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document
A clinical evaluation of a blood conservation device in medical intensive care unit patients . OBJECTIVES This study was designed to a ) document the efficacy of a device intended to conserve blood in critically ill patients ; b ) determine the effect of this blood conservation on hemoglobin concentration and the need for blood transfusions ; c ) determine if the blood conservation device resulted in interference with arterial pressure waveforms ; d ) determine if use of the blood conservation device resulted in a difference in the number of accidental needle punctures suffered by healthcare workers . DESIGN Prospective , randomized , controlled trial . A clinical trial using prospective , random allocation of consecutive eligible patients . SETTING The medical intensive care unit ( ICU ) of a university hospital located in a large metropolitan area . PATIENTS A total of 100 patients who were admitted to the medical ICU , required arterial line monitoring for clinical purposes , and were managed by the ICU medical service . Exclusion criteria included active bleeding or chronic renal failure at the time of ICU admission . INTERVENTIONS Patients in the experimental group had a blood conservation device incorporated into the arterial pressure monitoring system , while patients in the control group received a conventional arterial pressure monitoring system . MEASUREMENTS AND MAIN RESULTS Data gathered included : age ; gender ; ICU discharge status ; the duration of ICU stay ; time in the study ; volume of all blood drawn , discarded , or lost due to leakage ; hemoglobin concentrations ; blood transfusions ; and accidental needle injuries . Arterial pressure waveforms were recorded and inspected for dampening or other deformation . Mean hemoglobin concentrations were compared on ICU admission and at 12-hr intervals . Demographic and clinical characteristics of the two groups were not significantly different . The volume of blood drawn and discarded from arterial catheters was significantly lower in the blood conservation group ( blood conservation device : 5.7 +/- 7.5 mL ; control : 96.4 +/- 88.5 mL ; p < .0001 ) , as was the total volume of blood discarded ( blood conservation device : 19.4 +/- 47.4 mL ; control : 103.5 +/- 99.9 mL ; p < .0001 ) . Mean hemoglobin concentration on admission was similar in the two groups ( blood conservation device group : 11.8 +/- 2.5 g/dL ; control group : 12.6 +/- 2.3 g/dL ) . In both groups , the mean hemoglobin concentration declined most rapidly in the first 24 hrs of ICU care and , thereafter , declined more slowly . Although the mean hemoglobin concentration was higher in the blood conservation group after 6 days , statistical significance was not reached until 9.5 days of ICU care . The mean change in hemoglobin concentration ( overall : 1.2 +/- 2.2 g/dL ) during the study represents a statistically significant ( p < .0001 ) decrease of 9.7 % . Hemoglobin concentration during the study decreased by 1.4 +/- 2.2 g/dL in the control group and 1.0 +/- 2.3 g/dL in the blood conservation group ( p = nonsignificant ) . Univariate and multiple regression analysis demonstrated discarded blood volume to be a significant and independent predictor of the decline in hemoglobin concentration . Transfusion requirements were similar in both groups . The blood conservation system did not alter or interfere with pressure waveforms . There were no accidental needle injuries noted . CONCLUSIONS The conservation of blood in critically ill patients must be a high-priority concern of all healthcare workers . Our data indicate that the blood conservation system eliminates a significant factor in the decline in hemoglobin concentration . With devices as described here , there is no reason to continue the practice of wasting the blood of critically ill patients in order to prevent preanalytic error .
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Intervention_Physical
blood conservation device
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Intervention_Physical
blood conservation device incorporated into the arterial pressure monitoring system
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Intervention_Control
control group received a conventional arterial pressure monitoring system .
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Intervention_Physical
blood conservation system
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Outcome_Physical
hemoglobin concentration
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Outcome_Physical
need for blood transfusions
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Outcome_Other
duration of ICU stay ; time in the study ; volume of all blood drawn , discarded , or lost due to leakage ;
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Outcome_Physical
hemoglobin concentrations
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Outcome_Physical
blood transfusions
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Outcome_Mental
accidental needle injuries
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Outcome_Physical
Arterial pressure waveforms
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Outcome_Physical
Mean hemoglobin concentrations
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Outcome_Other
volume of blood drawn and discarded from arterial catheters
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Outcome_Other
total volume of blood discarded
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Outcome_Physical
hemoglobin concentration
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Outcome_Physical
hemoglobin concentration
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Outcome_Physical
hemoglobin concentration
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Outcome_Physical
hemoglobin concentration
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Outcome_Physical
Hemoglobin concentration
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Outcome_Physical
blood volume
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Outcome_Physical
Transfusion requirements
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Outcome_Mental
accidental needle injuries
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Outcome_Physical
hemoglobin concentration
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Participant_Condition
medical intensive care unit patients .
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Participant_Condition
critically ill patients ;