TY - JOUR
T1 - Use of blood products in sepsis
T2 - An evidence-based review
AU - Zimmerman, Janice L.
PY - 2004/11/1
Y1 - 2004/11/1
N2 - Objective: In 2003, critical care and infectious disease experts representing 11 international organizations developed management guidelines for the use of blood products in sepsis that would be of practical use for the bedside clinician, under the auspices of the Surviving Sepsis Campaign, an international effort to increase awareness and to improve outcome in severe sepsis. Design: The process included a modified Delphi method, a consensus conference, several subsequent smaller meetings of subgroups and key individuals, teleconferences, and electronic-based discussion among subgroups and among the entire committee. Methods: The modified Delphi methodology used for grading recommendations built on a 2001 publication sponsored by the International Sepsis Forum. We undertook a systematic review of the literature graded along five levels to create recommendation grades from A to E, with A being the highest grade. Pediatric considerations to contrast adult and pediatric management are in the article by Parker et al. on p. S591. Conclusion: In the absence of extenuating circumstances and following resolution of tissue hypoperfusion, red blood cell transfusion should be targeted to maintain hemoglobin at 7.0 g/dL or greater. Erythropoietin is not recommended as a specific treatment for sepsis-associated anemia. Fresh-frozen plasma should be given for documented deficiency of coagulation factors and in the presence of active bleeding or before surgical or invasive procedures. Antithrombin administration is not recommended. Specific platelet transfusion thresholds are based on the presence or absence of bleeding, significant risk for bleeding, plans for surgery or invasive procedures, and platelet count ≤5,000/mm 3.
AB - Objective: In 2003, critical care and infectious disease experts representing 11 international organizations developed management guidelines for the use of blood products in sepsis that would be of practical use for the bedside clinician, under the auspices of the Surviving Sepsis Campaign, an international effort to increase awareness and to improve outcome in severe sepsis. Design: The process included a modified Delphi method, a consensus conference, several subsequent smaller meetings of subgroups and key individuals, teleconferences, and electronic-based discussion among subgroups and among the entire committee. Methods: The modified Delphi methodology used for grading recommendations built on a 2001 publication sponsored by the International Sepsis Forum. We undertook a systematic review of the literature graded along five levels to create recommendation grades from A to E, with A being the highest grade. Pediatric considerations to contrast adult and pediatric management are in the article by Parker et al. on p. S591. Conclusion: In the absence of extenuating circumstances and following resolution of tissue hypoperfusion, red blood cell transfusion should be targeted to maintain hemoglobin at 7.0 g/dL or greater. Erythropoietin is not recommended as a specific treatment for sepsis-associated anemia. Fresh-frozen plasma should be given for documented deficiency of coagulation factors and in the presence of active bleeding or before surgical or invasive procedures. Antithrombin administration is not recommended. Specific platelet transfusion thresholds are based on the presence or absence of bleeding, significant risk for bleeding, plans for surgery or invasive procedures, and platelet count ≤5,000/mm 3.
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U2 - 10.1097/01.CCM.0000145906.63859.1A
DO - 10.1097/01.CCM.0000145906.63859.1A
M3 - Review article
C2 - 15542962
AN - SCOPUS:8444227812
VL - 32
JO - Critical Care Medicine
JF - Critical Care Medicine
SN - 0090-3493
IS - 11 SUPPL.
ER -