CHEST Guidelines-Reducing-Procedural-Hemorrhage-Risk

Reducing-Procedural-Hemorrhage-Risk_chest

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In a letter to the editor, Dr. Bruce L. Davidson critiques an article by Drs. Wolfe and Kress concerning the risks of procedural hemorrhage in ICU settings. Wolfe and Kress's article suggests that preprocedural blood product transfusions are often unwarranted. Dr. Davidson challenges this, arguing that the referenced study they used (Mueller et al.) does not conclusively support non-use of prophylactic transfusions. He highlights the exclusion of certain high-risk patients, like those on warfarin, from the study and emphasizes that the aim of transfusions is to enhance patient safety, rather than merely improve blood test results. He also notes the potential reduction of bleeding risks with factor replenishment and questions the absence of robust evidence against prophylactic transfusions, recalling the adage "absence of evidence is not evidence of absence."<br /><br />Wolfe and Kress respond by acknowledging the study's limitations due to its small sample size, which affects its generalizability. They maintain that the low incidence of major bleeding complications in the study is significant when evaluating whether preprocedural transfusions should be routine practice. While agreeing that transfusions should focus on patient safety instead of laboratory results, they caution against ignoring the associated risks of transfusions, like infection, volume overload, and lung injury. They highlight the need for judicious use of blood products, given the limited evidence supporting routine transfusions and the documented potential for harm.<br /><br />Overall, the exchange underlines the complexity of decisions in critical care concerning when to employ transfusions to reduce hemorrhage risks while balancing the potential complications from such interventions.

Keywords

ICU

procedural hemorrhage

blood transfusions

patient safety

Mueller study

Wolfe and Kress

Bruce L. Davidson

bleeding risks

transfusion complications

critical care