Fluid Overload Revisited
Iatrogenic hemodilution: a possible source for avoidable transfusion? - A Perel
Learning Points
The quest for the optimal Hb threshold for RBC transfusion seems a never-ending journey
Using same threshold for all patients is imprecision medicine.
Restrictive v Liberal transfusion has been extensively researched but ideal thresholds for transfusion are not known.
Dilutional anaemia may be a more significant factor.
Iatrogenic haemodilution may paradoxically decrease the DO2 due to reduced carriage in oxygenated haemoglobin.
References
Meta-analysis of fluid overload - J Silversides
Learning Points
Does oedema associated with +ve fluid balance contribute to organ dysfunction and mortality? Seems to in ARDS and sepsis.
Positive fluid balance is preventable - comes from maintenance fluid and drug infusions. Both of which are modifiable.
Programme of research - SR, pilot RCT, multicentre RCT
RADAR-2 pilot RCT, n=180 in 5 NI sites - starting next year