Blood utilization and conservation

There are still many unanswered questions regarding blood management in the critically ill patient. Patients with congenital cardiac disease are further complicated by their variable physiology and subsequent response to persistent hypoxia. This chapter discusses blood management throughout the perioperative time period for a pediatric patient undergoing cardiac surgery. It begins with the preoperative optimization of the patient and potential impact on clinical outcomes. A thorough discussion of the effects of bypass and the methods that are used to minimize and optimize blood product use in the intraoperative period follows. The chapter concludes with an evidence-based evaluation of blood management and utilization in the postoperative time period, including a discussion of the effect of red cell age on clinical outcomes.