Outcome of restrictive versus liberal blood transfusion strategies in intensive care unit admitted patients

Background: Anemia is a very common disease in critically ill patients. Approximately 29% of patients have lower than normal hemoglobin levels when admitted to an ICU, and about 95% develop anemia within 3 days of admission

Aim of the Work: The purpose of this study was to evaluate the effects of restrictive and liberal red blood cell transfusion strategies on mortality and morbidity in critically ill patients. And as a result, recommend the more beneficial and the less deleterious strategy for critically ill patients

Patients and Methods: This clinical interventional study was carried out at Intensive Care Unit, Benha Teaching Hospital, Egypt, during a period from July 2017 to November 2017. This study was approved by Ethical Committee of Faculty of Medicine, Ain Shams University, including the informed consents which were obtained from either the patient or the closest family member

Results: Mortality rates in ICU were 16 % and 20% in group A and B respectively, 24% and 28% within 60 days respectively. There were lower mortality rates with group A but with no statistically significant difference between groups according to mortality during ICU Stay and mortality within 60 days

Conclusion: Comparison between the effect of restrictive and liberal strategies of blood transfusion on mortality and morbidity in critically ill patients showed no significant differences. Restrictive strategy is at least as effective to liberal strategy in critically ill patients. Blood transfusion may be hazardous and cost-effective

Recommendations: Anemia is associated with adverse clinical outcomes. However, randomized clinical trials are required to establish if transfusion is beneficial or harmful in anemic patients. A restrictive transfusion strategy should be recommended within the well-studied patient populations and clinical conditions, and the clinicians must continue to use their experience and bedside clinical judgment to advocate the best management for their patients

Regional delivery of local anesthetic agents for postoperative analgesia following femoropopliteal arterial reconstruction

This study describes a new concept for postoperative analgesia following femoropopliteal arterial reconstruction by placing an indwelling catheter along the surgical wound, through which pulses of a local anesthetic agent can be delivered in the postoperative period. Twenty-five patients undergoing femoropopliteal bypass grafting with saphenous vein for superficial femoral arterial occlusive disease were included [16 males, 9 females. Mean age 59 +/- 6 years]. Patients were randomized into two groups for postoperative pain relief: Group I [n=12]: were assigned to regional delivery of Bupivicaine 0.25% 5cc every 8 hours via an indwelling catheter placed along the wound for 48 hours. Group II [n-13]: received Pethidine 1mg/Kg IM every 8 hours for 48 hours. Patients experiencing breakthrough pain during the 8-hour period between doses received IM injection of Diclofenac potassium 75mg. Postoperative pain was rated by means of a visual analog scale. The pain score during the first 48 hours following surgery was 3.25 +/- 0.87 for Group I compared to 5.08 +/- 1.04 for Group II, p<0.0001. Only two patients in Group I required Diclofenac doses for breakthrough pain compared to 8 patients in Group II, p < 0.05. The mean dose of Diclofenac per patient was 31.25 +/- 74.7mg for Group I vs 103.85 +/- 89.5mg for Group II, p < 0.05. There was no significant difference between the two groups regarding wound problems or hospital stay. Regional delivery of a local anesthetic [Bupivicaine] via an indwelling catheter following femoropopliteal bypass surgery is a simple, safe and effective method for providing prolonged postoperative analgesia. This technique should be considered for wider use among these patients