title: A Simple "Blood-Saving Bundle" Reduces Diagnostic Blood Loss and the Transfusion Rate in Mechanically Ventilated Patients.
abstract: BACKGROUND
  Aim of this study was to reduce blood loss caused by diagnostic blood sampling and to minimize the development of anemia in a high-risk group of mechanically ventilated medical intensive care patients. We therefore implemented a "blood-saving bundle" (BSB) combining a closed-loop arterial blood sampling system, smaller sampling tubes, reduced frequency of blood drawings, and reduced sample numbers.
  
  
  METHODS
  The study included all patients from our medical ICU who were ventilated for more than 72 hours. Exclusion criteria were: acute or chronic anemia on admission, bleeding episode(s) during the ICU stay, or end-of-life therapy. The BSB was introduced in 2009 with training and educational support. Patients treated in 2008, before the introduction of the BSB, served as a control group (n = 41, 617 observation days), and were compared with patients treated in 2010 after the introduction of the BSB (BSB group, n = 50, 559 observation days). Primary endpoints were blood loss per day, and development of anemia. Secondary endpoints were numbers of blood transfusions, number of days on mechanical ventilation, and length of the ICU stay.
  
  
  RESULTS
  Mean blood loss per ICU day was decreased from 43.3 ml (95% CI: 41.2 to 45.3 ml) in the controls to 15.0 ml (14.3 to 15.7 ml) in the BSB group (P < 0.001). The introduction of a closed-loop arterial blood sampling system was the major contributor to this effect. Mean hemoglobin concentrations showed no significant differences in both groups during the ICU stay. Hemoglobin values <9 g/dl, however, were recorded in 21.2% of observation days in the controls versus 15.4% in the BSB group (P = 0.01). Units of transfused red blood cells per 100 observation days decreased from 7 to 2.3 (P < 0.001). The mean number of ventilation days was 7.1 days (6.1 to 8.3 days) in the controls and 7.5 days (6.6 to 8.5 days) in the BSB group (P = NS). In total, patients in the BSB group stayed in ICU for a mean of 9.9 days (8.6 to 11.3 days), compared to a mean ICU stay of 13.0 days (10.9 to 15.4 days) in the control group (P = 0.014). Due to the longitudinal study design, however, we cannot exclude uncontrolled confounders affecting the transfusion frequency and mean ICU stay.
  
  
  CONCLUSIONS
  Our BSB could be easily implemented and was able to reduce diagnostic blood loss.
authors.affiliation: Department of Internal Medicine, Medical Intensive Care Unit, University of Tübingen, Tübingen, Germany.
authors.forename: Reimer
authors.initials: R
authors.lastname: Riessen
authors.affiliation: Department of Internal Medicine, Medical Intensive Care Unit, University of Tübingen, Tübingen, Germany.
authors.forename: Melanie
authors.initials: M
authors.lastname: Behmenburg
authors.affiliation: Department of Clinical Epidemiology and Applied Biometry, University of Tübingen, Tübingen, Germany.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Blumenstock
authors.affiliation: Department of Clinical Epidemiology and Applied Biometry, University of Tübingen, Tübingen, Germany.
authors.forename: Doris
authors.initials: D
authors.lastname: Guenon
authors.affiliation: Clinical Transfusion Medicine, University of Tübingen, Tübingen, Germany.
authors.forename: Sigrid
authors.initials: S
authors.lastname: Enkel
authors.affiliation: Institute for Transfusion Medicine and Immunohaematology, German Red Cross Blood Donor Service Baden-Württemberg-Hessen GmbH, Johann-Wolfgang-Goethe-University Hospital, Frankfurt/Main, Germany.
authors.forename: Richard
authors.initials: R
authors.lastname: Schäfer
authors.affiliation: Department of Internal Medicine, Medical Intensive Care Unit, University of Tübingen, Tübingen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Haap
mesh_terms: D000368:Aged; D000740:Anemia / Q000097:blood* / Q000628:therapy*; D001803:Blood Transfusion; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D057725:Operative Blood Salvage / Q000379:methods*; D012121:Respiration, Artificial