Welcome to the May 2015 REBELCast, where Swami, Matt, and I are going to tackle a couple of articles just published this year. First, there is a lack of research examining the efficacy of steroids in patients with allergic reactions or anaphylaxis. Despite this, corticosteroids are standard care for patients with these disorders. Second, current regulations permit storage of PRBCs for up to 42 days, but maybe fresh PRBCs may improve outcomes in the critically ill by enhancing oxygen delivery while minimizing toxic effects from cellular changes and accumulation of bioactive materials in blood components during prolonged storage. So with that introduction today we are going to specifically tackle:
- Topic #1: Corticosteroids in Allergic Reactions & Anaphylaxis
- Topic #2: Age of Packed Red Blood Cells (PRBCs) in Critically Ill Adults
May 2015 REBELCast Podcast
What clinical questions will be covered in the May 2015 REBELCast?
- Question #1: Does the addition of corticosteroids in the treatment of allergic reactions and anaphylaxis decrease the likelihood of relapse after emergency department (ED) discharge?
- Question #2: Does the age of PRBCs transfused in critically ill adults affect morbidity/mortality?
What specific articles will we be covering?
- Article #1: Grunau BE et al. Emergency Department Corticosteroid Use for Allergy or Anaphylaxis is Not Associated with Decreased Relapses. Ann Emerge Med 2015. [Published Online]
- Article #2: Lacroix J et al. Age of Transfused Blood in Critically Ill Adults. NEJM 2015; 372 (15): 1410-8. [cite source=”pubmed”]25853745[/cite]
What is the clinical bottom line for the above clinical questions:
- Bottom Line #1: Among ED patients with allergic reactions or anaphylaxis corticosteroid use was not associated with a decrease in biphasic allergic responses at 7 days. However, a significant difference in baseline characteristics of the patients limits the application of these results to patients with anaphylaxis.
- Bottom Line #2: Among critically ill adult patients the transfusion of fresh (<8 days) PRBCs vs standard issue PRBCs did not affect 90 day mortality.