Kardiyak cerrahi geçiren hastalarda “hasta kan yönetimi” eğitiminin kırmızı kan hücresi transfüzyon sayısı üzerine etkisi: 5 yıllık retrospektif çalışma

Abstract

Amaç: Kardiyak cerrahide hem kan kaybı hem de kardiyopulmoner baypas uygulamasına bağlı hemodilüsyon nedeniyle kırmızı kan hücresi transfüzyonu zorunlu hale gelebilir. Teknolojik gelişmeler sayesinde transfüzyon stratejileri zaman içinde değişiklik gösterebilir. Bu çalışmanın amacı kardiyak cerrahi geçiren hastalarda, güncel bilgilerin kullanılması ile kırmızı kan hücresi transfüzyon yaklaşımındaki değişikliklerin ortaya konmasıdır.

Gereç ve Yöntemler: Üçüncü basamak eğitim ve araştırma hastanesi  kardiyovasküler cerrahi kliniğinde  1 Ocak 2013 ile 31 Aralık 2017 tarihleri arasında 5 yıllık periyotta koroner arter baypas greftleme ve/veya kalp kapak cerrahisi geçiren hastalar çalışma kapsamına alındı. Tüm hastaların yaş, cinsiyet, kırmızı kan hücresi transfüzyonu sayısı, Euroscore II, ameliyat tipi, mekanik ventilasyon süresi, yoğun bakım ünitesinde yatış süresi, hastanede yatış süresi, hastane içi mortalite durumu kaydedildi. Aralık 2015’te kalp ve damar cerrahisinde çalışan anestezi ve yoğun bakım çalışanlarına “hasta kan yönetimi” kursu düzenlendi. 1 Ocak 2016 tarihinden itibaren hasta kan yönetimi programı, kardiyak cerrahi uygulanan hastalara perioperatif dönemde uygulanmaya başlandı. 1 Ocak 2016 dan önce (Grup I) ve  sonra (Grup II) kardiyak cerrahi geçiren hastalar iki gruba ayrıldı. Hastaların karakteristik özellikleri yanı sıra yoğun bakım ünitesinde mekanik ventilasyon süresi, yoğun bakım yatış süresi, hastanede yatış süresi ve hastane içi mortalite durumu açısından bu iki grup karşılaştırıldı.

Bulgular: Toplam 691 hasta çalışmaya dahil edildi. Grup I’deki (kontrol grubu) hastalar ile Grup II’deki (çalışma grubu) hastalar istatistiksel olarak yaş, cinsiyet, Euroscore II açısından benzer idi. Transfüzyon yapılan kırmızı kan hüresi sayısı Grup I de 3.55 ± 1.49 iken Grup II’de 2.77 ± 1.64 idi (P<0.001). Mekanik ventilasyon süresi Grup I’de (6.56± 1.18 gün) Grup II’ye (5.93 ± 1.14 gün) göre daha uzun idi (P<0.001). Hem yoğun bakımda hem de hastanede yatış süresi açısından iki grup arasında istatistiksel olarak fark yoktu (P=0.823). Mortalite oranı Grup I’de %3 iken Grup II’de %3.5 idi ve bu fark istatistiksel olarak önemli değil idi (P=0.736).

Sonuç: Sağlık personelinin mevcut “hasta kan yönetimi” protokolleri hakkındaki eğitimi, kalp cerrahisi geçiren hastalarda perioperatif kırmızı kan hücresi transfüzyonlarının azalması ve kısmen iyileşmiş klinik sonuçlarla ilişkili bulunmuştur.

Keywords

• Kardiyak cerrahi,kırmızı kan hücresi,transfüzyon eğitimi

The effect of “patient blood management” training on the number of red blood cell transfusions in patients undergoing cardiac surgery: a 5-year retrospective study

Abstract

Aim: Red blood cell transfusion may be inevitable in cardiac surgery due to both blood loss and hemodilution secondary to cardiopulmonary bypass. Transfusion strategies may change over time owing to technological advances. The aim of this study was to evaluate the effect of the patient blood management education applied to healthcare staff on the number of red blood cell transfusions and clinical outcomes of the patients undergoing cardiac surgery.

Material and Methods: Patients were included to the study if they had undergone coronary artery bypass grafting and/or heart valve surgery at the cardiovascular surgery clinic of tertiary training and research hospital during the five-year period between January 1, 2013 and December 31, 2017. Age, sex, number of RBC transfusions, Euroscore II, type of surgery, duration of mechanical ventilation, length of intensive care unit (ICU) stay, length of hospital stay, and in-hospital mortality of the patients were recorded. As the intervention, a patient blood management course was held for anesthesia and intensive care unit staff the department of cardiovascular surgery in December 2015. Patient blood management program was started as of 1^st January of 2016 during perioperative period in cardiac surgery patients. Patients were divided into two groups as those undergoing cardiac surgery before January 2016 (Group I, the control group) and those having the surgery after January 2016 (Group II, the intervention group). The groups were compared in terms of sex, age, Euroscore II, duration of mechanical ventilation at intensive care unit, length of stay at intensive care unit and hospital, and in-hospital mortality.

Results: A total of 691 patients were found to meet inclusion criteria. The patients in Group I and Group II were statistically similar in age, sex, and Euroscore II. Mean number of RBC transfusions were 3.55 ± 1.49 in Group I and 2.77 ± 1.64 in Group II (p<0.001). The duration of mechanical ventilation in Group I (6.56 ± 1.18 days) was significantly longer than that in Group II (5.93 ± 14.1 days), (p<0.001). There was no statistically significant difference between the groups in terms of length at ICU and hospital (p=0.255 and p=0.823, respectively). The mortality rate was 3.0% in Group I and 3.5% in Group II, where the difference was not statistically significant (p=0.736).

Conclusion: The training of healthcare personnel about current “patient blood management” protocols was associated with reduced number of perioperative RBC transfusions and partially improved clinical outcomes in patients undergoing cardiac surgery.

Keywords

• Cardiac surgery,red blood cell,transfusion training

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