Adverse effects of infusion therapy in anesthesia and intensive care

In this thesis we investigated adverse events following transfusion and infusion therapy during anesthesia and intensive care. We focussed on a selection of different aspects in patients in the operation room, intensive care and on the ward. First, we sought to provide insights for which patients the risk of a common transfusion complication, transfusion-associated circulatory overload (TACO), outweighs the potential benefit of a transfusion. Second, we explored possible mechanisms underlying the development of TACO. Third, we searched for ways to optimize infusion therapy in the perioperative period.
Our research suggests alternative mechanisms than just hydrostatic pressure overload for the development of TACO. Risk factors for TACO in comparison to patients developing circulatory overload without receiving transfusion products, COP of transfusion products, and clinical research on the effect of transfusion on hydrostatic pressure support a different pathogenesis. Our data helped put together one part of the puzzle. Future studies on TACO pathogenesis should focus on the effect of transfusion products on the endothelial barrier, and how an inflammatory process is part of this effect. Furthermore, we aimed to optimize perioperative infusion therapy. We showed a restrictive infusion regimen is associated with a reduction in complications. We developed a novel method of non-invasive CO monitoring derived from CCA flow. However, this method is not accurate and not precise.