Chu et al.[3232 Chu UB, Clevenger FW, Imami ER, Lampard SD, Frykberg ER, Tepas JJ 3rd.
The impact of selective laboratory evaluation on utilization of laboratory resources
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1996;172(5):558-62.]
|
To eliminate daily multiple routine phlebotomies |
Dech et al.[3333 Dech ZF, Szaflarski NL. Nursing strategies to minimize blood loss
associated with phlebotomy. AACN Clin Issues. 1996;7(2):277-87.]
|
Minimizar o volume de sangue retirado para diagnóstico (usar tubos
pequenos) |
Lamy et al.[3535 Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Paolasso E, et
al; CORONARY Investigators. Off-pump or on-pump coronary-artery bypass grafting at 30
days. N Engl J Med. 2012;366(16):1489-97.]
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Evitar ou reduzir ao máximo o tempo de CEC |
Zangrillo et al.[3636 Zangrillo A, Garozzo FA, Biondi-Zoccai G, Pappalardo F, Monaco F, et al.
Miniaturized cardiopulmonary bypass improves short-term outcome in cardiac surgery: a
meta-analysis of randomized controlled studies. J Thorac Cardiovasc Surg.
2010;139(5):1162-9.]
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Sistema e minicircuitos em CEC reduz hemotransfusões |
Boodhwani et al.[3737 Boodhwani M, Williams K, Babaev A, Gill G, Saleem N, Rubens FD.
Ultrafiltration reduces blood transfusions following cardiac surgery: a
meta-analysis. Eur J Cardiothorac Surg. 2006;30(6):892-7.]
|
Ultrafiltração reduz hemorragia e transfusões de sangue |
Van der Linden et al.[3939 Van der Linden P, De Hert S, Daper A, Trenchant A, Jacobs D, De
Boelpaepe C, et al. A standardized multidisciplinary approach reduces the use of
allogeneic blood products in patients undergoing cardiac surgery. Can J Anesth.
2001;48(9):894-901.]
|
Hipotermia moderada (temperatura durante a CEC entre 30 e 32°C) |
Degoute[4040 Degoute CS. Controlled hypotension: a guide to drug choice. Drugs.
2007;67(7):1053-76.]
|
Pressão Arterial no menor nível possível que mantenha a perfusão
tecidual (PAM de 50-65 mmHg) |
Milas et al.[3434 Milas BL, Jobes DR, Gorman RC. Management of bleeding and coagulopathy
after heart surgery. Semin Thorac Cardiovasc Surg.
2000;12(4):326-36.]
|
Hemostasia meticulosa (controle rápido e extremamente cuidadoso de
hemorragias) |
Abrishami et al.[5050 Abrishami A, Chung F, Wong J. Topical application of antifibrinolytic
drugs for on-pump cardiac surgery: a systematic review and meta-analysis. Can J
Anaesth. 2009;56(3):202-12.]
|
Agentes hemostáticos tópicos para controlar sangramento local |
Menkis et al.[1616 Menkis AH, Martin J, Cheng DC, Fitzgerald DC, Freedman JJ, Gao C, et al.
Drug, devices, technologies, and techniques for blood management in minimally
invasive and conventional cardiothoracic surgery: a consensus statement from the
International Society for Minimally Invasive Cardiothoracic Surgery (ISMICS) 2011.
Innovations (Phila). 2012;7(4):229-41.]
|
Hemostasia farmacológica com ácido tranexâmico ou ácido épsilon
animocaproico |
Carless et al.[4242 Carless PA, Stokes BJ, Moxey AJ, Henry DA. Desmopressin use for
minimizing perioperative allogeneic blood transfusion. Cochrane Database Syst Rev.
2008;(1):CD001884.]
|
Desmopressina aumenta a adesão plaquetária e melhora hemostasia |
Lin et al.[4545 Lin Y, Stanworth S, Birchall J, Doree C, Hyde C. Recombinant factor VIIa
for the prevention and treatment of bleeding in patients without haemophilia.
Cochrane Database Syst Rev. 2011;(2):CD005011.]
|
r-FVIIa para controlar hemorragias em situações de trombocitopenia,
desordens da função plaquetária e coagulopatias pré-existentes ou
induzidas por drogas |
Nienaber et al.[4747 Nienaber U, Innerhofer P, Westermann I, Schöchl H, Attal R, Breitkopf R,
et al. The impact of fresh frozen plasma vs coagulation factor concentrates on
morbidity and mortality in trauma-associated haemorrhage and massive transfusion.
Injury. 2011;42(7):697-701.]
|
CCP para restaurar de forma rápida os fatores de coagulação e controlar
sangramento maior |
Rahe-Meyer et al.[4848 Rahe-Meyer N, Hanke A, Schmidt DS, Hagl C, Pichlmaier M. Fibrinogen
concentrate reduces intraoperative bleeding when used as first-line hemostatic
therapy during major aortic replacement surgery: results from a randomized,
placebo-controlled trial. J Thorac Cardiovasc Surg. 2013;145(3
Suppl):S178-85.]
|
Concentrado de fibrinogênio humano para repor fibrinogênio e controlar
sangramento maior |
Ferraris et al.[4949 Society of Thoracic Surgeons Blood Conservation Guideline Task Force,
Ferraris VA, Brown JR, Despotis GJ, Hammon JW, Reece TB, Saha SP, et al; Society of
Cardiovascular Anesthesiologists Special Task Force on Blood Transfusion,
International Consortium for Evidence Based Perfusion. 2011 update to the Society of
Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists blood
conservation clinical practice guidelines. Ann Thorac Surg.
2011;91(3):944-82.]
|
Fator XIII recombinante humano para controlar sangramentos maior, quando
outros hemostáticos não produziram resultados satisfatórios |
Davies et al.[5353 Davies L, Brown TJ, Haynes S, Payne K, Elliott RA, McCollum C.
Cost-effectiveness of cell salvage and alternative methods of minimizing
perioperative allogeneic blood transfusion: : a systematic review and economic model.
Health Tech Assess. 2006;10(44):iii-iv, ix-x, 1-210.]
|
Hemodiluição normovolêmica aguda é segura e custo-efetivo em reduzir
transfusão de sangue alogênico em cirurgias |
Carless et al.[5656 Carless PA, Henry DA, Moxey AJ, O'Connell D, Brown T, Fergusson DA. Cell
salvage for minimising perioperative allogeneic blood transfusion. Cochrane Database
Syst Rev. 2010;(4):CD001888.]
|
Recuperação sanguínea intraoperatória (cell saver) em cirurgias para
conservação do sangue autólogo |