/ Prof Christa Boer
Christa Boer is Professor of Anesthesiology (Research in Perioperative Care), and published more than 160 papers in international journals. She is member of the editorial board of the British Journal of Anaesthesia and chair of the Human Subjects Committee of VUmc.
Her translational research focuses on the interplay between microcirculatory perfusion, endothelial activation and coagulation during cardiopulmonary bypass and hemorrhagic shock and on postoperative care. She is principle investigator of a large multicenter study focusing on postoperative care by anesthesiologists (TRACE study). She is member of the subcommittee Transfusion, Haemostasis and Thrombosis of the ESA, and chair of the subcommittee Transfusion & Haemostasis of the EACTA. She recently published the EACTS-EACTA guideline Patient Blood Management in Cardiac Surgery. In addition, she is member of the SCA Blood Conservation workgroup and NATA scientific committee.
Transfusion triggers: Changing practice?
Transfusion of packed red blood cells is commonly based on haemoglobin levels. In the last years, randomised controlled trials in cardiac surgery however showed that restrictive transfusion based on a haemoglobin level of <7.5 g/dl does not increase the risk for postoperative morbidity or mortality. Based on these trials, the recently published guidelines for patient blood management in cardiac surgery recommend titration of packed red blood cell transfusion based on the individual need of the patient. In particular, patients with cardiovascular conditions such as heart failure or pulmonary dysfunction might even benefit from a liberal transfusion threshold in order to reduce the risk for tissue hypoxia.
The limitations of haemoglobin levels as transfusion threshold warrant exploration of novel transfusion markers, such as microcirculatory perfusion and oxygenation, or markers for oxygen metabolism. Recent studies suggest that the measurement of oxygen delivery (DO2) and oxygen consumption (VO2) may be of particular interest in transfusion practice and could be used to reduce postoperative complications rates in these patients. This lecture provides an overview of currently explored, novel transfusion triggers, and their applicability in clinical practice.
How anaesthesiologists can engage with the postoperative period?
Although mortality rates associated with anaesthesia and surgery are relatively low in Western society, a substantial number of patients still face complications and delayed recovery in the postoperative phase. Postsurgical mortality is mainly caused by the lack of a standardized follow-up of patients who develop early signs of postoperative complications, resulting in failure to rescue. Interestingly, anaesthesiologists are currently not routinely involved in postoperative monitoring of surgical patients in most European centres.
In the Routine posTsuRgical Anaesthesia visit to improve patient outcome (TRACE) study we investigated in 5600 patients whether intensified monitoring and early diagnosis and treatment of deteriorations in the postoperative health status of the surgical patient by anaesthesiologists reduces the failure to rescue rate. Moreover, by introducing remote monitoring of vital signs at a general ward we explored the added value of automated notification for patient deterioration to current health care practice. This lecture provides an overview of our experience with routine visits and remote monitoring in the postoperative period. We will demonstrate that the introduction of continuous monitoring of vital parameters at general wards may contribute to reduced postoperative complication rates in populations at risk.