27 de janeiro de 2015

Artigo recomendado: The role of the anesthesiologist in perioperative patient safety

Johannes Wacker; Sven Staender
2014 Wolters Kluwer Health/Lippincott Williams & Wilkins

Purpose of review
Despite the benefits of rapidly advancing therapeutic and diagnostic possibilities, the perioperative setting still exposes patients to significant risks of adverse events and harm. Anesthesiologists are in midstream of perioperative care and can make significant contributions to patient safety and patient outcomes. This article reviews recent research results outlining the current trends of perioperative patient harm and summarizes the evidence in favor of patient safety practices.

Recent findings
Adverse events and patient harm continue to be frequent in the perioperative period. Adverse events occur in about 30% of hospital admissions, are associated with higher mortality, and may be preventable in more than 50%. Evidence-based recommendations are available for many patient safety issues. No magic bullet practices exist, but promising targets include the prevention and limitation of perioperative infections and of complications of airway and respiratory management, the maintenance of achieved safety standards, the use of checklists, and others.

Summary
Current research provides growing evidence for the effectiveness of several patient safety practices designed to prevent or diminish perioperative adverse events and patient harm. Future investigations will hopefully fill the numerous persisting knowledge gaps.

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12 de janeiro de 2015

Artigo Recomendado: Transfusion Requirements in Surgical Oncology Patients

A Prospective, Randomized Controlled Trial


Juliano Pinheiro de Almeida; Jean-Louis Vincent; Filomena Regina Barbosa Gomes Galas; Elisangela Pinto Marinho de Almeida; Julia T. Fukushima; Eduardo A. Osawa; Fabricio Bergamin; Clarice Lee Park; Rosana Ely Nakamura; Silvia M. R. Fonseca; Guilherme Cutait; Joseane Inacio Alves; Mellik Bazan; Silvia Vieira; Ana C. Vieira Sandrini; Henrique Palomba; Ulysses Ribeiro Jr.; Alexandre Crippa; Marcos Dalloglio; Maria del Pilar Estevez Diz; Roberto Kalil Filho; Jose Otavio Costa Auler; Andrew Rhodes; Ludhmila Abrahao Hajjar

Anesthesiology 2015; 122:29-38

ABSTRACT
Background: 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.

Methods: 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 < 7 g/dl) was superior to a liberal one (transfusion when hemoglobin concentration < 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.

Results: 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).

Conclusion: 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.


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