Transfusion Requirements in Critical Care

Hébert, Paul C.; Wells, George A.; Marshall, John C.; Martin, Claudio M.; Tweeddale, Martin; Pagliarello, Giuseppe; Blajchman, Morris A.

doi:10.1001/jama.1995.03520420055038

Cited by 135 publications

(28 citation statements)

References 32 publications

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“…The mortality rate in our study was slightly higher than that reported in the TRICC study but similar to other previous reports [11,21]. Mortality rates differed significantly by organ failure, consistent with previous reports [1].…”

Section: Discussionsupporting

confidence: 92%

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

Al-Faris¹,

Al-Fares

Malek

et al. 2012

Med Princ Pract

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Objectives: To assess the transfusion practice in the intensive care unit (ICU) in a general hospital in Kuwait relative to indications, pretransfusion hemoglobin, red blood cell (RBC) use and outcome. Subjects and Methods: 475 patients were admitted to the ICU during the study period (January 2009 to February 2010). Ninety-nine received RBC transfusion. Demographic, clinical and transfusion data were prospectively collected for the 99 patients who were followed up for 30 days, until hospital discharge, or death, whichever occurred first. Indications for RBC transfusion included hemorrhage in 39 patients, improving oxygen-carrying capacity in 55, and hemolysis in 5. Results: Of the 99 transfused patients, 22 (22.22%) were also transfused after discharge from the ICU. Transfusions were more frequent in patients admitted with respiratory failure (30, 30.3%), hemorrhagic shock (24, 24.2%), and septic shock (18, 18.4%). The mean pretransfusion hemoglobin in ICU transfusions was statistically different (70.9 ± 12.7 g/l) from transfusions after discharge (79.7 ± 9.4 g/l) (p < 0.001). Longer ICU stay was associated with more RBC units transfused per transfusion episode per patient (p < 0.001). The Sequential Organ Failure Assessment (SOFA) score was significantly associated with the number of RBC units transfused per patient (p = 0.006). Mortality was significantly associated with Acute Physiology and Chronic Health Evaluation II and SOFA scores, the need and duration for mechanical ventilation, and the length of stay in hospital. Conclusion: Intensivists in our center followed a restrictive transfusion practice, by adopting a low pretransfusion hemoglobin threshold. Decisions on RBC transfusions seemed in most cases to be based on a ‘transfusion trigger’ rather than a physiologic need.

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Section: Discussionsupporting

confidence: 92%

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

Al-Faris¹,

Al-Fares

Malek

et al. 2012

Med Princ Pract

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“…3 We know of only 5 randomized clinical trials, including a total of 207 patients, that have contrasted transfusion triggers. [4][5][6][7][8] No differences in mortality or morbidity were found between high and low transfusion thresholds. However, even collectively, these trials followed too few patients to evaluate the effect of lower transfusion triggers on clinically important outcomes.…”

mentioning

confidence: 99%

Perioperative Blood Transfusion and Postoperative Mortality

Carson¹,

Duff

Berlin

et al. 1998

JAMA

401

121

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“…Leukocytes from donated blood may play a key role in immune system suppression; however, the exact mechanism is unclear [ 47 ]. Studies had reported a decrease in mortality rate among patients receiving prestorage leukoreduced blood compared to patients receiving nonfiltered blood [ 22 , 23 ]; however, a meta-analysis of 12 RCTs comparing leukodepleted and nonleukodepleted RBCs failed to identify an association between leukoreduction and mortality (OR 1.14, 95%CI, 0.89 to 1.45) [ 48 ]. Of the eighteen studies included in our review, only seven of them had information on percentage of patients receiving nonfiltered blood.…”

Section: Discussionmentioning

confidence: 99%

“…and Hebert et al . had reported decreased mortality among patients receiving prestorage leukoreduced blood compared to patients receiving nonfiltered blood [ 22 , 23 ], indicating that leukocytes from donated blood may be crucial in the development of immune system suppression. Another transfusion practice is using ‘fresh’ transfused RBCs instead of ‘old’ blood; some studies suggested that the use of old stored RBCs is a potential risk factor for mortality [ 24 , 25 ].…”

Section: Introductionmentioning

confidence: 99%

Association of red blood cell transfusion and in-hospital mortality in patients admitted to the intensive care unit: a systematic review and meta-analysis

Zheng

Wei

et al. 2014

Crit Care

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IntroductionPrevious research has debated whether red blood cell (RBC) transfusion is associated with decreased or increased mortality in patients admitted to the intensive care unit (ICU). We conducted a systematic review and meta-analysis to assess the relationship of RBC transfusion with in-hospital mortality in ICU patients.MethodsWe carried out a literature search on Medline (1950 through May 2013), Web of Science (1986 through May 2013) and Embase (1980 through May 2013). We included all prospective and retrospective studies on the association between RBC transfusion and in-hospital mortality in ICU patients. The relative risk for the overall pooled effects was estimated by random effects model. Sensitivity analyses were conducted to assess potential bias.ResultsThe meta-analysis included 28,797 participants from 18 studies. The pooled relative risk for transfused versus nontransfused ICU patients was 1.431 (95% CI, 1.105 to 1.854). In sensitivity analyses, the pooled relative risk was 1.211 (95% CI, 0.975 to 1.505) if excluding studies without adjustment for confounders, 1.178 (95% CI, 0.937 to 1.481) if excluding studies with relative high risk of bias, and 0.901 (95% CI, 0.622 to 1.305) if excluding studies without reporting hazard ratio (HR) or relative risk (RR) as an effect size measure. Subgroup analyses revealed increased risks in studies enrolling patients from all ICU admissions (RR 1.513, 95%CI 1.123 to 2.039), studies without reporting information on leukoreduction (RR 1.851, 95%CI 1.229 to 2.786), studies reporting unadjusted effect estimates (RR 3.933, 95%CI 2.107 to 7.343), and studies using odds ratio as an effect measure (RR 1.465, 95%CI 1.049 to 2.045). Meta-regression analyses showed that RBC transfusion could decrease risk of mortality in older patients (slope coefficient −0.0417, 95%CI −0.0680 to −0.0154).ConclusionsThere is lack of strong evidence to support the notion that ICU patients who receive RBC transfusion have an increased risk of in-hospital death. In studies adjusted for confounders, we found that RBC transfusion does not increase the risk of in-hospital mortality in ICU patients. Type of patient, information on leukoreduction, statistical method, mean age of patient enrolled and publication year of the article may account for the disagreement between previous studies.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-014-0515-z) contains supplementary material, which is available to authorized users.

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Transfusion Requirements in Critical Care

Cited by 135 publications

References 32 publications

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

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

Perioperative Blood Transfusion and Postoperative Mortality

Association of red blood cell transfusion and in-hospital mortality in patients admitted to the intensive care unit: a systematic review and meta-analysis

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