Abstract：
The objective of this work was to carry out a systematic review of clinical practice guidelines (CPGs) pertaining to intraoperative red blood cell (RBC) transfusions, in terms of indications, decision-making, and supporting evidence base.
RBC transfusions are common during surgery and there is evidence of wide variability in practice.
Major electronic databases (MEDLINE, EMBASE, and CINAHL), guideline clearinghouses and Google Scholar were systematically searched from inception to January 2019 for CPGs pertaining to indications for intraoperative RBC transfusion. Eligible guidelines were retrieved and their quality assessed using AGREE II. Relevant recommendations were abstracted and synthesized to allow for a comparison between guidelines.
Ten guidelines published between 1992 and 2018 provided indications for intraoperative transfusions. No guideline addressed intraoperative transfusion decision-making as its primary focus. Six guidelines provided criteria for transfusion based on hemoglobin (range 6.0-10.0 g/dL) or hematocrit (<30%) triggers. In the absence of objective transfusion rules, CPGs recommended considering other parameters such as blood loss (n = 7), signs of end organ ischemia (n = 5), and hemodynamics (n = 4). Evidence supporting intraoperative recommendations was extrapolated primarily from the nonoperative setting. There was wide variability in the quality of included guidelines based on AGREE II scores.
This review has identified several clinical practice guidelines providing recommendations for intraoperative transfusion. The existing guidelines were noted to be highly variable in their recommendations and to lack a sufficient evidence base from the intraoperative setting. This represents a major knowledge gap in the literature.
RBC transfusions are common during surgery and there is evidence of wide variability in practice.
Major electronic databases (MEDLINE, EMBASE, and CINAHL), guideline clearinghouses and Google Scholar were systematically searched from inception to January 2019 for CPGs pertaining to indications for intraoperative RBC transfusion. Eligible guidelines were retrieved and their quality assessed using AGREE II. Relevant recommendations were abstracted and synthesized to allow for a comparison between guidelines.
Ten guidelines published between 1992 and 2018 provided indications for intraoperative transfusions. No guideline addressed intraoperative transfusion decision-making as its primary focus. Six guidelines provided criteria for transfusion based on hemoglobin (range 6.0-10.0 g/dL) or hematocrit (<30%) triggers. In the absence of objective transfusion rules, CPGs recommended considering other parameters such as blood loss (n = 7), signs of end organ ischemia (n = 5), and hemodynamics (n = 4). Evidence supporting intraoperative recommendations was extrapolated primarily from the nonoperative setting. There was wide variability in the quality of included guidelines based on AGREE II scores.
This review has identified several clinical practice guidelines providing recommendations for intraoperative transfusion. The existing guidelines were noted to be highly variable in their recommendations and to lack a sufficient evidence base from the intraoperative setting. This represents a major knowledge gap in the literature.
摘要：
这项工作的目的是对与术中红细胞（RBC）输血有关的临床实践指南（CPG）进行系统回顾。在适应症方面，决策,和支持证据基础。
RBC输血在手术过程中很常见，并且有证据表明实践中存在广泛的变异性。
主要电子数据库(MEDLINE，EMBASE,和CINAHL），从开始到2019年1月，对指南交换所和GoogleScholar进行了系统搜索，以了解与术中红细胞输血适应症相关的CPG。检索合格的指南，并使用AGREEII评估其质量。对相关建议进行了抽象和综合，以便对准则进行比较。
1992年至2018年发布的十项指南为术中输血提供了适应症。没有指南将术中输血决策作为其主要重点。六项指南提供了基于血红蛋白（范围6.0-10.0g/dL）或血细胞比容（<30％）触发因素的输血标准。在没有客观输血规则的情况下，CPG建议考虑其他参数，如失血(n=7)，末端器官缺血的迹象（n=5），和血液动力学（n=4）。支持术中建议的证据主要是从非手术设置推断的。基于AGREEII评分的纳入指南的质量差异很大。
本综述确定了一些临床实践指南，为术中输血提供了建议。注意到现有指南在其建议中存在很大差异，并且从术中设置缺乏足够的证据基础。这代表了文献中的主要知识差距。
RBC输血在手术过程中很常见，并且有证据表明实践中存在广泛的变异性。
主要电子数据库(MEDLINE，EMBASE,和CINAHL），从开始到2019年1月，对指南交换所和GoogleScholar进行了系统搜索，以了解与术中红细胞输血适应症相关的CPG。检索合格的指南，并使用AGREEII评估其质量。对相关建议进行了抽象和综合，以便对准则进行比较。
1992年至2018年发布的十项指南为术中输血提供了适应症。没有指南将术中输血决策作为其主要重点。六项指南提供了基于血红蛋白（范围6.0-10.0g/dL）或血细胞比容（<30％）触发因素的输血标准。在没有客观输血规则的情况下，CPG建议考虑其他参数，如失血(n=7)，末端器官缺血的迹象（n=5），和血液动力学（n=4）。支持术中建议的证据主要是从非手术设置推断的。基于AGREEII评分的纳入指南的质量差异很大。
本综述确定了一些临床实践指南，为术中输血提供了建议。注意到现有指南在其建议中存在很大差异，并且从术中设置缺乏足够的证据基础。这代表了文献中的主要知识差距。
