Apport de la saturation veineuse centrale en oxygène dans la décision transfusionnelle postopératoire

Objective

The aim of this study was to assess the value of central venous oxygen saturation (ScvO₂) for the decision of blood transfusion in comparison with the criteria of the French guidelines for blood transfusion (2003).

Study design

Prospective, observational.

Patients and methods

Sixty patients, haemodynamically stable, for whom a blood transfusion (BT) was discussed in the postoperative course of general surgery, were included. ScvO₂ (%) and haemoglobin (g/dl) were measured before and after BT. Patients were retrospectively divided into two groups according to ScvO₂ measured before BT (< or ≥ 70%). Results are expressed as median.

Results

The ScvO₂ before transfusion was greater or equal to 70% in 25 (47.2%) patients. Following BT, the ScvO₂ increased significantly (from 57.8 to 68.5%) in the group with initial ScvO₂ less than 70% whereas it was unchanged in patients with initial ScvO₂ greater or equal 70% (from 76.8 to 76.5%). Twenty patients (37.7%) did not meet the French guidelines for BT criteria. Eighteen patients out of 33 that met the criteria had ScvO₂ greater or equal 70% before BT while 13 patients with ScvO₂ less than 70% were not detected by these same criteria.

Conclusion

ScvO₂ could be a relevant biological parameter to complete the current guidelines for BT in stable patient with a central venous catheter during the postoperative period.     

Décision médicale chez la personne très âgée : à propos d’un cas d’application de la loi Leonetti en médecine d’urgence

Advanced care decision in emergency medicine is difficult for the elderly. How to be fair, avoiding an unreasonable obstinacy? Based on the case of very old person, we show how an optimal management can be decided in accordance with the spirit of the law.