Management of severe perioperative bleeding Guidelines from the European Society of Anaesthesiology 2/3
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vor 11 Jahren
The aims of severe perioperative bleeding management are
three-fold. First, preoperative identification by anamesis and
laboratory testing of those patients for whom the perioperative
bleeding risk may be increased. Second, implementation of
strategies for correcting preoperative anaemia and stabilisation of
the macro- and microcirculations in order to optimise the patient's
tolerance to bleeding. Third, targeted procoagulant interventions
to reduce the amount of bleeding, morbidity, mortality and costs.
The purpose of these guidelines is to provide an overview of
current knowledge on the subject with an assessment of the quality
of the evidence in order to allow anaesthetists throughout Europe
to integrate this knowledge into daily patient care wherever
possible. The Guidelines Committee of the European Society of
Anaesthesiology (ESA) formed a task force with members of
scientific subcommittees and individual expert members of the ESA.
Electronic databases were searched without language restrictions
from the year 2000 until 2012. These searches produced 20 664
abstracts. Relevant systematic reviews with meta-analyses,
randomised controlled trials, cohort studies, case-control studies
and cross-sectional surveys were selected. At the suggestion of the
ESA Guideline Committee, the Scottish Intercollegiate Guidelines
Network (SIGN) grading system was initially used to assess the
level of evidence and to grade recommendations. During the process
of guideline development, the official position of the ESA changed
to favour the Grading of Recommendations Assessment, Development
and Evaluation (GRADE) system. This report includes general
recommendations as well as specific recommendations in various
fields of surgical interventions. The final draft guideline was
posted on the ESA website for four weeks and the link was sent to
all ESA members. Comments were collated and the guidelines amended
as appropriate. When the final draft was complete, the Guidelines
Committee and ESA Board ratified the guidelines.
three-fold. First, preoperative identification by anamesis and
laboratory testing of those patients for whom the perioperative
bleeding risk may be increased. Second, implementation of
strategies for correcting preoperative anaemia and stabilisation of
the macro- and microcirculations in order to optimise the patient's
tolerance to bleeding. Third, targeted procoagulant interventions
to reduce the amount of bleeding, morbidity, mortality and costs.
The purpose of these guidelines is to provide an overview of
current knowledge on the subject with an assessment of the quality
of the evidence in order to allow anaesthetists throughout Europe
to integrate this knowledge into daily patient care wherever
possible. The Guidelines Committee of the European Society of
Anaesthesiology (ESA) formed a task force with members of
scientific subcommittees and individual expert members of the ESA.
Electronic databases were searched without language restrictions
from the year 2000 until 2012. These searches produced 20 664
abstracts. Relevant systematic reviews with meta-analyses,
randomised controlled trials, cohort studies, case-control studies
and cross-sectional surveys were selected. At the suggestion of the
ESA Guideline Committee, the Scottish Intercollegiate Guidelines
Network (SIGN) grading system was initially used to assess the
level of evidence and to grade recommendations. During the process
of guideline development, the official position of the ESA changed
to favour the Grading of Recommendations Assessment, Development
and Evaluation (GRADE) system. This report includes general
recommendations as well as specific recommendations in various
fields of surgical interventions. The final draft guideline was
posted on the ESA website for four weeks and the link was sent to
all ESA members. Comments were collated and the guidelines amended
as appropriate. When the final draft was complete, the Guidelines
Committee and ESA Board ratified the guidelines.
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