TY - JOUR
T1 - Dissemination of patient blood management practices in Swiss intensive care units
T2 - a cross-sectional survey
AU - Previsdomini, Marco
AU - Colombo, Jacopo
AU - Cerutti, Bernard
AU - Gerber, Bernhard
AU - Hofmann, Axel
AU - Chiesa, Alessandro F.
AU - Saporito, Andrea
AU - Regina, Davide La
AU - Cafarotti, Stefano
AU - Patella, Miriam
AU - Perren, Andreas
N1 - Funding Information:
All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. BC reports consulting fees paid to his institution from the Swiss Society of Intensive Care Medicine and having stocks from Air Liquide. BG reports grants (unrestricted research grant) and personal fees from Pfizer; personal fees and funding for accredited con- tinuing medical education from Sanofi, Alnylam and Thermo Fisher Scientific; during the conduct of the study, funding for an accredited continuing medical education programme from Axonlab, Bayer, Bristol Myers Squibb, Daiichi-Sankyo, Janssen, Mitsubishi Tanabe Pharma, NovoNordisk, Octapharma, Takeda, Sanofi, SOBI; nonfinancial support from Axonlab and Thermo Fisher from outside the submitted work. AH reports personal fees and financial support during the past 36 months from Celgene, G1 Therapeutics, PBMe Solutions, Takeda SA, Vifor Pharma AG, Vision Plus, Werfen; personal honoraria for lectures from Heart Team Education Association Switzerland, Korean Surgical Society, Med Ed Global Solutions France; Takeda SA, Vifor Pharma AG, Vision Plus and Werfen. AS reports that Alliance Rouge currently supports implementing a PBM programme in his institution. No potential conflict of interest was disclosed.
Publisher Copyright:
© 2022 EMH Swiss Medical Publishers Ltd.. All rights reserved.
PY - 2022/5/23
Y1 - 2022/5/23
N2 - BACKGROUND: Patient blood management (PBM) promotes the routine detection and treatment of anaemia before surgery, optimising the management of bleeding disorders, thus minimising iatrogenic blood loss and preempting allogeneic blood utilisation. PBM programmes have expanded from the elective surgical setting to nonsurgical patients, including those in intensive care units (ICUs), but their dissemination in a whole country is unknown. METHODS: We performed a cross-sectional, anonymous survey (10 October 2018 to 13 March 2019) of all ordinary medical members of the Swiss Society of Intensive Care Medicine and the registered ICU nurses from the 77 certified adult Swiss ICUs. We analysed PBM-related interventions adopted in Swiss ICUs and related them to the spread of PBM in Swiss hospitals. We explored blood test ordering policies, blood-sparing strategies and red blood cell-related transfusion practices in ICUs. RESULTS: A total of 115 medical doctors and 624 nurses (response rates 27% and 30%, respectively) completed the surveys. Hospitals had implemented a PBM programme according to 42% of physicians, more commonly in Switzerland’s German-speaking regions (Odds Ratio [OR] 3.39, 95% confidence interval [CI] 1.23–9.35; p = 0.018) and in hospitals with more than 500 beds (OR 3.91, 95% CI 1.48–10.4; p = 0.006). The PBM programmes targeted the detection and correction of anaemia before surgery (79%), minimising perioperative blood loss (94%) and optimising anaemia tolerance (98%). Laboratory tests were ordered in 70.4% by the intensivist during morning rounds; the nurses performed arterial blood gas analyses autonomously in 48.4%. Blood-sparing techniques were used by only 42.1% of nurses (263 of 624, missing: 6) and 47.0% of physicians (54 of 115). Approximately 60% of respondents used an ICU-specific transfusion guideline. The reported haemoglobin threshold for the nonbleeding ICU population was 70 g/l and, therefore, was at the lower limit of current guidelines. CONCLUSIONS: Based on this survey, the estimated proportion of the intensivists working in hospitals with a PBM initiative is 42%, with significant variability between regions and hospitals of various sizes. The risk of iatrogenic anaemia is relevant due to liberal blood sample collection practices and the underuse of blood-sparing techniques. The reported transfusion threshold suggests excellent adherence to current international ICU-specific transfusion guidelines.
AB - BACKGROUND: Patient blood management (PBM) promotes the routine detection and treatment of anaemia before surgery, optimising the management of bleeding disorders, thus minimising iatrogenic blood loss and preempting allogeneic blood utilisation. PBM programmes have expanded from the elective surgical setting to nonsurgical patients, including those in intensive care units (ICUs), but their dissemination in a whole country is unknown. METHODS: We performed a cross-sectional, anonymous survey (10 October 2018 to 13 March 2019) of all ordinary medical members of the Swiss Society of Intensive Care Medicine and the registered ICU nurses from the 77 certified adult Swiss ICUs. We analysed PBM-related interventions adopted in Swiss ICUs and related them to the spread of PBM in Swiss hospitals. We explored blood test ordering policies, blood-sparing strategies and red blood cell-related transfusion practices in ICUs. RESULTS: A total of 115 medical doctors and 624 nurses (response rates 27% and 30%, respectively) completed the surveys. Hospitals had implemented a PBM programme according to 42% of physicians, more commonly in Switzerland’s German-speaking regions (Odds Ratio [OR] 3.39, 95% confidence interval [CI] 1.23–9.35; p = 0.018) and in hospitals with more than 500 beds (OR 3.91, 95% CI 1.48–10.4; p = 0.006). The PBM programmes targeted the detection and correction of anaemia before surgery (79%), minimising perioperative blood loss (94%) and optimising anaemia tolerance (98%). Laboratory tests were ordered in 70.4% by the intensivist during morning rounds; the nurses performed arterial blood gas analyses autonomously in 48.4%. Blood-sparing techniques were used by only 42.1% of nurses (263 of 624, missing: 6) and 47.0% of physicians (54 of 115). Approximately 60% of respondents used an ICU-specific transfusion guideline. The reported haemoglobin threshold for the nonbleeding ICU population was 70 g/l and, therefore, was at the lower limit of current guidelines. CONCLUSIONS: Based on this survey, the estimated proportion of the intensivists working in hospitals with a PBM initiative is 42%, with significant variability between regions and hospitals of various sizes. The risk of iatrogenic anaemia is relevant due to liberal blood sample collection practices and the underuse of blood-sparing techniques. The reported transfusion threshold suggests excellent adherence to current international ICU-specific transfusion guidelines.
UR - http://www.scopus.com/inward/record.url?scp=85132998414&partnerID=8YFLogxK
U2 - 10.4414/smw.2022.w30184
DO - 10.4414/smw.2022.w30184
M3 - Article
C2 - 35752954
AN - SCOPUS:85132998414
SN - 1424-7860
VL - 152
JO - Swiss Medical Weekly
JF - Swiss Medical Weekly
IS - 21-22
M1 - w30184
ER -