Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

作者：Sibylle A. Kietaibl, Aamer B. Ahmed, Arash J. Afshari, Pierre Albaladejo, César Aldecoa, Giedrius Barauskas, Edoardo DE ROBERTIS, David Faraoni, Daniela Carmen Filipescu, Dietmar R. Fries, Anne Godiér, Thorsten Haas, Matthias Jacob, Marcus Daniel Lance, Juan V. Llau, Jens Meier, Zsolt Molnár, Lidia Mora, Niels Rahe‐Meyer, Charles Marc Samama, Ecaterina Scărlătescu, Christoph J. Schlimp, Anne Juul Wikkelsø, Kai D. Zacharowski · 发表于：European Journal of Anaesthesiology · 年份：2023 · DOI：10.1097/eja.0000000000001803 · 被引用次数：341 · 研究领域：Trauma, Hemostasis, Coagulopathy, Resuscitation、Blood transfusion and management、Gastrointestinal Bleeding Diagnosis and Treatment

BACKGROUND: Management of peri-operative bleeding is complex and involves multiple assessment tools and strategies to ensure optimal patient care with the goal of reducing morbidity and mortality. These updated guidelines from the European Society of Anaesthesiology and Intensive Care (ESAIC) aim to provide an evidence-based set of recommendations for healthcare professionals to help ensure improved clinical management. DESIGN: A systematic literature search from 2015 to 2021 of several electronic databases was performed without language restrictions. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to assess the methodological quality of the included studies and to formulate recommendations. A Delphi methodology was used to prepare a clinical practice guideline. RESULTS: These searches identified 137 999 articles. All articles were assessed, and the existing 2017 guidelines were revised to incorporate new evidence. Sixteen recommendations derived from the systematic literature search, and four clinical guidances retained from previous ESAIC guidelines were formulated. Using the Delphi process on 253 sentences of guidance, strong consensus (>90% agreement) was achieved in 97% and consensus (75 to 90% agreement) in 3%. DISCUSSION: Peri-operative bleeding management encompasses the patient's journey from the pre-operative state through the postoperative period. Along this journey, many features of the patient's pre-operative coagulation status...