRESUMO
BACKGROUND: To evaluate the efficacy and cost-effectiveness of cell salvage (CS) in reducing allogeneic transfusion in patients undergoing surgery for idiopathic scoliosis. METHODS: A case-control study with 42 patients with adolescent idiopathic scoliosis (AIS), submitted to posterior arthrodesis with instrumentation from 8/2008 to 12/2014 at the General Hospital of Fortaleza, Brazil. CS was used in 27 patients and not used in 15. The data was processed using the SPSS 20.0. The confidence level was 0.05. RESULTS: There were no significant differences between the groups for the variables of age, sex, preoperative weight, postoperative blood drainage, and surgical time. There was a significant reduction in the intra-operative allogeneic transfusion in the case group compared to the control; there was no significant difference in the postoperative period. Adding the two periods together there was a significant difference with less allogeneic red blood cells (RBC) transfused in the CS group. The total cost of allogeneic RBC between the intra and postoperative groups was higher in the control group (P=0.01). Due to this difference ($350.00-$136.93) the cost was $213.07. The net savings were $213.07. Multiplying this by the 27 subjects, allogeneic RBC transfusion led to a cost reduction of $5,752.89 for the State. CONCLUSIONS: The CS was effective in reducing allogeneic transfusion during surgery and in the total period that AIS patients underwent surgery it was also cost-effective.
RESUMO
Introducción: Los pacientes sometidos a cirugía cardiaca son candidatos a recibir múltiples transfusiones sanguíneas homólogas por causas como el sangrado; el desarrollo de estrategias de conservación sanguínea (ECS) ha permitido proteger al paciente y limitar el riesgo de enfermedades infectocontagiosas, inmunológicas e inflamatorias. Objetivo: Analizar el efecto de las estrategias de conservación sanguínea sobre la transfusión de hemoderivados en los pacientes sometidos a cirugía cardiaca con derivación cardiopulmonar. Material y métodos: Estudio no experimental, exploratorio y transversal. Muestra no probabilística (n = 105) incluyó a pacientes adultos y pediátricos sometidos a cirugía cardiopulmonar con circulación extracorpórea (CEC) que utilizaron las ECS. Recolección de datos con cédula ex profeso de las variables demográficas, hematológicas y transfusionales, CEC, ECS. Datos analizados con frecuencias, porcentajes, medidas de tendencia central y de dispersión; así como prueba de Pearson, U de Mann Whitney y T de Student; significancia p < 0.05. Resultados: Prevalecieron las valvulopatías (42%), cirugías correctivas (98%), tipo de sangre O+. Se recuperaron 120,511 ml de sangre, en promedio 1,161 ml por paciente. Tiempo de CEC relacionado con volumen sangre transfundido (r = 0.318, p = 0.000). Mayor número ECS en la cirugía correctiva (Z = -2.467, p = 0.014), en pacientes con cirugías previas se recupera un mayor volumen (t = 2.072, p = 0.039), cantidad de sangre transfundida durante la CEC es mayor en la bomba centrífuga (t = -4.022, p = 0.000), pero no hay diferencias por sexo (t = 1.488, p = 0.137). La hemoglobina y hematocrito antes y después de la CEC fue semejante (p > 0.05). Conclusiones: Las ECS son una excelente opción de uso para evitar la transfusión homóloga, ya que logran recuperar una gran cantidad de sangre autóloga, potencializándose sus beneficios. (AU)
Background: Patients undergoing cardiac surgery are eligible to receive multiple blood transfusions counterparts for reasons such as bleeding; the development of blood conservation strategies (BCS) has protected the patient and limit the risk of infectious, immunologic and inflammatory diseases. Objective: To analyze the effect of blood conservation strategies on blood transfusion in patients undergoing cardiac surgery with cardiopulmonary bypass. Material and methods: Non-experimental, exploratory and transversal study. Probabilistic sample (n = 105) included adult and pediatric patients undergoing ardiopulmonary surgery with extracorporeal circulation (ECC) using the BCS. Data collection with charter expressly demographic, blood transfusion and variables, ECC, BCS. Data analyzed using frequencies, percentages, measures of central tendency and dispersion; and Pearson test, Mann Whitney and tudent t; significance p < 0.05. Results: A prevalence of valvular heart disease (42%), corrective surgeries (98%), blood type O+. 120,511 ml blood was recovered 1,161 ml per patient. ECC time related to transfused blood volume (r = 0.318, p = 0.000). BCS largest number in corrective surgery (Z = 2467, p = 0.014) in patients with previous surgeries increased volume (t = 2.072, p = 0.039), amount of blood transfused during ECC is recovered is greater in the pump centrifuge (t = 4,022, p = 0.000), but no sex differences (t = 1.488, p = 0.137). Hemoglobin and hematocrit before and after ECC was similar (p > 0.05). Conclusions: The BCS is an excellent choice for use to avoid homologous transfusion, and who manage to recover a large amount of autologous, enhancing its benefits. (AU)
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares , Índice de Massa Triponderal , Cardiopatias , Cardiopatias/cirurgiaRESUMO
Autologous blood transfusion (ABT) has been gradually attracting more attention due to the increasingly prominent problem of blood transfusion safety and blood shortage in recent years. With the rapid development of blood conservation techniques, blood component separation technology, blood transfusion medicine and a constant increase in clinical needs, ABT technology has been expanded and innovated to a large degree. In this study, the development of preoperative autologous blood donation (PABD), acute normovolemic hemodilution (ANH), intraoperative and postoperative autotransfusion, and other new technologies and theories are reviewed and existing questions are analyzed. Challenges and applications are also discussed in order to provide reference for peers.
Assuntos
Humanos , Transfusão de Sangue Autóloga , Hemodiluição , Assistência PerioperatóriaRESUMO
Objetivo - Testar a efetividade da reinfusäo do sangue drenado em pós-operatório de cirurgia cardíaca para diminuiçäo das transfusöes homólogas, e avaliar possíveis para efeitos relacionados com esta técnica. Métodos - Quinze pacientes adultos, submetidos a cirurgia cardíaca com circulaçäo extracorpórea, receberam reinfusäo do sangue drenado, em pós-operatório e foram comparados a outros 15 pacientes em que se tomou a conduta usual. Ambos os grupos foram estudados quanto ao volume de sangue drenado e consumo de sangue no pós-operatório, cultura do sangue drenado, complicaçöes, tempo de internaçäo, hematócrito na alta e mortalidade. Resultados - Houve diminuiçäo do consumo de sangue total e concentrado de glóbulos de 25 para 10 undades quando empregada a reinfusäo de sangue (p < 0,01) e foram semelhantes a drenagem de sangue, as complicaçöes, o tempo de internaçäo e o hematócrito na alta. Näo houve óbito no grupo estudado. As culturas de sangue drenado, realizadas em 8 pacientes do grupo controle e em todos os pacientes do grupo de reinfusäo foram negativas. Conclusäo - A reinfusäo de sangue drenado é efetiva para diminuir a necessidade de transfusöes homólogas, sem trazer riscos adicionais aos pacientes
Purpose - To asses effectivity of postoperative reinfusion of shed mediastinal blood in reduction of homologous transfusions at cardiac surgery and to study the possibility of side effects. Methods - Fifteen patients submitted to cardiac surgery that had their shed mediastinal blood reinfused after surgery were compared to another group of 15 patients. The two groups were compared in relation to: volurne of shed blood, number of units of blood used in postoperative period, culture of shed blood, postoperative complications, number of days of hospitalization, hematocrit at the end of hospitalization and mortality. Results - The use of whole blood and packed blood cells decreased from 25 to 10 units with reinfusion of shed mediastinal blood (p <0.01). Volume of shed blood, postoperative complications, period of hospitalization, hematocnt at the end of hospitalization and mortality were not difierent in both groups. Culture of shed blood, in 8 patients of control group and all patients of study group were negative. Conclusion - Reinfusion of shed mediastinal blood in postoperative of cardiac surgery proved to be very efficient in decreasing homologous blood transfusions. This procedure is also safe, with no additional risk to patients