The “sticky” business of “adherence” to transfusion guidelines

Impact of national transfusion indicators on appropriate blood usage in critically ill patients

“…During the study periods, a total of 1808 patients were admitted to the six participating ICUs, and 602 patients (33.3%) received at least 1 unit of blood components. APACHE II scores (median [IQR], 16 [11][12][13][14][15][16][17][18][19][20][21] vs. 11 [7][8][9][10][11][12][13][14][15][16]), the length of ICU stay (6 [3][4][5][6][7][8][9][10][11] vs. 3 [1][2][3][4] days), and crude mortality (24.5% vs. 11.4%) were significantly higher in transfused patients compared to nontransfused patients (p < 0.01). Table 1.…”

“…16 These audits may reduce unnecessary blood transfusions by 25 to 43% 13,17 ; however, they may require periodic updates. 18 Protocols with the intention of decreasing inappropriate blood use should be simple, have a wide distribution, be endorsed by local opinion leaders, and require minor changes over time. 19 It has been recently shown that the implementation of an evidence-based transfusion protocol in a surgical ICU (based on a single variable that can be identified and monitored), together with continued reinforcement on the rationale for transfusion, led to a significant reduction in the number of infused RBC units and number of patients transfused without an increase in mortality.…”

“…A total of 111 patients received at least 1 unit of FFP for a total of 628 units (3 [3][4][5][6] units per patient) distributed over 155 transfusion episodes (1 [1-1] episodes per patient; Table 2). There were no significant differences with respect to patients' mean age (56 [49-66] years), APACHE II score (20 [15][16][17][18][19][20][21][22][23][24]), and ICU length of stay (7 [5][6][7][8][9][10][11][12][13][14][15] days) among the four study periods. Most FFPT episodes (71.6%) occurred in patients who were admitted to the ICU after surgical procedures such as cardiac surgery (29%), gastrointestinal cancer surgery (24.5%), and liver transplantation (18%).…”

“…Most FFPT episodes (71.6%) occurred in patients who were admitted to the ICU after surgical procedures such as cardiac surgery (29%), gastrointestinal cancer surgery (24.5%), and liver transplantation (18%). After FFPT, there was a mean decrement of PT (from 21 [16][17][18][19][20][21][22][23][24][25][26][27][28] to 17 [15][16][17][18][19][20][21][22] seconds; p < 0.0001) and APTT (from 53 [40-71] to 43 [36-54]; p < 0.0001), without differences across the study periods (Table 2).…”

“…A total of 147 patients were transfused with at least one pool of PLT concentrates for a total of 337 pools ( [14][15][16][17][18][19][20][21][22][23][24]), and ICU length of stay (7 [4-15] days) were similar in the four study periods.…”