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Jay R Malone1

  • 1Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA.

Transfusion
|December 22, 2025
PubMed
Resumen

Los protocolos de transfusión masiva deben diferenciar entre la futilidad específica del paciente y las limitaciones del sistema. Un nuevo marco propone tiempos de espera sensibles a la capacidad para mejorar la rendición de cuentas y la transparencia en las decisiones de atención crítica.

Palabras clave:
toma de decisioneséticatransfusión masivatransfusióntraumatología

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Área de la Ciencia:

  • Medicina de atención crítica
  • Gestión de sistemas de salud
  • Ética médica

Sus antecedentes:

  • La transfusión masiva es una intervención vital pero intensiva en recursos que se realiza bajo presión.
  • La literatura existente sobre los 'umbrales de futilidad' puede traducir de manera inapropiada los datos de la población en reglas de cabecera.

Objetivo del estudio:

  • Diferenciar entre la futilidad centrada en el paciente y las limitaciones basadas en el sistema en la transfusión masiva.
  • Proponer un nuevo marco para la toma de decisiones durante las transfusiones masivas.

Principales métodos:

  • Distinguir tres justificaciones establecidas para la futilidad: fisiológica, tratamiento inapropiado y administración.
  • Introducir una cuarta categoría: salvabilidad limitada por el sistema.

Principales resultados:

  • La salvabilidad limitada por el sistema ocurre cuando la transfusión no puede servir de puente para el control de la hemorragia debido a límites de infraestructura.
  • Se propone un tiempo de espera del protocolo de transfusión masiva (PTM) sensible a la capacidad, desencadenado por la trayectoria clínica.

Conclusiones:

  • Las brechas de capacidad, no la fisiología del paciente, deberían desencadenar una revisión estructurada como eventos centinela.
  • Este marco mejora la transparencia, asigna la rendición de cuentas y previene la asignación implícita de recursos en la atención crítica.