Patient Blood Management In Cardiac Surgery

This book provides a multidisciplinary approach to the maintenance of hemostasis and minimisation of blood loss in patients undergoing cardiac surgery. All aspects of patient blood management are covered that may contribute to a reduction in perioperative bleeding and transfusion requirements in cardiac surgery. This is achieved through practical cases and a theoretical background that gives a better understanding of patient hemostasis and the occurrence of bleeding complications. This book is relevant to cardiac surgeons, anesthesiologists, clinical perfusionists, hematologists and intensivists.

This book provides a multidisciplinary approach to the maintenance of hemostasis and minimisation of blood loss in patients undergoing cardiac surgery. All aspects of patient blood management are covered that may contribute to a reduction in perioperative bleeding and transfusion requirements in cardiac surgery. This is achieved through practical cases and a theoretical background that gives a better understanding of patient hemostasis and the occurrence of bleeding complications. This book is relevant to cardiac surgeons, anesthesiologists, clinical perfusionists, hematologists and intensivists.

Here, two of the foremost cardiothoracic surgeons have brought together many of the top cardiologists and haematologists to produce the most current reference source on all aspects of blood conservation, from an overall clinical approach to the use of erythropoietin and the benefits of post-operative blood salvage. The subject matter covers numerous areas involved in the preoperative considerations in cardiac surgery, the intraoperative decision-making in cardiac surgery, postoperative bleeding and management and a section on the algorithm for bloodless surgery used at the New York Hospital-Cornell Medical Center.

Patient Blood Management (PBM) is an innovative clinical concept that aims to reduce the need for allogenic blood transfusions, cut health-care costs, and avert or correct the risk factors related to blood transfusion, thus minimizing the rate of side effects and complications. This comprehensive hands-on volume offers a three-point approach for the implementation of PBM to improve patient outcome, focusing on how to prevent or treat anemia, reduce blood loss, and increase anemia tolerance. The book also goes beyond preoperative PBM, with detailed accounts of coagulation disorder management and the administration of coagulation products and platelet concentrates. Special Features: Presents a clear three-pillar strategy for the application of PBM: diagnosis and treatment of anemia, reduction of peri-interventional blood loss, and optimization of the tolerance to anemia in the everyday clinical setting Covers issues such as PBM during surgery, requirements for modern transfusion medicine, ordering blood products, the role of pre-anesthesia clinics, benchmarking processes, and potential implications of PBM in the public health sector Overview of research in PBM including landmark studies and current clinical trials Boxes in each chapter highlighting key information, core statements, and summaries A multidisciplinary and international team of contributors experienced in PBM Patient Blood Management is a guide for clinicians and residents whose patients are at risk for anemia, coagulation disorders, or severe blood loss. Anesthesiologists, surgeons, and specialists involved in the use of blood and blood products can use the book for quick reference or to learn more about a leading-edge concept for optimizing patient safety and improving outcome.

This latest edition provides a comprehensive, state-of-the-art overview of the major issues specific to managing bleeding patients. Like the previous edition, the sections of this new edition have been structured to review the overall scope of issues, among them bleeding associated with disease condition, bleeding from specific organs, bleeding associated with medication, and bleeding associated with procedures. In addition to thoroughly revised and updated chapters from the previous edition, the latest edition features new chapters on such topics as the basics of hemostasis, bleeding due to rare coagulation factor deficiencies, bleeding associated with connective tissue disorders, massive transfusion protocol, bleeding associated with ventricular assist device, and evaluation of bleeding risk prior to invasive procedures. The volume also includes brief etiology and a practical reference guide regarding type of blood components, medication, dose, and duration. Written by authors from a variety of integrated disciplines, Management of Bleeding Patients, Second Edition is a valuable resource for clinicians working in the area of bleeding management.

Cardiac surgery has developed dramatically since the first open-he art operations were performed in the mid 1950s. Although the improvement of surgical technique, extracorporeal circulation, and postoperative management has contributed to a marked reduction of morbidity and mortality, the development of cardiac surgery to its present state would not have been possible without blood substitution by homologous donor blood. Only 20 years ago, open-heart operations required an average of 8 units of blood preserves. The excessive need of donor blood in those early days was mainly due to premature surgical technique, insecure control of anticoagulation, severe blood trauma by extracorporeal circulation, and the lack of retransfusion technologies that would have allowed the reuse of shed mediastinal blood. The introduction of new technologies, such as normovolemic hemodilution, in traoperative autotransfusion, postoperative return of shed mediastinal blood, and predonation of autologous blood has greatly reduced donor blood requirements. At present the majority of routine coronary artery surgical procedures can be performed without any blood transfusion. Blood loss, however, may be considerable in patients undergoing complex valve surgery or reoperations, as they often require several units of transfused blood. Blood conservation has now become an area of major interest for the cardiac surgeon. This increased concern is caused by infectious complications of blood transfusion, in particular hepatitis and, more recently, AIDS.

"Practicing critical care entails understanding human physiology, pharmacokinetics and molecular pathways in concert with adherence to evidence based literature. Some may say combining all of these entities into practice creates the "art" of critical care medicine. One strategy to gain proficiency in the practice of critical care medicine is to simulate what you would do in specific problem-based scenarios. That is the aim of this textbook aptly titled" "What Do I Do Now?" This text focuses on Cardiothoracic Critical Care and will cover guidelines for evidence-based practice, respiratory and metabolic physiology, common hemodynamic perturbations, ventricular failure and mechanical circulatory support devices. All clinicians who care for cardiothoracic patients who are critically ill can find pearls of practice wisdom complemented by literature citations within this text. So go ahead, place yourself at the foot of the bed and try to think through, "What Would I Do Now" when presented with each patient within these pages of your handheld cardiothoracic intensive care unit"--