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

Yıl 2019, Cilt: 10 Sayı: 1, 98 - 103, 21.03.2019

Ayşe Lafçı Derya Gökçınar Osman Dağ Eren Günertem Serdar Günaydın

https://doi.org/10.18663/tjcl.499101

Cited By: 1

Öz

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.

Anahtar Kelimeler

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

Öz

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.

Anahtar Kelimeler

Cardiac surgery, red blood cell, transfusion training

Kaynakça

• 1. Bennett-Guerrero E, Zhao Y, O'Brien SM et al. Variation in use of blood transfusion in coronary artery bypass graft surgery. JAMA 2010; 304: 1568-75.
• 2. Demirok M, Askin D, Emin I. Autologous blood transfusions during the bypass and valve operations. Turk Gogus Kalp Dama 2005; 13: 193-96.
• 3. Curley GF, Shehata N, Mazer CD, Hare GM, Friedrich JO. Transfusion triggers for guiding RBC transfusion for cardiovascular surgery: a systematic review and meta-analysis. Crit Care Med 2014; 12: 2611-24.
• 4. National Blood Transfusion Committee. Patient Blood Management: An evidence-based approach to patient care https://www.transfusionguidelines.org/uk-transfusion-committees/national-blood-transfusion-committee/patient-blood-management.
• 5. National Blood Authority. Patient Blood Management Guidelines: Module 2: Perioperative https://www.blood.gov.au/system/files/documents/pbm-module-2.pdf
• 6. Bracey AW, Radovancevic R, Riggs SA et al. Lowering the hemoglobin threshold for transfusion in coronary artery bypass procedures: Effect on patient outcome. Transfusion 1999; 39: 1070–77.
• 7. Slight RD, Fung AK, Alonzi C et al. Rationalizing blood transfusion in cardiac surgery: Preliminary findings with a red cell volume-based model. Vox Sanguinis 2007; 92: 154–56.
• 8. Slight RD, O'Donohoe P, Fung AK et al. Rationalizing blood transfusion in cardiac surgery: The impact of a red cell volume-based guideline on blood usage and clinical outcome. Vox Sang 2008; 95: 205–10.
• 9. Hajjar LA, Vincent JL, Galas FR et al. Transfusion requirements after cardiac surgery: The TRACS randomized controlled trial. JAMA 2010; 304: 1559–67.
• 10. Goodnough LT, Shander A. Patient blood management. Anesthesiology 2012; 116: 1367-76.
• 11. Carless PA, Henry DA, Anthony DM. Fibrin sealant use for minimising peri-operative allogeneic blood transfusion. Cochrane Database Syst Rev 2003; 2: 4171.
• 12. Abrishami A, Chung F, Wong J. Topical application of antifibrinolytic drugs for on-pump cardiac surgery: a systematic review and meta-analysis. Can J Anaesth 2009; 56: 202–12.
• 13. IBM Corp. (2015). IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp.
• 14. Shehata N, Burns LA, Nathan H et al. A randomized controlled pilot study of adherence to transfusion strategies in cardiac surgery. Transfusion 2012; 52: 91–99.
• 15. Lilly CM, Badawi O, Liu X, Christine S G, Harris I. Red Blood Cell Product Transfusion Thresholds and Clinical Outcomes. J Intensive Care Med 2018; 1: 885066618762746.
• 16. Mazer CD, Whitlock RP, Fergusson DA et al. TRICS Investigators and Perioperative Anesthesia Clinical Trials Group. Restrictive or Liberal Red-Cell Transfusion for Cardiac Surgery. N Engl J Med 2017; 30: 2133-44.
• 17. Koch CG, Li L, Duncan AI et al. Morbidity and mortality risk associated with red blood cell and blood-component transfusion in isolated coronary artery bypass grafting. Crit Care Med 2006; 34: 1608-16.
• 18. Murphy GJ, Reeves BC, Rogers CA et al. Increased mortality, postoperative morbidity, and cost after red blood cell transfusion in patients having cardiac surgery. Circulation 2007; 116: 2544–52.
• 19. Paone G, Brewer R, Theurer PF et al. Michigan Society of Thoracic and Cardiovascular Surgeons. Preoperative predicted risk does not fully explain the association between red blood cell transfusion and mortality in coronary artery bypass grafting. J Thorac Cardiovasc Surg 2012; 143: 178–85.