Post on 18-Dec-2015
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Dear Consult Guys:
I need your advice regarding the practice style of one of our newest
physician hires. He joined us in 2012 after completion of his residency
and now does most of the care of our hospital patients. While he seems
to be excellent I have a major gripe with his management of our
seriously ill patients in the ICU.
My complaint relates to his management of our ICU patients and
postoperative patients who are anemic. Based on my training (I
began practice 25 years ago) I’ve been liberal regarding the approach
to anemia in our ICU and postoperative patients. I think that a Hgb as
close to 10 gm/dl really helps to maximize oxygen delivery.
Our newest associate’s approach to blood transfusion is much more
restrictive. He seems to tolerate a Hgb as low at 7 g/dL in the ICU
patient and 8 g/dL in the post operative patient. I think that his
approach is wrong and may even be dangerous.
By the end of this year we’ll have to decide whether or not to give him a
long term contract. What do you guys think?
A.B.
Corncob General Medical Assoc
Dear Consult Guys:
I need your advice regarding the practice style of one of our newest
physician hires. He joined us in 2012 after completion of his residency
and now does most of the care of our hospital patients. While he seems
to be excellent I have a major gripe with his management of our
seriously ill patients in the ICU.
My complaint relates to his management of our ICU patients and
postoperative patients who are anemic. Based on my training (I
began practice 25 years ago) I’ve been liberal regarding the approach
to anemia in our ICU and postoperative patients. I think that a Hgb as
close to 10 gm/dl really helps to maximize oxygen delivery.
Our newest associate’s approach to blood transfusion is much more
restrictive. He seems to tolerate a Hgb as low at 7 g/dL in the ICU
patient and 8 g/dL in the post operative patient. I think that his
approach is wrong and may even be dangerous.
By the end of this year we’ll have to decide whether or not to give him a
long term contract. What do you guys think?
A.B.
Corncob General Medical Assoc
A Difference of Opinion
How high should Hgb be in the ICU and postoperative patient?
LIBERAL (higher Hgb goals) Hgb 10-12
RESTRICTIVE (transfusion approach) Hgb 7-9
Doesn’t the LIBERAL approach deliver more O2 to the tissues and improve outcome?
Copyright © 2014
Carson JL, Terrin ML, Noveck H, et al. Liberal or restrictive transfusion in high-risk patients after hip surgery. N Engl J Med. 2011;365:2453-62.
Hebert PC, Wells G, Blajchman MA, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. N
Engl J Med 1999;340:409-417.
Red Blood Cell Transfusion: A Clinical Practice Guideline From the AABB*
Restrictive transfusion in hospitalized stable patientTransfuse if Hgb < 7-8 Restrictive transfusion in hospitalized patient with CV
diseaseTransfuse if symptomatic or Hgb < 8Transfusion decisions guided by symptoms and HgbNo data for guide in hospitalized stable ACS patient
Copyright © 2014
Liberal or Restrictive Transfusion in High-Risk Patients after Hip Surgery
Patients > age 50 Known or at risk for cardiovascular disease Hip fracture surgery
Liberal: transfuse if Hgb< 10Restrictive: transfuse if anemia symptoms or Hgb<8No difference in:
Mortality Morbidity Functional capacity at 60 days postop
Copyright © 2014