Watson, D. M., Stanworth, S. J., Wyncoll, D., McAuley, Daniel F., Perkins, Gavin D., Young, D., Biggin, K. J. and Walsh, T. S.. (2011) A national clinical scenario-based survey of clinicians' attitudes towards fresh frozen plasma transfusion for critically ill patients. Transfusion Medicine, Vol.21 (No.2). pp. 124-129. ISSN 0958-7578

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Abstract

Background: It is known that 20-30% of fresh frozen plasma (FFP) is used in intensive care units (ICUs), but little is known about variations in decision making between clinicians in relation to coagulopathy management. Our aim was to describe ICU clinicians' beliefs and practice in relation to FFP treatment of non-bleeding coagulopathic critically ill patients.

Methods: Two patient-based scenarios were developed and sent to 2700 members of two UK intensive care professional societies. Scenario 1 was a non-bleeding septic patient with coagulopathy; scenario 2 was a non-bleeding critically ill patient with hepatic cirrhosis and coagulopathy. Responses were sought in relation to FFP prophylaxis, and prior to central venous cannulation. A supplementary question asked clinicians' view of prophylaxis in relation to other ICU procedures.

Results: Two-thousand-and-seven-hundred clinicians were surveyed from whom 601 responses were received (22.3% response rate). For scenario 1 52% of respondents stated that they would never routinely administer prophylactic FFP, but this decreased to 9% when central venous cannulation was planned (P < 0.01). There was wide variation in the 'trigger' INR (international normalised ratio) value used prior to central vein cannulation, the most common range being 2.0-2.4. For scenario 2, responses were very similar. More than 80% of clinicians stated that they would routinely treat coagulopathy prior to lumbar puncture, epidural catheterisation, intracranial pressure monitoring and tracheostomy; and 54% prior to chest drain insertion.

Conclusion: Our survey demonstrated a wide range of responses consistent with important variations in clinical practice and substantial clinical uncertainty in relation to FFP treatment for non-bleeding ICU patients.

Item Type:	Journal Article
Subjects:	R Medicine > R Medicine (General)
Divisions:	Faculty of Medicine > Warwick Medical School
Journal or Publication Title:	Transfusion Medicine
Publisher:	Wiley-Blackwell Publishing Ltd.
ISSN:	0958-7578
Official Date:	April 2011
Volume:	Vol.21
Number:	No.2
Page Range:	pp. 124-129
Identification Number:	10.1111/j.1365-3148.2010.01049.x
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Restricted or Subscription Access
URI:	http://wrap.warwick.ac.uk/id/eprint/41874

Data sourced from Thomson Reuters' Web of Knowledge

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