Sunil In my opinion the transfusing to a Hct of 30 only applies when in refractory shock. Once the shock has subsided I feel the transfusion risk is greater than the benefit so I would not. Do you know if she has myocardial dysfunction. If so then transfusion is not the answer and I see myocardial depression often in severe sepsis and it usually improves in a few days. Associated with pregnancy however it may be a more serious problem if it is present.
Terry P. Clemmer, MD Director of Critical Care Medicine LDS Hospital 8th Ave and 'C' Street Salt Lake City, Utah 84143 Phone 801-408-3661 E-mail: [email protected]<mailto:[email protected]> "Confidential Report for Improvement of Hospital, Facility and Patient Care--Not Part of Medical Record and Not to be Used in Litigation--Prepared Pursuant to Utah Code Ann. § 26-25-1 et seq., or Idaho Code Ann. § 39-1392 et seq." From: [email protected] [mailto:[email protected]] On Behalf Of Dr.Sunil T Pandya Sent: Tuesday, December 18, 2012 7:55 PM To: [email protected] Subject: [Sepsis Groups] Maternal sepsis with low scvo2 Hi friends, We have a young lady who had premature rupture of membranes (PROM), had an emergency Cesarean section after 48Hrs, was already on prophylactic antibiotics (IV. Cephazolin) as per the protocol. Intraoperatively developed refractory hypotension / full blown SIRS (Unexplained by low dose spinal), and chorio amnionitis - severe sepsis was suspected / and confirmed (High vag swab at admission revealed Klebsiella growth) considering 48 hrs of PROM. Sepsis profile / CVP line inserted for fluid administration and vasopressors support. Lactate was 4 and SCVO2 was 48%. (Hb-10g). Change of antibiotics as per the cultures and fluids and nor adr / organ supports etc. have helped her and is stabilizing. Her lactate improved and is within normal limits. SCVO2 is still @ 55% and her Hb is 8.2g%. CLinically she is doing good and on soft diet. Blood culture also was positive for klebsiella My question to the the expert is: My fellows were debating whether to give her couple of units of Packed cell transfusion in view of low ScVO2.....I seek you opinion as well - Does she need blood transfusion? She has come out of all organ dysfunctions (Renal / ALI / Low plt) and is asymptomatic and white cell counts are 10800/cumm, Polymorphs - 72%, Bands - 4%! Thanking you in advance! Regards, Sunil ------------ Dr.Sunil T Pandya Hon. Secretary, Association of Obstetric Anaesthesiologists, India (www.aoaindia.com<http://www.aoaindia.com>) Hon. Secretary, Society of Obstetric Medicine, India Head, Dept. of Anaesthesia, Pain and Critical Care, Fernandez Hospital (Health care for Women and the Newborn), www.fernandezhospital.com<http://www.fernandezhospital.com> Director, Prerna Anaesthesia and Critical Care Services Pvt Ltd (www.prernaanaesthesia.com<http://www.prernaanaesthesia.com>) Hyderabad, India.
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