Transfusion Requirement in Burn Care Evaluation (TRIBE)

Palmieri, Tina L; Holmes, James H.; Arnoldo, Brett D.; Peck, Michael D.; Potenza, Bruce; Cochran, Amalia; King, Booker T.; Dominic, William; Cartotto, Robert; Bhavsar, Dhaval; Kemalyan, Nathan; Tredget, Edward E.; Stapelberg, Francois; Mozingo, D.W.; Friedman, Bruce; Greenhalgh, David G.; Taylor, Sandra L.; Pollock, Bradley H

doi:10.1097/sla.0000000000002408

Cited by 84 publications

(57 citation statements)

References 26 publications

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“…In fact, the very recent 2018 Frankfurt Consensus Conference on patient blood management strongly recommended the use of the restrictive RBC transfusion threshold in critically ill but clinically stable intensive care patients and in patients undergoing cardiac surgery; however, use of the restrictive RBC transfusion threshold was not clearly recommended in patients with hip fracture and cardiovascular diseases or other risk factors as well as in hemodynamically stable patients with acute gastrointestinal bleeding (conditional recommendation) [17]. Apparently, recent clinical trials investigating the hemoglobin threshold for transfusion have been more focused on narrow and specific populations [18–22].…”

Section: Discussionmentioning

confidence: 99%

Liberal versus restrictive red blood cell transfusion strategy in sepsis or septic shock: a systematic review and meta-analysis of randomized trials

Hirano¹,

Miyoshi²,

Kondo³

et al. 2019

Crit Care

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Background We assessed the effect of liberal versus restrictive red blood cell transfusion strategy on survival outcome in sepsis or septic shock by systematically reviewing the literature and synthesizing evidence from randomized controlled trials (RCTs). Methods We searched the MEDLINE, Cochrane Central Register of Controlled Trials, and Web of Science databases. We included RCTs that compared mortality between a liberal transfusion strategy with a hemoglobin threshold of 9 or 10 g/dL and a restrictive transfusion strategy with a hemoglobin threshold of 7 g/dL in adults with sepsis or septic shock. Two investigators independently screened citations and conducted data extraction. The primary outcome was 28- or 30-day mortality. Secondary outcomes were 60- and 90-day mortality, use of life support at 28 days of admission, and number of patients transfused during their intensive care unit stay. DerSimonian-Laird random-effects models were used to report pooled odds ratios (ORs). Results A total of 1516 patients from three RCTs were included; 749 were randomly assigned to the liberal transfusion group and 767 to the restrictive strategy group. Within 28–30 days, 273 patients (36.4%) died in the liberal transfusion group, while 278 (36.2%) died in the restrictive transfusion group (pooled OR, 0.99; 95% confidence interval [CI], 0.67–1.46). For the primary outcome, heterogeneity was observed among the studies ( I 2 = 61.0%, χ 2 = 5.13, p = 0.08). For secondary outcomes, only two RCTs were included. There were no significant differences in secondary outcomes between the two groups. Conclusions We could not show any difference in 28- or 30-day mortality between the liberal and restrictive transfusion strategies in sepsis or septic shock patients by meta-analysis of RCTs. Our results should be interpreted with caution due to the existence of heterogeneity. As sepsis complicates a potentially wide range of underlying diseases, further trials in carefully selected populations are anticipated. Trial registration This present study was registered in the PROSPERO database ( CRD42018108578 ). Electronic supplementary material The online version of this article (10.1186/s13054-019-2543-1) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Liberal versus restrictive red blood cell transfusion strategy in sepsis or septic shock: a systematic review and meta-analysis of randomized trials

Hirano¹,

Miyoshi²,

Kondo³

et al. 2019

Crit Care

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“…In this secondary analysis of 303 adult burn patients receiving at least one RBC transfusion in the TRIBE study (30), we found that neither the mean storage age of transfused blood nor the proportion of transfused very old blood (≥ 35 days old) affected multiple organ dysfunction, time to wound healing, or in-hospital mortality. A weak positive statistical association, of unknown clinical significance, was observed between the duration of mechanical ventilation, the mean storage age of transfused blood, and the proportion of very old transfused RBC units.…”

Section: Discussionmentioning

confidence: 92%

“…This was a secondary analysis of TRIBE (30), an institutional review board-approved phase III multicenter open-label registered clinical trial, (Clintrials.gov NCT01079247), in which adults with major burns were randomized to receive RBC transfusions to maintain a hemoglobin level approximately 10–11 g/dL (liberal group) or a hemoglobin level approximately 7–8 g/dL (restrictive group).…”

Section: Methodsmentioning

confidence: 99%

“…We utilized outcome measures employed in the original TRIBE study (30). The primary outcome was the severity of multiple organ dysfunction (MOD) measured by the highest (worst) daily MOD score (31), following initiation of blood transfusion(s).…”

Section: Methodsmentioning

confidence: 99%

“…The recently completed Transfusion Requirement in Burn Care Evaluation (TRIBE) study was a multicenter prospective RCT that compared outcomes between patients transfused with a restrictive or liberal transfusion target (30). The storage age of over 7000 RBC units administered during this study was also collected.…”

Section: Introductionmentioning

confidence: 99%

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The Effects of Storage Age of Blood in Massively Transfused Burn Patients: A Secondary Analysis of the Randomized Transfusion Requirement in Burn Care Evaluation Study

Cartotto

Taylor

Holmes

et al. 2018

Critical Care Medicine

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Objective: Major trials examining storage age of blood transfused to critically-ill patients administered relatively few blood transfusions. We sought to determine if the storage age of blood affects outcomes when very large amounts of blood are transfused. Design: A secondary analysis of the multicenter randomized Transfusion Requirement in Burn Care Evaluation (TRIBE) study which compared restrictive and liberal transfusion strategies. Setting: Eighteen tertiary-care burn centers. Patients: TRIBE evaluated 345 adults with burns ≥ 20% of the body surface area. We included only the 303 patients that received blood transfusions. Interventions: The storage ages of all transfused red-cell units were collected during TRIBE. A priori measures of storage age were the the mean storage age of all transfused blood and the proportion of all transfused blood considered very old (stored ≥ 35 days). Measurements and Main Results: The primary outcome was the severity of multiple organ dysfunction (MOD). Secondary outcomes included time to wound healing, the duration of mechanical ventilation, and in-hospital mortality.There were 6786 red-cell transfusions with a mean (±SD) storage age of 25.6 ± 10.2 days. Participants received a mean of 23.4 ± 31.2 blood transfusions (range 1–219), and a mean of 5.3 ± 10.7 units of very old blood. Neither mean storage age nor proportion of very old blood had any influence on MOD severity, time to wound healing, or mortality. Duration of ventilation was significantly predicted by both mean blood storage age and the proportion of very old blood but this was of questionable clinical relevance given extreme variability in duration of ventilation (adjusted r2 ≤0.01). Conclusion: Despite massive blood transfusion, including very old blood, the duration of red-cell storage did not influence outcome in burn patients. Provision of the oldest blood first by Blood Banks is rational, even for massive transfusion. Trial Registration: Clintrials.gov NCT01079247.

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Patient Blood Management

Mueller

Remoortel

Meybohm

et al. 2019

JAMA

426

146

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IMPORTANCE Blood transfusion is one of the most frequently used therapies worldwide and is associated with benefits, risks, and costs. OBJECTIVE To develop a set of evidence-based recommendations for patient blood management (PBM) and for research. EVIDENCE REVIEWThe scientific committee developed 17 Population/Intervention/ Comparison/Outcome (PICO) questions for red blood cell (RBC) transfusion in adult patients in 3 areas: preoperative anemia (3 questions), RBC transfusion thresholds (11 questions), and implementation of PBM programs (3 questions). These questions guided the literature search in 4 biomedical databases (MEDLINE, EMBASE, Cochrane Library, Transfusion Evidence Library), searched from inception to January 2018. Meta-analyses were conducted with the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology and the Evidence-to-Decision framework by 3 panels including clinical and scientific experts, nurses, patient representatives, and methodologists, to develop clinical recommendations during a consensus conference in Frankfurt/Main, Germany, in April 2018.FINDINGS From 17 607 literature citations associated with the 17 PICO questions, 145 studies, including 63 randomized clinical trials with 23 143 patients and 82 observational studies with more than 4 million patients, were analyzed. For preoperative anemia, 4 clinical and 3 research recommendations were developed, including the strong recommendation to detect and manage anemia sufficiently early before major elective surgery. For RBC transfusion thresholds, 4 clinical and 6 research recommendations were developed, including 2 strong clinical recommendations for critically ill but clinically stable intensive care patients with or without septic shock (recommended threshold for RBC transfusion, hemoglobin concentration <7 g/dL) as well as for patients undergoing cardiac surgery (recommended threshold for RBC transfusion, hemoglobin concentration <7.5 g/dL). For implementation of PBM programs, 2 clinical and 3 research recommendations were developed, including recommendations to implement comprehensive PBM programs and to use electronic decision support systems (both conditional recommendations) to improve appropriate RBC utilization. CONCLUSIONS AND RELEVANCEThe 2018 PBM International Consensus Conference defined the current status of the PBM evidence base for practice and research purposes and established 10 clinical recommendations and 12 research recommendations for preoperative anemia, RBC transfusion thresholds for adults, and implementation of PBM programs. The relative paucity of strong evidence to answer many of the PICO questions supports the need for additional research and an international consensus for accepted definitions and hemoglobin thresholds, as well as clinically meaningful end points for multicenter trials.

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Transfusion Requirement in Burn Care Evaluation (TRIBE)

Cited by 84 publications

References 26 publications

Liberal versus restrictive red blood cell transfusion strategy in sepsis or septic shock: a systematic review and meta-analysis of randomized trials

Liberal versus restrictive red blood cell transfusion strategy in sepsis or septic shock: a systematic review and meta-analysis of randomized trials

The Effects of Storage Age of Blood in Massively Transfused Burn Patients: A Secondary Analysis of the Randomized Transfusion Requirement in Burn Care Evaluation Study

Patient Blood Management

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