medigraphic.com
ISSN 1405-0315 (Impreso)

2002, Número 1

<< Anterior Siguiente >>

Rev Mex Enf Cardiol 2002; 10 (1)


Eficacia de la hemodilución aguda y la recuperación celular intraoperatoria en la cirugía de corazón

Maldonado RN, González Chon O, Cisneros RJ

Idioma: Español
Referencias bibliográficas: 70
Paginas: 5-14
Archivo PDF: 374.55 Kb.


RESUMEN

Los efectos adversos potenciales, los altos costos y la escasez de donadores, han hecho que se desarrollen diversas estrategias de conservación de sangre. La disminución de las transfusiones alogénicas reducen el costo total de la atención en cirugías como la de corazón, la abdominal y ortopédica, en aproximadamente $5,000.00 dólares por paciente. En un estudio reciente la transfusión de productos de sangre alógena (PSA), se asoció con un 35% de mayor riesgo de infecciones bacterianas serias y un 52% más de riesgo de neumonías, con un total de $14,000 dólares de aumento por paciente con infección posoperatoria, una estimación conservadora considera que en promedio los costos adicionales por paciente relacionados a la transfusión de PSA es de $1,003 USD. La ventaja de la hemodilución aguda es que puede realizarse en pacientes que entran a cirugía no electiva y que disminuye el desperdicio de unidades colectadas con otros métodos, esta técnica combinada con otros procedimientos como el rescate celular, intra o posoperatorio ha dado buenos resultados para disminuir el uso de sangre alogénica, aunque tiene 25 años de descrita, hasta el momento no hay grandes series de pacientes en estudios controlados que definan totalmente sus indicaciones, por lo que su utilización continúa siendo motivo de estudios. Los costos de la utilización de este método de conservación de sangre sí se han identificado bien y son tres veces menores que utilizar la donación autóloga preoperatoria. El rescate celular es aceptado como una técnica eficaz para disminuir las necesidades de transfusiones alogénicas.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Goodnough LT, Brecher ME et al. Transfusion medicine: First of two parts, blood transfusion. N Engl J Med 1999; 340: 438-47.

  2. Vamvkas EC, Carven JH. Allogenic blood transfusion, hospital charges, and length of hospitalization: A study of 487 consecutive patients undergoing colorectal cancer resection. Arch Pathol Lab Med 1988; 122: 145-51.

  3. Jensen LS, Grunnet H, Sorensen F, Jirgensen J. Cost-efectivenesses of blood transfusion and white cell reduction in elective colorectal surgery. Transfusion 1995; 35: 719-22.

  4. Blumberg N, Kirkley SA, Heal JM. A cost analysis of autologous and allogenic transfusion in hip replacement surgery. Am J Surg 1996; 171: 324-30.

  5. Keiepert PE. Perfluorochemical emulsions: Future alternatives to transfusion: Blood Subst Princ Meth Prod. Clin Trials 1988; 2: 127-56.

  6. Randal J. “Look back” program initiated for hepatitis C infection. J Natl Cancer Inst 1999; 91: 907.

  7. AuBuchon JP. Public health, public trust and public decision making: Making hepatitis C virus look back work. Transfusion 1999; 39: 123-7.

  8. Greenburg AG. Benefits and risk of blood transfusion in surgical patients. Worls J Surg 1996; 20: 1189-93.

  9. Herbert PC, Wells G, Blajchman MA et al. And the transfusion requirements in critical care investitors for the canadian critical care trial groups: A multicenter randomized, controlled clinical trial of transfusion requirements in critical care. N Engl J Med 1999; 340: 409-17.

  10. Tremper KK. Perfluorochemical “blood substitutes”: Indications for an oxygen carrying colloid. Anesthesiology 1999; 1: 1185-7.

  11. Fitzgearald RD, Martin CM et al. Transfusion red blood cell stored in citrate phosphate dextrose adenine-1 for 28 days fails to improve tissue oxygenation in rats. Crit Care Med 1997; 25: 726-32.

  12. Sielenkamper AW, Chien YIH. Disapirin crosslinked hemoglobine improves systemic oxygen uptake in oxygen supply-dependent septic rats. Am J Respir Crit Care Med 1997; 156: 1066-72.

  13. Maarik PE, Sibbald WJ. Effect of sored blood transfusion on oxygen delivery in patients whith sepsis. JAMA 1993; 269: 3024-9.

  14. Prudy FR, Tweeddale MG, Merrick PM. Association of mortality whith age of blood transfused in septic ICU patients. Can J Anaesth 1997; 44: 1256-61.

  15. Cantaloube JF, Gallian P, Biagini P et al. Prevalence of GB virus type C/hepatitis G virus RNA and anti E2 among blood donors in southesteen france. Transfusion 1999; 39: 95-102.

  16. Lefreere JJ, Thoraval R, Morand J et al. Prevalence of virus Type C/hepatitis G virus RNA of anti E2 in individuals at high or low risk for blood borne or sexually transmited viruses: Evidence of sexual and parenteral transmission. Transfusion 1999; 39: 522-6.

  17. Blackbourn DJ, Ambroziak J et al. Infectious human herpesvirus 8 in a healthy North American blood donor. Lancet 1997; 349: 609-11.

  18. Simmonds P. Transfusion virology: progress and challenges. Blood Rev 1998; 12: 171-7.

  19. Bengtsson A, Bengsston JP. Autologus blood transfusion: Perioperative blood collection and blood savage techniques. Acta Anaestheiol Scand 1996; 36: 633-9.

  20. Thomas MJ, Gillon J et al. Consensus conference on autologus transfusion: Perioperative autologous donation. Transfusion 1996; 36: 633-9.

  21. Etchason J, Petz L, Keeler E et al. The cost effectiveness of perioperative autologous blood transfusion. N Engl J Med 1995; 332: 719-24.

  22. Innerhofer P, Walleczek C, Luz G. Transfusion of buffy coat depleted blood components and risk of postoperative infection in orthopedic patients. Transfusion 1999; 39: 625-32.

  23. Triulzi DJ, Vanek K. A clinical and immunologic study of blood transfusion and postoperative bacterial infection in spinal surgery. Transfusion 1992: 32: 517-24.

  24. Ryan T, McCarthy JF et al. Early bloodstream infection after cardiopulmonary bypass: frequency rate, risk, factors and implications. Crit Care Med 1997; 38: 595-600.

  25. Goodnough LT, Brecher ME. Transfusion Medicine: Second of two parts, conservation. N Engl J Med 1999; 340: 525-33.

  26. Goh M, Kleer CG et al. Autologous blood donation prior to anatomical radical rethropubic prostatectomy: is it necessary? Urology 1997; 49: 569-73.

  27. Popovsky MA, Whitaker B, Arnold NL. Severe outcomes of allogenic and autologous bloos donation: frequency and characterization. Transfusion 1995; 35: 734-7.

  28. Trouern-Trebd JJ, Cable RG, Badin SJ et al. A case controlled multicenter study of vasovagal reactions in blood donors: Influence of sex, age, donation status, weight, blood pressure and pulse. Transfusion 1999; 39: 316-20.

  29. Hillyer CD, Hart KK, Lackey DA. Comparable safety of blood collection in “high-risk” autologous donors versus non high-risk autologous and directed donors in a hospital setting. Am J Clin Pathol 1994: 102: 275-7.

  30. Gandini G, Franchini M, Bertuzzo D. Preoperative autologous blood donation by 1,073 elderly patients undergoing elective surgery: a safe and efective practice. Transfusion 1999; 39: 174-8.

  31. Kasper SM, Ellering J et al. All adverse events in autologous blood donors with cardiac disease are not necessarily caused by blood donation. Transfusion 1998; 38: 669-73.

  32. The National Blood Resource Education Program Expert Panel: The use of autologous blood. JAMA 1990; 263: 414-7.

  33. Miller RD, Von Ehrenburg W. Controversies in transfusion medicine: Indications for autologous and allogenics transfusion should be the same: con: transfusion. 1995; 35: 450-2.

  34. Gould SA, Forbes JM. Controversies in transfusion medicine: Indications for autologous and allogenic transfusion should be the same: pro Transfusion. 1998: 38: 296-300.

  35. Domen RE. Adverse reactions associated with autologous blood transfusion: Evaluation and incidence at a large academic hospital. Transfusion 1998; 38: 296-300.

  36. Linden JV, Kruskall MS. Autologous blood Always safer? Transfusion 1997; 37: 455-6.

  37. Sowade O, Warnke H. Avoidance of allogenic blood transfusion by treatment with epoetin beta (recombinant human erytropoyetin) in patients undergoing open heart surgery. Blood 1997; 89: 411-8.

  38. Goodnough LT, Monk TG. Current concepts: Erythropoyetin therapy. N Engl J Med 336: 933-8.

  39. Weiskop RB. Mathematical analysis of isovolemic haemodilution indicates that it can decrease the need for allogenic blood transfusion. Transfusion 1995: 35: 37-41.

  40. Gillon J, Thomas MJ. Consensus conference on autologous transfusion: Acute normovolemic hemodilution. Transfusion 1996; 36: 640-3.

  41. Goodnough LT, Monk TG. Acute normovolemic hemodilution should replace the preoperative donation of autologous blood as a method of autologous blodd procurement. Transfusion. 1998: 38: 473-6.

  42. Desmond MJ, Thomas MJ. Consensus conference on autologous transfusion. Perioperative red cell savage. Transfusion 1996; 36: 644-51.

  43. National Heart. Lung and Blood Institute Expert Paneal on the use of autologous blood. Transfusion Alert: Use of autologous blood. Transfusion 1995; 35: 703-11.

  44. Huet C, Salmi LR. International study of perioperative transfusion (ISPOT) Investigators: A metaanalysis of the effectiveness af cel savage to minimize perioperative allogenic blood transfusion in cardiac and orthopedic surgery. Anesth Analg 1999; 89: 861-9.

  45. Halpern NA, Alicea M et al. Cell saber autologous transfusion: Metabolic coquences of washing blood with normal saline. J Trauma 1996; 41: 407-1.

  46. Halpern NA, Alicea M et al. Isolyte S a physiologic multielectrolyte solution, is preferable to normal saline to wash cell saber savaged blood. Conclusions from a prospective, randomized study in a canine model. Crit Care Med 1997; 25: 2031-8.

  47. Linden JV, Kaplan HS. Fatal air embolism due to perioperative blood recovery. Aesth Analg 1997; 84: 422-6.

  48. Laupacis A, Fergusson D. Drugs to minimize perioperative blood loss in cardiac surgery: Meta analysis using perioperative blood transfusion as the outcome. The international study of peri-operative transfusion (ISPOT) investigators. Anesth Analg 1997; 85: 1258-67.

  49. Alderman EI, Levy JH et al. Analysis of coronary graft patency after aprotinin use: Results from the international multicenter aprotinin graft patency experience (IMAGE) trial. J Thorac Cardiovasc Surg 1998; 116: 716-30.

  50. Reich JB. The efficacy and safety of aprotinin use in cardiac surgery. Ann Thorac Surg 1998; 66: S6-11.

  51. Levy JH. Hemostatic agents and their safety. Cardiothoracic Vasc Aesth 1999; 13: 6-11.

  52. Kurz A, Sessle DI. For the study of wound infection and temperature group: Perioperative normotermia to reduce the incidence of surgical wound-infections and shorten hospitalization. N Engl J Med 1996; 334: 1209-15.

  53. Bock M, Muller J, Back A. Effects of preinduction and perioperative warming during major laparotomy. Br J Anaesth 1998; 80: 150-163.

  54. Schimed H, Kurtz A. Mild hypothermia increase blood loss and transfusion requirements during total hip arthoplasty. Lancet 1996; 347: 289-92.

  55. Schimed H, Scheifer A. The effects of red cell scavenging, hemodilution and active warming on allogenic blood requirements in patients undergoing hip or knee arthroplasty. Anaesth Analg 1998; 86: 9-15.

  56. Egli GA, Zollinger A. Effect of progressive haemodilution with hydroxyethyl starch, gelatin and albumin on blood coagulation: An in vitro thromboelastograpy study. Br J Anaesth 1997; 78: 684-9.

  57. Sinclair S, James S, Singer M. Intraoperative intravascular column optimization and lenght of hospital stay after repair of proximal femoral fracture. Randomised controlled trial. Br Med J 1997; 315: 909-12.

  58. Ruttmann TG, James MFM. In vivo investigation into the effects of haemodilution with hydroxyethyl starch (200/0.5) and normal saline on coagulation. Br J Anaesth 1998: 80: 612-6.

  59. Mortelmans YJ, Vernaut G et al. Effects of 6% hydroxyethil starch and 3% modified fluid gelatin on intravascular volume and coagulation during intraoperative haemodilution. Anaesth Analg 1995; 81: 1235-42.

  60. Karoustsos S, Nathan N. Thromboelastogram reveals hypercoagulability after administration of gelatin solution. Br J Anaesth 1999; 82: 175-7.

  61. Hobsich-Hagen P, Wirleittenr B. Consequences of acute normovolemic haemodilution on haemostasis during major orthopedic surgery. Br J Anaesth 1999; 82: 503-9.

  62. Adams RC, Lundy JS. Anaeasthesia in cases of poor surgical risk: some suggestions for decreasing the risk. Surg Gynecol Obstet 1942: 74-1011.

  63. Stehling I, Zauder HL. Acute a normovolemic haemodilution. Transfusion 1991; 31: 957-868.

  64. Robertie PG, Gravlee GP. Sale limits of isovolemic haemodilution and recommendations for erithrocyte transfusion. Int Anesthesiolgy Clin 1990: 28: 197-204.

  65. Chapler CK, Carn SM. The physiologic reserve in oxygen carryng capacity: Studies in experiment haemodilution. Can J Physiol Pharmacol 1986; 64: 7-12.

  66. Wnslow RM. A physiological basis for the transfusion triggerin: pies BD, Counts RB. Perioperative a transfusion medicine. Baltimore, MD: Williams & Wilkins: 1998: 27-43.

  67. Carmel R, Shuman IA. Blood transfusion in medically teatrable choronic anemia: pernicious anemia as a model for transfusion overuse. Arc Pathol Lab Med 1989; 113: 995-997.

  68. Muller G, N’tial I. Application of blood transfusion guidelines in a major hospital of Kinshasa, Zaire. AIDS 1992: 6: 431-432.

  69. Weiskopf RB, Viele MD et al. Human cardiovascular and metabolic response to acute, severe isovolemic anemia. JAMA 1998; 279: 217-221

  70. Faeanza S, Fato R et al. Experimental isovolemic haemodilution: study of tissue perfusion whith Hb 3% in swine. Minerva Anestiolo 1997; 63: 229-236.




2020     |     www.medigraphic.com