Patient Blood Management (Teil 2) – Praktisches Vorgehen: die 3 Säulen

Hans Gombotz; Axel Hofman; Peter Rehak; Johann Kurz

doi:10.1055/s-0031-1284465

AINS - Anästhesiologie · Intensivmedizin · Notfallmedizin · Schmerztherapie, Table of Contents

Anästhesiol Intensivmed Notfallmed Schmerzther 2011; 46(07/08): 466-474
DOI: 10.1055/s-0031-1284465

Fachwissen

Intensivmedizin

Patient Blood Management (Teil 2) – Praktisches Vorgehen: die 3 Säulen

Der Beitrag ist im Rahmen der 2. Österreichischen Benchmarkstudie entstanden, die vom Fonds der Bundesgesundheitsagentur finanziert wurde.Patient blood management (part 2) – Practice: the 3 pillars

Hans Gombotz

,

Axel Hofman

,

Peter Rehak

,

Johann Kurz

Abstract

Zusammenfassung

Patient Blood Management (PBM) ist ein multidisziplinäres, evidenzbasiertes Behandlungskonzept mit dem Ziel, das endogene Blutvolumen von Patienten weitgehend zu bewahren und – wo angezeigt – zu verbessern. PBM basiert auf 3 sich ergänzenden Säulen: erstens der Optimierung des (präoperativen) Erythrozytenvolumens, zweitens der Minimierung des diagnostischen, interventionellen und operativen Blutverlusts und drittens der Ausnützung und Unterstützung der individuellen, physiologischen Anämietoleranz bei strenger Indikationsstellung zur Bluttransfusion. Die Anwendung von PBM reduziert demnach systematisch den Einfluss von 3 Faktoren, die den Krankheitsverlauf negativ beeinflussen können: Anämie, Blutverlust und Transfusion. PBM ist besonders bei Patienten mit erhöhtem Anämie- und Transfusionsrisiko angezeigt und sorgt für individualisierte Behandlungsstrategien. Dadurch werden nicht nur diese Risiken reduziert, sondern auch Versorgungsengpässe verringert und stark steigende Kosten in Verbindung mit Transfusionen eingespart.

Abstract

Patient blood management (PBM) is a patient-specific multidisciplinary, multimodal, evidence-based concept to appropriately conserve and manage a patient's own blood as a vital resource. PBM is based on 3 pillars: the first is the optimization of the patient's endogenous red cell mass, the second is the minimization of bleeding and blood loss and the third involves harnessing and optimizing the patient-specific physiological tolerance of anemia, including adopting more restrictive transfusion thresholds. PBM primarily identifies patients at risk of transfusion and provides a management plan aimed at reducing or eliminating the need for allogeneic transfusion, thus reducing the inherent risks, inventory pressures and the escalating costs associated with transfusion. PBM is applicable to surgical and medical patients. The application of PBM systematically reduces the impact of 3 major contributors to negative outcome: anemia, blood loss and transfusion.

Schlüsselwörter:

Anämie - Transfusion - Blutverlust - präoperativ - Erythropoetin - Eisen - Patient Blood Management

Key words:

anemia - transfusion - blood loss - erythropoetin - iron - patient blood management

Full Text

References

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