Canterbury DHB
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There are clearly multiple factors which determine survival in the critically ill patient. A number of studies have demonstrated that transfusions do not translate to an improved mortality and may even be associated with a worse prognosis [14]. Patients with ischaemic heart disease, however, may benefit from higher (100 g/L) haemoglobin concentrations [15].
Although previously thought to be ineffective in critically ill patients, recombinant human erythropoietin has also been used in this setting [16]. A randomised controlled trial showed that a weekly Epo dose of 40,000 IU led to increased Hb and reduced transfusion requirements in non-JW patients but further studies are required to assess whether clinical outcome is affected [17]. Doses of Epo used in this setting have also varied widely. In this setting, if the treating clinician feels erythropoietin is indicated, in the absence of evidence-based dosing regimens, the schedule described above in the paragraph entitled "enhance haemoglobin production" can be considered.
Respiratory support in the form of a ventilator can help reduce myocardial oxygen consumption and early discussion with critical care is advocated.
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Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document.
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Topic Code: 47849
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