Transfusion Requirements in Surgical Oncology Patients

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  • Juliano Pinheiro de Almeida
    From the Surgical Intensive Care Unit and Department of Anesthesiology, Cancer Institute, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (J.P.d.A., F.R.B.G.G., E.P.M.d.A., J.T.F., E.A.O., F.B., C.L.P., R.E.N., S.M.R.F., J.I.A., M.B., S.V., A.C.V.S., H.P., R.K.F., J.O.C.A., L.A.H.); Department of Intensive Care, Erasme Hospital, Université Libre de B
  • Jean-Louis Vincent
    From the Surgical Intensive Care Unit and Department of Anesthesiology, Cancer Institute, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (J.P.d.A., F.R.B.G.G., E.P.M.d.A., J.T.F., E.A.O., F.B., C.L.P., R.E.N., S.M.R.F., J.I.A., M.B., S.V., A.C.V.S., H.P., R.K.F., J.O.C.A., L.A.H.); Department of Intensive Care, Erasme Hospital, Université Libre de B
  • Filomena Regina Barbosa Gomes Galas
    From the Surgical Intensive Care Unit and Department of Anesthesiology, Cancer Institute, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (J.P.d.A., F.R.B.G.G., E.P.M.d.A., J.T.F., E.A.O., F.B., C.L.P., R.E.N., S.M.R.F., J.I.A., M.B., S.V., A.C.V.S., H.P., R.K.F., J.O.C.A., L.A.H.); Department of Intensive Care, Erasme Hospital, Université Libre de B
  • Elisangela Pinto Marinho de Almeida
    From the Surgical Intensive Care Unit and Department of Anesthesiology, Cancer Institute, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (J.P.d.A., F.R.B.G.G., E.P.M.d.A., J.T.F., E.A.O., F.B., C.L.P., R.E.N., S.M.R.F., J.I.A., M.B., S.V., A.C.V.S., H.P., R.K.F., J.O.C.A., L.A.H.); Department of Intensive Care, Erasme Hospital, Université Libre de B
  • Julia T. Fukushima
    From the Surgical Intensive Care Unit and Department of Anesthesiology, Cancer Institute, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (J.P.d.A., F.R.B.G.G., E.P.M.d.A., J.T.F., E.A.O., F.B., C.L.P., R.E.N., S.M.R.F., J.I.A., M.B., S.V., A.C.V.S., H.P., R.K.F., J.O.C.A., L.A.H.); Department of Intensive Care, Erasme Hospital, Université Libre de B
  • Eduardo A. Osawa
    From the Surgical Intensive Care Unit and Department of Anesthesiology, Cancer Institute, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (J.P.d.A., F.R.B.G.G., E.P.M.d.A., J.T.F., E.A.O., F.B., C.L.P., R.E.N., S.M.R.F., J.I.A., M.B., S.V., A.C.V.S., H.P., R.K.F., J.O.C.A., L.A.H.); Department of Intensive Care, Erasme Hospital, Université Libre de B
  • Fabricio Bergamin
    From the Surgical Intensive Care Unit and Department of Anesthesiology, Cancer Institute, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (J.P.d.A., F.R.B.G.G., E.P.M.d.A., J.T.F., E.A.O., F.B., C.L.P., R.E.N., S.M.R.F., J.I.A., M.B., S.V., A.C.V.S., H.P., R.K.F., J.O.C.A., L.A.H.); Department of Intensive Care, Erasme Hospital, Université Libre de B
  • Clarice Lee Park
    From the Surgical Intensive Care Unit and Department of Anesthesiology, Cancer Institute, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (J.P.d.A., F.R.B.G.G., E.P.M.d.A., J.T.F., E.A.O., F.B., C.L.P., R.E.N., S.M.R.F., J.I.A., M.B., S.V., A.C.V.S., H.P., R.K.F., J.O.C.A., L.A.H.); Department of Intensive Care, Erasme Hospital, Université Libre de B
  • Rosana Ely Nakamura
    From the Surgical Intensive Care Unit and Department of Anesthesiology, Cancer Institute, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (J.P.d.A., F.R.B.G.G., E.P.M.d.A., J.T.F., E.A.O., F.B., C.L.P., R.E.N., S.M.R.F., J.I.A., M.B., S.V., A.C.V.S., H.P., R.K.F., J.O.C.A., L.A.H.); Department of Intensive Care, Erasme Hospital, Université Libre de B
  • Silvia M. R. Fonseca
    From the Surgical Intensive Care Unit and Department of Anesthesiology, Cancer Institute, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (J.P.d.A., F.R.B.G.G., E.P.M.d.A., J.T.F., E.A.O., F.B., C.L.P., R.E.N., S.M.R.F., J.I.A., M.B., S.V., A.C.V.S., H.P., R.K.F., J.O.C.A., L.A.H.); Department of Intensive Care, Erasme Hospital, Université Libre de B
  • Guilherme Cutait
    From the Surgical Intensive Care Unit and Department of Anesthesiology, Cancer Institute, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (J.P.d.A., F.R.B.G.G., E.P.M.d.A., J.T.F., E.A.O., F.B., C.L.P., R.E.N., S.M.R.F., J.I.A., M.B., S.V., A.C.V.S., H.P., R.K.F., J.O.C.A., L.A.H.); Department of Intensive Care, Erasme Hospital, Université Libre de B
  • Joseane Inacio Alves
    From the Surgical Intensive Care Unit and Department of Anesthesiology, Cancer Institute, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (J.P.d.A., F.R.B.G.G., E.P.M.d.A., J.T.F., E.A.O., F.B., C.L.P., R.E.N., S.M.R.F., J.I.A., M.B., S.V., A.C.V.S., H.P., R.K.F., J.O.C.A., L.A.H.); Department of Intensive Care, Erasme Hospital, Université Libre de B
  • Mellik Bazan
    From the Surgical Intensive Care Unit and Department of Anesthesiology, Cancer Institute, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (J.P.d.A., F.R.B.G.G., E.P.M.d.A., J.T.F., E.A.O., F.B., C.L.P., R.E.N., S.M.R.F., J.I.A., M.B., S.V., A.C.V.S., H.P., R.K.F., J.O.C.A., L.A.H.); Department of Intensive Care, Erasme Hospital, Université Libre de B
  • Silvia Vieira
    From the Surgical Intensive Care Unit and Department of Anesthesiology, Cancer Institute, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (J.P.d.A., F.R.B.G.G., E.P.M.d.A., J.T.F., E.A.O., F.B., C.L.P., R.E.N., S.M.R.F., J.I.A., M.B., S.V., A.C.V.S., H.P., R.K.F., J.O.C.A., L.A.H.); Department of Intensive Care, Erasme Hospital, Université Libre de B
  • Ana C. Vieira Sandrini
    From the Surgical Intensive Care Unit and Department of Anesthesiology, Cancer Institute, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (J.P.d.A., F.R.B.G.G., E.P.M.d.A., J.T.F., E.A.O., F.B., C.L.P., R.E.N., S.M.R.F., J.I.A., M.B., S.V., A.C.V.S., H.P., R.K.F., J.O.C.A., L.A.H.); Department of Intensive Care, Erasme Hospital, Université Libre de B
  • Henrique Palomba
    From the Surgical Intensive Care Unit and Department of Anesthesiology, Cancer Institute, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (J.P.d.A., F.R.B.G.G., E.P.M.d.A., J.T.F., E.A.O., F.B., C.L.P., R.E.N., S.M.R.F., J.I.A., M.B., S.V., A.C.V.S., H.P., R.K.F., J.O.C.A., L.A.H.); Department of Intensive Care, Erasme Hospital, Université Libre de B
  • Ulysses Ribeiro
    From the Surgical Intensive Care Unit and Department of Anesthesiology, Cancer Institute, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (J.P.d.A., F.R.B.G.G., E.P.M.d.A., J.T.F., E.A.O., F.B., C.L.P., R.E.N., S.M.R.F., J.I.A., M.B., S.V., A.C.V.S., H.P., R.K.F., J.O.C.A., L.A.H.); Department of Intensive Care, Erasme Hospital, Université Libre de B
  • Alexandre Crippa
    From the Surgical Intensive Care Unit and Department of Anesthesiology, Cancer Institute, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (J.P.d.A., F.R.B.G.G., E.P.M.d.A., J.T.F., E.A.O., F.B., C.L.P., R.E.N., S.M.R.F., J.I.A., M.B., S.V., A.C.V.S., H.P., R.K.F., J.O.C.A., L.A.H.); Department of Intensive Care, Erasme Hospital, Université Libre de B
  • Marcos Dalloglio
    From the Surgical Intensive Care Unit and Department of Anesthesiology, Cancer Institute, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (J.P.d.A., F.R.B.G.G., E.P.M.d.A., J.T.F., E.A.O., F.B., C.L.P., R.E.N., S.M.R.F., J.I.A., M.B., S.V., A.C.V.S., H.P., R.K.F., J.O.C.A., L.A.H.); Department of Intensive Care, Erasme Hospital, Université Libre de B
  • Maria del Pilar Estevez Diz
    From the Surgical Intensive Care Unit and Department of Anesthesiology, Cancer Institute, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (J.P.d.A., F.R.B.G.G., E.P.M.d.A., J.T.F., E.A.O., F.B., C.L.P., R.E.N., S.M.R.F., J.I.A., M.B., S.V., A.C.V.S., H.P., R.K.F., J.O.C.A., L.A.H.); Department of Intensive Care, Erasme Hospital, Université Libre de B
  • Roberto Kalil Filho
    From the Surgical Intensive Care Unit and Department of Anesthesiology, Cancer Institute, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (J.P.d.A., F.R.B.G.G., E.P.M.d.A., J.T.F., E.A.O., F.B., C.L.P., R.E.N., S.M.R.F., J.I.A., M.B., S.V., A.C.V.S., H.P., R.K.F., J.O.C.A., L.A.H.); Department of Intensive Care, Erasme Hospital, Université Libre de B
  • Jose Otavio Costa Auler
    From the Surgical Intensive Care Unit and Department of Anesthesiology, Cancer Institute, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (J.P.d.A., F.R.B.G.G., E.P.M.d.A., J.T.F., E.A.O., F.B., C.L.P., R.E.N., S.M.R.F., J.I.A., M.B., S.V., A.C.V.S., H.P., R.K.F., J.O.C.A., L.A.H.); Department of Intensive Care, Erasme Hospital, Université Libre de B
  • Andrew Rhodes
    From the Surgical Intensive Care Unit and Department of Anesthesiology, Cancer Institute, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (J.P.d.A., F.R.B.G.G., E.P.M.d.A., J.T.F., E.A.O., F.B., C.L.P., R.E.N., S.M.R.F., J.I.A., M.B., S.V., A.C.V.S., H.P., R.K.F., J.O.C.A., L.A.H.); Department of Intensive Care, Erasme Hospital, Université Libre de B
  • Ludhmila Abrahao Hajjar
    From the Surgical Intensive Care Unit and Department of Anesthesiology, Cancer Institute, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (J.P.d.A., F.R.B.G.G., E.P.M.d.A., J.T.F., E.A.O., F.B., C.L.P., R.E.N., S.M.R.F., J.I.A., M.B., S.V., A.C.V.S., H.P., R.K.F., J.O.C.A., L.A.H.); Department of Intensive Care, Erasme Hospital, Université Libre de B

説明

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background:</jats:title> <jats:p>Several studies have indicated that a restrictive erythrocyte transfusion strategy is as safe as a liberal one in critically ill patients, but there is no clear evidence to support the superiority of any perioperative transfusion strategy in patients with cancer.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods:</jats:title> <jats:p>In a randomized, controlled, parallel-group, double-blind (patients and outcome assessors) superiority trial in the intensive care unit of a tertiary oncology hospital, the authors evaluated whether a restrictive strategy of erythrocyte transfusion (transfusion when hemoglobin concentration &lt;7 g/dl) was superior to a liberal one (transfusion when hemoglobin concentration &lt;9 g/dl) for reducing mortality and severe clinical complications among patients having major cancer surgery. All adult patients with cancer having major abdominal surgery who required postoperative intensive care were included and randomly allocated to treatment with the liberal or the restrictive erythrocyte transfusion strategy. The primary outcome was a composite endpoint of mortality and morbidity.</jats:p> </jats:sec> <jats:sec> <jats:title>Results:</jats:title> <jats:p>A total of 198 patients were included as follows: 101 in the restrictive group and 97 in the liberal group. The primary composite endpoint occurred in 19.6% (95% CI, 12.9 to 28.6%) of patients in the liberal-strategy group and in 35.6% (27.0 to 45.4%) of patients in the restrictive-strategy group (P = 0.012). Compared with the restrictive strategy, the liberal transfusion strategy was associated with an absolute risk reduction for the composite outcome of 16% (3.8 to 28.2%) and a number needed to treat of 6.2 (3.5 to 26.5).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion:</jats:title> <jats:p>A liberal erythrocyte transfusion strategy with a hemoglobin trigger of 9 g/dl was associated with fewer major postoperative complications in patients having major cancer surgery compared with a restrictive strategy.</jats:p> </jats:sec>

収録刊行物

  • Anesthesiology

    Anesthesiology 122 (1), 29-38, 2015-01-01

    Ovid Technologies (Wolters Kluwer Health)

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