The best strategy for red blood cell transfusion in severe burn patients, restrictive or liberal: A randomized controlled trial

Salehi, Seyed Hamid; Daniali, Maziar; Motaghi, Paniz; Momeni, Maryam

doi:10.1016/j.burns.2020.06.038

Cited by 9 publications

(18 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…TBSA also acted as an important risk factor for AKI and ARDS. In previous studies, intraabdominal hypertension, hypernatremia, and inhalation injury were risk factors for serious complications (27)(28)(29), while in the present study, inhalation injury was also found to be a risk factor for ARDS, but there was no significant relationship between it and AKI. Sepsis is also a common complication in severe burns patients, and we found its incidence to be 21.1% in the control group and 19.5% in the study group.…”

Section: Discussioncontrasting

confidence: 50%

Fluid resuscitation based on pulse contour cardiac output monitoring is associated with improved prognosis in adult severe burn patients: a retrospective cohort study

Zhu¹,

Yang²,

Ding³

et al. 2021

Ann Palliat Med

View full text Add to dashboard Cite

Background: A monitoring method is needed to further guide fluid resuscitation in severe burn injury. This study was performed to investigate the effects of pulse contour cardiac output (PCCO) monitoring on the prognosis of adult severe burns patients. Methods:We conducted a retrospective study enrolling patients from January 2015 to December 2020, who were divided into a control group receiving conventional monitoring and a study group receiving PCCO monitoring. The primary outcomes were 28-day mortality and total mortality, and the secondary outcomes included burn-related complications and the length of hospital stay and ICU stay. Multivariable logistic regression analysis and linear regression analysis were performed to determine the risk factors of burnsrelated complications and length of hospital stay in enrolled patients.Results: A total of 109 patients in the control group and 82 patients in the study group were enrolled. While the area of full thickness burn was much higher in the control group than in the study group (P=0.021), no significant difference was found in other characteristics between the two groups. During fluid resuscitation, the fluid volume ratio of the study group was significantly different from that of the control group, and both in the first 24 hours and the second 24 hours, the resuscitation fluid volume ratio and colloid volume ratio was significantly higher in the control group than in the study group (all P<0.001). Eight patients died during treatment, and there were more patients experiencing AKI and ARDS in the control group than in the study group (P=0.029 and 0.016). The lengths of hospital stay and ICU stay in the study group was much shorter than in the control group (P<0.001 and 0.005). In addition, TBSA was an important risk factor for both AKI and ARDS, and the existence of inhalation injury and older age increased the incidence of ARDS. Higher TBSA, inhalation injury, and burn-related complications were related to longer hospital stay in enrolled patients.Conclusions: Fluid resuscitation according to PCCO monitoring can effectively reduce the volume of colloid and overall fluid volume and reduce the incidence of burns-related complications and shorten the length of hospital stay.

show abstract

Section: Discussioncontrasting

confidence: 50%

Fluid resuscitation based on pulse contour cardiac output monitoring is associated with improved prognosis in adult severe burn patients: a retrospective cohort study

Zhu¹,

Yang²,

Ding³

et al. 2021

Ann Palliat Med

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

“…Other recent studies evaluating burn patients randomized to maintain an Hgb of either 7 or 8 versus 10 did not show a higher infection rate in the liberal transfusion groups, but did support the current findings of no difference in mortality or other secondary outcomes measured in those studies. 6,7 This study was underpowered for multiple other potential complications relevant to anemia or transfusion such as cardiac and renal events, pneumonia, urinary tract infection, deep venous thrombosis, and others. Post hoc power analysis was not performed for these secondary outcomes because it was apparent the number of patients needed for these other outcomes would not be practical for a prospective, randomized study.…”

Section: Discussionmentioning

confidence: 99%

Orthopaedic Trauma and Anemia: Conservative versus Liberal Transfusion Strategy: A Prospective Randomized Study

Mullis,

Kempton

et al. 2024

Journal of Orthopaedic Trauma

View full text Add to dashboard Cite

OBJECTIVES: To determine whether it is safe to use a conservative packed red blood cell transfusion hemoglobin (Hgb) threshold (5.5 g/dL) compared with a liberal transfusion threshold (7.0 g/dL) for asymptomatic musculoskeletal injured trauma patients who are no longer in the initial resuscitative period. METHODS: Design: Prospective, randomized, multicenter trial. Setting: Three level 1 trauma centers. Patient Selection Criteria: Patients aged 18–50 with an associated musculoskeletal injury with Hgb less than 9 g/dL or expected drop below 9 g/dL with planned surgery who were stable and no longer being actively resuscitated were randomized once their Hgb dropped below 7 g/dL to a conservative transfusion threshold of 5.5 g/dL versus a liberal threshold of 7.0 g/dL. Outcome Measures and Comparisons: Postoperative infection, other post-operative complications and Musculoskeletal Functional Assessment scores obtained at baseline, 6 months, and 1 year were compared for liberal and conservative transfusion thresholds. RESULTS: Sixty-five patients completed 1 year follow-up. There was a significant association between a liberal transfusion strategy and higher rate of infection (P = 0.01), with no difference in functional outcomes at 6 months or 1 year. This study was adequately powered at 92% to detect a difference in superficial infection (7% for liberal group, 0% for conservative, P < 0.01) but underpowered to detect a difference for deep infection (14% for liberal group, 6% for conservative group, P = 0.2). CONCLUSIONS: A conservative transfusion threshold of 5.5 g/dL in an asymptomatic young trauma patient with associated musculoskeletal injuries leads to a lower infection rate without an increase in adverse outcomes and no difference in functional outcomes at 6 months or 1 year. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

show abstract

“…Other recent studies evaluating patients with burn randomized to maintain a Hgb of either 7 or 8 versus 10 did not show a higher infection rate in the liberal transfusion groups but did support our findings of no difference in mortality or other secondary outcomes measured in those studies. 3,4 Multiple other studies suggest that allogeneic blood transfusion may suppress the immune system or increase the risk for infection; however, the mechanism for this remains unclear. [5][6][7][8][9][10][11][12][13][14][15][16][17][18] A meta-analysis of 20 studies reviewing outcomes of the effects of transfusion on postoperative bacterial infection found strong evidence supporting a correlation.…”

Section: Discussionmentioning

confidence: 99%

Early Results of Orthopaedic Trauma and Anemia: Conservative Versus Liberal Transfusion Strategy

Mullis,

Kempton

et al. 2023

J Am Acad Orthop Surg

View full text Add to dashboard Cite

Introduction: The purpose of this study was to determine whether it is safe to use a conservative packed red blood cell transfusion hemoglobin threshold (5.5 g/dL) compared with a liberal transfusion threshold (7.0 g/dL) for asymptomatic patients with musculoskeletal-injured trauma out of the initial resuscitative period. Methods: This was a multicenter, prospective, nonblinded, randomized study done at three level 1 trauma centers. One hundred patients were enrolled. One patient was inappropriately enrolled, withdrawn from the study, and excluded from analysis leaving 99 patients (49 liberal and 50 conservative) with 30-day follow-up. After initial resuscitation, patients were enrolled and randomized to either a liberal or a conservative transfusion strategy. This strategy was followed throughout the index hospitalization. The primary outcome of the study was infection. Superficial infection was defined as clinical diagnosis of cellulitis or other superficial infection treated with oral antibiotics only. Deep infection was defined as clinical diagnosis of fracture-related infection requiring IV antibiotics and/or surgical débridement. Results: Ninety-nine patients were successfully followed for 30 days with 100% follow-up during this time. Seven infections (14%) occurred in the liberal group and none in the conservative group (P < 0.01). Five deep infections (10%) occurred in the liberal group and none in the conservative group (P = 0.03). Three superficial infections (6%) occurred in the liberal and none in the conservative group, which was not a significant difference (P = 0.1). No difference was observed in length of stay between groups. Discussion: Transfusing young healthy asymptomatic patients with orthopaedic trauma for hemoglobin <7.0 g/dL increases the risk of infection. No increased risk of anemia-related complications was identified with a conservative transfusion threshold of 5.5 g/dL. Data availability and trial registration numbers: Data are available on request. IRB protocol number is 1402557771. This study was registered with Clinicaltrials.gov identifier NCT02972593. Level of evidence: Level 2, unblinded prospective randomized multicenter study.

show abstract

The best strategy for red blood cell transfusion in severe burn patients, restrictive or liberal: A randomized controlled trial

Cited by 9 publications

References 13 publications

Fluid resuscitation based on pulse contour cardiac output monitoring is associated with improved prognosis in adult severe burn patients: a retrospective cohort study

Fluid resuscitation based on pulse contour cardiac output monitoring is associated with improved prognosis in adult severe burn patients: a retrospective cohort study

Orthopaedic Trauma and Anemia: Conservative versus Liberal Transfusion Strategy: A Prospective Randomized Study

Early Results of Orthopaedic Trauma and Anemia: Conservative Versus Liberal Transfusion Strategy

Contact Info

Product

Resources

About