Intended for perioperative clinicians, this learning module focuses on practical and effective intraoperative patient blood management (PBM) strategies. The material is presented with easily processed overviews and illustrative examples on how to employ the PBM strategies. The liberal use of related photographs and videos taken from real, working patient care environments is present throughout this module, which is organized by sections that include the following:
- Blood conservation strategies
- Transfusion strategies
- Surgical techniques
The blood conservation strategies section includes a brief consideration of the importance of preoperative assessment and preparation as well as extensive discussion on how to employ the following: clinically useful hemostasis monitoring practices, acute normovolemic hemodilution, cell salvage and pharmacologic-based bleeding prophylaxis adjuncts. The transfusion strategies section focuses on the use of evidence-based transfusion guidelines combined with the use of laboratory/point-of-care-testing-based customized transfusion algorithms. The presented algorithms include the use of allogeneic blood products as well as pharmacologic hemostatic adjuncts. The surgical techniques section includes instruction on the use of controlled hypotension, topical hemostatic agents and fibrin sealants as well as specially designed blood conservation devices that preserve a patient's autologous red blood cell mass.
- Gain practical knowledge of basic preoperative anemia management, assessment of the hemostatic system, how to address antithrombotic/antiplatelet medications, and when to involve hematology consultants.
- Gain practical knowledge of point-of-care coagulation monitoring, surgical and pharmacologic strategies to reduce the need for blood component therapy, as well as evidence-based indications for appropriate administration of blood components.
- Describe specialized devices used both intraoperatively and postoperatively that promote conservation of a patient's red cell mass.
Authors: Edwin G. Avery, IV, MD, CPI, Chief of Cardiac Anesthesia, Chairman of the Transfusion Committee and Co-Chairman of the Patient Blood Management Committee, University Hospitals Case Medical Center, and Associate Professor of Anesthesiology, Case Western Reserve University School of Medicine; John Klick, MD, Co-Director of the Surgical Intensive Care Unit, University Hospitals Case Medical Center, and Assistant Professor of Anesthesiology, Case Western Reserve University School of Medicine
Intended Audience: This learning module is prepared for clinicians involved in the perioperative care of patients, including anesthesiologists, surgeons, perfusionists, intensivists and nurses.