1.
Prevalence of shunt dependency and clinical outcome in patients with massive intraventricular haemorrhage treated with endoscopic washout and external ventricular drainage
Johnson JR, Idris Z, Abdullah JM, Alias A, Haspani MS
The Malaysian Journal of Medical Sciences : Mjms. 2017;24((1)):40-46.
Abstract
BACKGROUND Intraventricular haemorrhage (IVH) causes blockage of ventricular conduits leading to hydrocephalus, increased intracranial pressure (ICP), and a reduced level of consciousness. The current standard management of IVH is insertion of an external ventricular drainage (EVD) catheter. However, this procedure addresses only the problems of acute hydrocephalus and raised ICP. Endoscopic washout allows for a more complete removal of the intraventricular clot. This study compared these two types of treatment in terms of shunt dependency and relevant clinical outcomes. METHODS Patients who were 10-80 years old and presented with a Graeb score of more than six were randomised into endoscopic washout and EVD treatment groups. A CT brain was repeated on each patient within 24 hours after surgery, and if a patient's Graeb score was still more than six, a repeat endoscopic washout was performed to clear the remaining clots. All patients were monitored for shunt dependency at two weeks and three months, and clinical outcomes were measured at six months after the procedure. RESULTS A total of 39 patients were recruited; 19 patients were randomised into the endoscopic washout group, and 20 were randomised into the EVD group. However, three patients in the endoscopic group refused that treatment and opted for EVD insertion. Patients treated with endoscopic washout had significantly less drainage dependency at two weeks (P < 0.005) and at three months (P < 0.004) as compared to patients in the external ventricular drainage group. The reduction in Graeb scores was also significantly greater in the endoscopic washout group (P < 0.001). However, the functional outcome at six months measured via a modified Rankin scale score was no different in the two groups of patients. The difference in the functional outcome of the patients was mainly dependent on the initial pathology, with those presenting with a thalamic bleed with IVH showing a poor functional outcome. This parameter was also influenced by the Glasgow Coma Scale (GCS) score on admission, with those patients with a score of 12 or less having a poor functional outcome (MRS 5-6) at three and six months after the surgery. CONCLUSIONS The use of neuroendoscopy in patients with a massive IVH significantly reduced drainage dependency. However, it did not alter the final functional outcome.
2.
Reducing blood transfusion requirements in preterm infants by a new device: a pilot study
Ballin A, Livshiz V, Mimouni FB, Dollberg S, Kohelet D, Oren A, Arbel E, Boaz M, Tal A, Matas Z, et al
Acta Paediatrica (Oslo, Norway : 1992). 2009;98((2):):247-50.
Abstract
OBJECTIVE To test a new device designed to salvage red blood cells (RBCs) from blood samples drawn from preterm infants, with the intent of decreasing blood loss and lowering the requirements for RBC transfusions. DESIGN A case-controlled pilot study was conducted in two Israeli neonatal intensive care units in large municipal hospitals. Twenty low-birthweight preterm infants were randomly and equally divided into the ErythroSave group or a control group. All blood tests in the study group (except for complete blood count and coagulation parameters) were obtained during the first week of life by the new device in the study group and by ordinary syringes in the control group. The main outcome measure was the total number of units of blood needed. RESULTS The average volume of blood obtained for laboratory analyses from each infant was 27 mL in the ErythroSave group and 24 mL in controls (not significant). The average volume of transfused packed cells was 6. 4 mL for the ErythroSave group and 21. 3 mL for the controls (p = 0. 008). CONCLUSION The use of ErythroSave for sampling blood significantly reduced blood transfusion requirements in premature infants compared to sampling by conventional syringes.
3.
Intraoperative blood salvage in penetrating abdominal trauma: a randomised, controlled trial
Bowley DM, Barker P, Boffard KD
World Journal of Surgery. 2006;30((6):):1074-80.
Abstract
BACKGROUND Blood is a scarce and costly resource. Transfusion is often required after major trauma but blood may not be readily available, and concerns remain over the potential adverse consequences of allogeneic blood transfusion. Intraoperative blood salvage (IBS) is used extensively after blunt abdominal trauma, but when blood is contaminated by enteric contents its use has been considered contraindicated. METHODS This was a randomised, controlled trial conducted with Ethical Review Board approval in an inner city trauma unit. Patients with penetrating torso injury requiring a laparotomy and who had exhibited hypotension either pre-hospital or on arrival and in whom there was considered to be significant blood loss were randomly assigned to 2 groups. The control group was given allogeneic blood transfusion at the discretion of the attending medical staff. The cell save (CS) group underwent IBS with transfusion of both allogeneic and autologous blood. All patients received prophylactic antibiotics. The primary outcome was exposure to allogeneic blood up to the first 24 hours postinjury. RESULTS Twenty-three patients were entered into the control group and 21 into the CS group. The groups were equivalent in demographic details, injury patterns and injury severity. The mean volume of salvaged blood re-infused in the CS group was 1,493 ml (range 0-2,690 ml). The mean number of units of allogeneic blood transfused in the first 24 hours in the control group was 11. 17 compared to 6. 47 in the CS group (P=0. 008). Enteric injury had been sustained in 17/23 (75%) of the control group and 18/21 (85%) of the CS group (P=NS). Survival in the control group was 8/23 (35%) compared to 7/21 (33. 3%) in the CS arm (P=NS). Patients with documented postoperative sepsis were significantly more likely to die compared to those without sepsis (P=0. 04); however, those patients in the CS arm were no more likely to develop sepsis compared to those who received allogeneic blood alone. CONCLUSION In this randomised, controlled trial for patients with penetrating abdominal injuries, IBS led to a significant reduction in allogeneic blood usage with no discernable effect on rates of postoperative infection or mortality.
4.
Minimizing diagnostic blood loss in critically ill patients
Gleason E, Grossman S, Campbell C
American Journal of Critical Care. 1992;1((1):):85-90.
Abstract
BACKGROUND Blood loss from diagnostic procedures in critically ill patients needs to be minimized. Traditionally, when drawing blood from arterial lines, the initial sample used to clear the line has been discarded (open method). Use of a temporary reservoir enables this discard sample to be returned to the patient (closed method). METHODS Critically ill surgical patients were prospectively randomized to the open or closed method of drawing blood from arterial lines. Blood loss to diagnostic sampling was measured in both groups. RESULTS A comparison study (n = 1657) of these two methods revealed that blood loss to the patient was significantly decreased (P << .01) using the closed method. Mean blood loss per patient per day was 69 mL in the open group (n = 873) vs 35 mL in the closed group (n = 784). CONCLUSIONS Use of the closed method when drawing blood from arterial lines results in a significant decrease in blood lost to diagnostic procedures.