Document Detail


Hemoglobin drift after cardiac surgery.
MedLine Citation:
PMID:  22609121     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Recent literature suggests that a restrictive approach to red blood cell transfusions is associated with improved outcomes in cardiac surgery patients. Even in the absence of bleeding, intravascular fluid shifts cause hemoglobin levels to drift postoperatively, possibly confounding the decision to transfuse. The purpose of this study was to define the natural progression of hemoglobin levels in postoperative cardiac surgery patients.
METHODS: All cardiac surgery patients from October 2010 through March 2011 who did not receive a postoperative transfusion were included. Primary stratification was by intraoperative transfusion status. Change in hemoglobin was evaluated relative to the initial postoperative hemoglobin. Maximal drift was defined as the maximum minus the minimum hemoglobin for a given hospitalization. Final drift was defined as the difference between initial and discharge hemoglobin.
RESULTS: The final cohort included 199 patients: 71 (36%) received an intraoperative transfusion, whereas 128 (64%) did not. The average initial and final hemoglobin levels for all patients were 11.0±1.4 g/dL and 9.9±1.3 g/dL, respectively, giving a final drift of 1.1±1.4 g/dL. The maximal drift was 1.8±1.1 g/dL and was similar regardless of intraoperative transfusion status (p=0.9). Although all patients' hemoglobin initially dropped, 79% of patients reached a nadir and experienced a mean recovery of 0.7±0.7 g/dL by discharge. On multivariable analysis, increasing cardiopulmonary bypass time was significantly associated with total hemoglobin drift (coefficient/hour, 0.3 [0.1-0.5] g/dL; p=0.02).
CONCLUSIONS: In this report of hemoglobin drift after cardiac surgery, although all postoperative patients experienced downward hemoglobin drift, 79% of patients exhibited hemoglobin recovery before discharge. Physicians should consider the eventual upward hemoglobin drift before administering red blood cell transfusions.
Authors:
Timothy J George; Claude A Beaty; Arman Kilic; Kara A Haggerty; Steven M Frank; William J Savage; Glenn J Whitman
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural     Date:  2012-05-19
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  94     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-08-24     Completed Date:  2012-11-13     Revised Date:  2013-09-03    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  703-9     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Affiliation:
Division of Cardiac Surgery, Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Blood Transfusion / methods
Cardiac Surgical Procedures / adverse effects,  methods*
Cardiopulmonary Bypass / adverse effects,  methods
Cohort Studies
Confidence Intervals
Coronary Artery Bypass / adverse effects,  methods
Databases, Factual
Education, Medical, Continuing
Erythrocyte Transfusion / methods*
Female
Follow-Up Studies
Hemoglobins / analysis*
Humans
Intraoperative Care / methods*
Male
Middle Aged
Multivariate Analysis
Postoperative Period
Prospective Studies
Regression Analysis
Risk Assessment
Statistics, Nonparametric
Treatment Outcome
Grant Support
ID/Acronym/Agency:
T32 2T32DK007713-12/DK/NIDDK NIH HHS; T32 DK007713/DK/NIDDK NIH HHS
Chemical
Reg. No./Substance:
0/Hemoglobins
Comments/Corrections
Comment In:
Ann Thorac Surg. 2012 Sep;94(3):709   [PMID:  22916742 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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