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Prediction of massive transfusion in trauma patients in the surgical intensive care units (THAI-SICU study)

Chinese Journal of Traumatology 2019年第4期22卷 219-222页

作者： Osaree Akaraborworn Onuma Chaiwat Sunisa Chatmongkolchart Chanatthee Kitsiripant Kaweesak Chittawatanarat Sunthiti Morakul thammasak thawitsri Petch Wacharasintg Sujaree Poopipatpab Waraporn Chau-In Chaiyapruk Kusumaphanyo Division of Trauma and Critical Care Department of Surgery Faculty of Medicine Prince of Songkla University Hat Yai Songkhla Thailand Department of Anesthesiology Faculty of Medicine Srinakharinwirot University Nakhon Nayok Thailand Department of Anesthesiology. Faculty of Medicine Siriraj Hospital Mahidol University Bangkok Thailand Department of Anesthesiology Faculty of Medicine Prince of Songkla University Hat Yai Songkhla Thailand Department of Surgery Faculty of Medicine Chiang Mai University Chiang Mai Thailand Department of Anesthesiology Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailand Department of Anesthesiology Faculty of Medicine King Chulalongkorn Memorial Hospital Bangkok Chulalongkorn University Thailand Department of Anesthesiology Phramongkutklao Hospital Bangkok Thailand Department of Anesthesiology Navamindradhiraj University Bangkok Thailand Department of Anesthesiology Khon Kaen University Khon Kaen Thailand

Purpose: After damage control surgery, trauma patients are transferred to intensive care units to restore the physiology. During this period, massive transfusion might be required for ongoing bleeding and coagulopathy. This research aimed to identify predictors of massive blood transfusion in the surgical intensive care units (SICUs). Methods: This is an analysis of the THAI-SICU study which was a prospective cohort that was done in the 9-university-based SICUs in Thailand. The study included only patients admitted due to trauma mechanisms. Massive transfusion was defined as received >10 units of packed red blood cells on the first day of admission. Patient characteristics and physiologic data were analyzed to identify the potential factors. A multivariable regression was then performed to identify the significant model. Results: Three hundred and seventy patients were enrolled. Sixteen patients (5%) received massive transfusion in the SICUs. The factors that significantly predicted massive transfusion were an initial sequential organ failure assessment (SOFA)>9 (risk difference (RD) 0.13, 95% confidence interval (CI): 0.03—0.22, p = 0.01);intra-operative blood loss > 4900 mL (RD 0.33, 95% CI: 0.04—0.62, p = 0.02) and intra-operative blood transfusion > 10 units (RD 0.45, 95% Cl: 0.06 to 0.84, p = 0.02). The probability to have massive transfusion was 0.976 in patients who had these 3 factors. Conclusion: Massive blood transfusion in the SICUs occurred in 5%. An initial SOFA >9, intra-operative blood loss >4900 mL, and intra-operative blood transfusion >10 units were the significant factors to predict massive transfusion in the SICUs.

关键词： Massive transfusion Massive bleeding Surgical intensive care Multiple trauma

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