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Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology: First update
Sibylle A Kozek-Langenecker1, Aamer B Ahmed, Arash Afshari
1From the Department of Anaesthesiology & Intensive Care, Evangelical Hospital Vienna, Vienna, Austria (SAKL), Department of Anaesthesiology & Intensive Care, Glenfield Hospital, Leicester, United Kingdom (ABA), Department of Anaesthesiology, University Hospital of Copenhagen, Copenhagen, Denmark (AA, JS), Department of Anaesthesiology & Intensive Care, CHU De Grenoble Hôpital, Michallon, Grenoble, France (PA), Department of Anaesthesiology & Intensive Care, Hospital Universitario Rio Hortega, Valladolid, Spain (CA), Department of General Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania (GB), Department of Anaesthesiology & Intensive Care, University Hospital 'Federico II', Napoli, Italy (EDR), Department of Anaesthesiology, Boston Children's Hospital, Boston, Massachusetts, United States (DFa), Department of Anaesthesiology & Intensive Care, Emergency Institute for Cardiovascular Disease, Bucharest, Romania (DCF), Department of Anaesthesiology, University Hospital of Innsbruck, Innsbruck, Austria (DFr), Department of Anaesthesiology, Children's University Hospital Zurich, Zürich, Switzerland (TH), Department of Anaesthesiology & Intensive Care, Klinikum Straubing, Straubing, Germany (MJ), Department of Anaesthesiology & Pain Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands (MDL), Department of Anaesthesiology & Intensive Care, Hospital Clinico Universitario Valencia, Valencia, Spain (JVLP), Department of Anaesthesia, Royal Free Hospital, London, United Kingdom (SM), Department of Anaesthesiology & Intensive Care, General Hospital Linz, Linz, Austria (JM), Department of Anaesthesiology & Intensive Care, University Hospital of Szeged, Szeged, Hungary (ZLM), Department of Anaesthesiology & Intensive Care, Franziskus Hospital, Bielefeld, Germany (NRM), Department of Anaesthesiology & Intensive Care, Groupe Hospitalier Cochin, Paris, France (CMS), Department of Anaesthesiology, CHU Brugmann, Brussels, Belgium (PJFVDL), Department of Anaesthesiology, Herlev University Hospital, Herlev, Denmark (AJW), Department of Anaesthesiology, Ghent University Hospital, Ghent, Belgium (PWo, PWy) and Department of Anaesthesiology & Intensive Care, University Frankfurt/Main, Frankfurt am Main, Germany (KZ).
: The management of perioperative bleeding involves multiple assessments and strategies to ensure appropriate patient care. Initially, it is important to identify those patients with an increased risk of perioperative bleeding. Next, strategies should be employed to correct preoperative anaemia and to stabilise macrocirculation and microcirculation to optimise the patient's tolerance to bleeding. Finally, targeted interventions should be used to reduce intraoperative and postoperative bleeding, and so prevent subsequent morbidity and mortality. The objective of these updated guidelines is to provide healthcare professionals with an overview of the most recent evidence to help ensure improved clinical management of patients. For this update, electronic databases were searched without language restrictions from 2011 or 2012 (depending on the search) until 2015. These searches produced 18 334 articles. All articles were assessed and the existing 2013 guidelines were revised to take account of new evidence. This update includes revisions to existing recommendations with respect to the wording, or changes in the grade of recommendation, and also the addition of new recommendations. The final draft guideline was posted on the European Society of Anaesthesiology website for four weeks for review. All comments were collated and the guidelines were amended as appropriate. This publication reflects the output of this work.
: The management of perioperative bleeding involves multiple assessments and strategies to ensure appropriate patient care. Initially, it is important to identify those patients with an increased risk of perioperative bleeding. Next, strategies should be employed to correct preoperative anaemia and to stabilise macrocirculation and microcirculation to optimise the patient's tolerance to bleeding. Finally, targeted interventions should be used to reduce intraoperative and postoperative bleeding, and so prevent subsequent morbidity and mortality. The objective of these updated guidelines is to provide healthcare professionals with an overview of the most recent evidence to help ensure improved clinical management of patients. For this update, electronic databases were searched without language restrictions from 2011 or 2012 (depending on the search) until 2015. These searches produced 18 334 articles. All articles were assessed and the existing 2013 guidelines were revised to take account of new evidence. This update includes revisions to existing recommendations with respect to the wording, or changes in the grade of recommendation, and also the addition of new recommendations. The final draft guideline was posted on the European Society of Anaesthesiology website for four weeks for review. All comments were collated and the guidelines were amended as appropriate. This publication reflects the output of this work.
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