Blood Transfusion Practice in Critically Ill Patients: A Single Institutional Experience

Al-Faris, Lama; Al-Fares, Abdul Rahman; Malek, Kefaya Abdul; Omran, Alaa; Al-Humood, Salah

doi:10.1159/000338887

Cited by 8 publications

(10 citation statements)

References 40 publications

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“…Two of the nine studies with death as outcome were excluded from the meta-analysis due to missing crude and/or adjusted odds ratios [20, 21]. As a result, 2762 patients from 7 studies were included.…”

Section: Resultsmentioning

confidence: 99%

Impact of transfusion on patients with sepsis admitted in intensive care unit: a systematic review and meta-analysis

Dupuis

Sonneville

Adrie

et al. 2017

Ann. Intensive Care

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Red blood cell transfusion (RBCT) threshold in patients with sepsis remains a matter of controversy. A threshold of 7 g/dL for stabilized patients with sepsis is commonly proposed, although debated. The aim of the study was to compare the benefit and harm of restrictive versus liberal RBCT strategies in order to guide physicians on RBCT strategies in patients with severe sepsis or septic shock. Four outcomes were assessed: death, nosocomial infection (NI), acute lung injury (ALI) and acute kidney injury (AKI). Studies assessing RBCT strategies or RBCT impact on outcome and including intensive care unit (ICU) patients with sepsis were assessed. Two systematic reviews were achieved: first for the randomized controlled studies (RCTs) and second for the observational studies. MEDLINE, EMBASE, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Clinical Trials.gov were analyzed up to March 01, 2015. Der Simonian and Laird random-effects models were used to report pooled odds ratios (ORs). Subgroup analyses and meta-regressions were performed to explore studies heterogeneity. One RCT was finally included. The restrictive RBCT strategy was not associated with harm or benefit compared to liberal strategy. Twelve cohort studies were included, of which nine focused on mortality rate. RBCT was not associated with increased mortality rate (overall pooled OR was 1.10 [0.75, 1.60]; I 2 = 57%, p = 0.03), but was associated with the occurrence of NI (2 studies: pooled OR 1.25 [1.04–1.50]; I 2 = 0%, p = 0.97), the occurrence of ALI (1 study: OR 2.75 [1.22–6.37]; p = 0.016) and the occurrence of AKI (1 study: OR 5.22 [2.1–15.8]; p = 0.001). Because there was only one RCT, the final meta-analyses were only based on the cohort studies. As a result, the safety of a RBCT restrictive strategy was confirmed, although only one study specifically focused on ICU patients with sepsis. Then, RBCT was not associated with increased mortality rate, but was associated with increased in occurrence of NI, ALI and AKI. Nevertheless, the data on RBCT in patients with sepsis are sparse and the high heterogeneity between studies prevents from drawing any definitive conclusions.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-016-0226-5) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Impact of transfusion on patients with sepsis admitted in intensive care unit: a systematic review and meta-analysis

Dupuis

Sonneville

Adrie

et al. 2017

Ann. Intensive Care

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“…Similar studies examining the appropriateness of RBC transfusion practices have been described in the literature. Previous retrospective audits, for example, have primarily focused on characterizing mean pre-transfusion hemoglobin levels and found them to range substantially between 71 g/L and 91 g/L for most non-hemorrhagic, ICU patient populations [31–34]. One of the larger studies conducted in the USA, a longitudinal analysis RBC transfusion practice between 1997 and 2007, reported a similar mean pre-transfusion hemoglobin level to our patient cohort after their 10 year follow-up period (significantly decreasing from 79 ± 1.3 to 73 ± 1.3 g/L) [32].…”

Section: Discussionmentioning

confidence: 99%

A retrospective observational analysis of red blood cell transfusion practices in stable, non-bleeding adult patients admitted to nine medical-surgical intensive care units

et al. 2019

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Background Red blood cell (RBC) transfusions are common procedures performed in the intensive care unit (ICU). However, conservative transfusion approaches have been recommended to avoid RBC transfusions that are not clinically necessary and to achieve optimal patient outcomes. The objective of this study was to examine the utilization and costs of RBC transfusions in medical-surgical ICUs and to compare this information against clinical guideline recommendations for best practice. Methods Retrospective observational analysis of RBC transfusions in stable, non-bleeding adult patients was examined in a geographically-defined, population-based cohort of nine integrated ICUs between April 1, 2014 and December 31, 2016. RBC transfusions associated with a pre-transfusion hemoglobin value of 70 g/L or more were examined through linear and logistic regression. The total costs of RBC transfusions, based on the RBC unit cost, were estimated. Results A total of 4632 RBC transfusions (2287 ICU admissions) were included. Pre-transfusion hemoglobin values were identified for 4487 transfusions. On average, 61% occurred at or above a hemoglobin value of 70 g/L (mean 73.4 ± 9.2 g/L). Factors associated with such transfusions included being male, age over 75, Sequential Organ Failure Assessment (SOFA) score greater or equal to 10, transfer from operating room, gastrointestinal bleeding, and trauma. A pre-transfusion hemoglobin value at or above 70 g/L was associated with increased odds of ICU mortality; there was no impact on overall hospital mortality. The total estimated cost of RBC transfusions was $2.99M Canadian dollars (CAD), with $1.82M CAD attributed to those with a hemoglobin value at or above 70 g/L. Conclusions Over half of the examined RBC transfusions may not have aligned with recommended best practice; this suggests significant opportunity for improvement. The present findings are an essential step towards optimizing RBC transfusions in the ICU. Electronic supplementary material The online version of this article (10.1186/s40560-019-0375-3) contains supplementary material, which is available to authorized users.

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“…Our institution implements the Brain Trauma Foundation treatment guidelines for TBI. We also have a restrictive transfusion practice due to recommendations with a restrictive hemoglobin transfusion trigger of <8 g/dl and transfusion decisions guided by risk and benefit analysis for each patient with emergency neurosurgical intervention, whose efficacy has been studied before [ 13 , 14 ].…”

Section: Methodsmentioning

confidence: 99%

Twenty-Eight-Day Mortality of Blunt Traumatic Brain Injury and Co-Injuries Requiring Mechanical Ventilation

Jovanović

Milan²,

Djurić³

et al. 2016

Med Princ Pract

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Objective: This paper aims to assess the impact of co-injuries and consequent emergency surgical interventions and nosocomial pneumonia on the 28-day mortality of patients with severe traumatic brain injuries (TBIs). Subjects and Methods: One hundred and seventy-seven patients with TBI admitted to the emergency trauma intensive care unit at the Clinical Center of Serbia for more than 48 h were studied over a 1-year period. On admission, the Glasgow Coma Scale (GCS), Injury Severity Score (ISS) and Acute Physiology and Chronic Health Evaluation II score (APACHE II) were calculated. At admission, an isolated TBI was recorded in 45 of the patients, while 44 had three or more co-injuries. Results: Of the 177 patients, 78 (44.1%) died by the end of the 28-day follow-up period. They had a significantly higher ISS score (25 vs. 20; p = 0.024) and more severe head (p = 0.034) and chest (p = 0.013) injuries compared to those who survived. Nonsurvivors had spent more days on mechanical ventilation (9.5 vs. 8; p = 0.041) and had a significantly higher incidence of ventilator-associated pneumonia (VAP) than survivors (67.9 vs. 40.4%; p < 0.001). A high Rotterdam CT score (OR 2.062; p < 0.001) and a high APACHE II score (OR 1.219; p < 0.001) were identified as independent predictors of early TBI-related mortality. Conclusion: Patients who had TBI with a high Rotterdam score and a high APACHE II score were at higher risk of 28-day mortality. VAP was a very common complication of TBI and was associated with an early death and higher mortality in the subgroup of patients with a GCS ≤8.

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Blood Transfusion Practice in Critically Ill Patients: A Single Institutional Experience

Cited by 8 publications

References 40 publications

Impact of transfusion on patients with sepsis admitted in intensive care unit: a systematic review and meta-analysis

Impact of transfusion on patients with sepsis admitted in intensive care unit: a systematic review and meta-analysis

A retrospective observational analysis of red blood cell transfusion practices in stable, non-bleeding adult patients admitted to nine medical-surgical intensive care units

Twenty-Eight-Day Mortality of Blunt Traumatic Brain Injury and Co-Injuries Requiring Mechanical Ventilation

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