Red blood cell transfusion strategies in critically ill patients: lessons from recent randomized clinical studies.

Red blood cell transfusion strategies in critically ill patients: lessons from recent randomized clinical studies. Minerva Anestesiol. 2016 Jan 12; Authors: Lelubre C, Vincent JL, Taccone FS Abstract Recently, Holst et al. (N Engl J Med 2014; 371:1381-1391) reported the results from a randomized, multicenter trial conducted in 32 northern European general intensive care units (ICUs), in which patients with septic shock were randomly assigned to receive a red blood cell transfusion when the hemoglobin (Hb) level was ≤ 7 g/dl ("lower threshold"; n=502) or ≤ 9 g/dl ("higher threshold"; n=496) throughout the ICU stay. Patients were excluded if they had an acute coronary syndrome, life-threatening bleeding, acute burn injury, had already been transfused or had previously experienced transfusion-related reactions. The two groups of patients had comparable severity of disease scores and chronic cardiovascular conditions. Median Hb values were 7.7 g/dL in the lower and 9.3 g/dL in the higher threshold groups and these values remained stable during the study period. There was no significant difference in 90-day mortality (primary end-point) between the two groups (216/502, 43.0% in the lower vs. 223/496, 45.0% in the higher group, RR 0.94 [95%CI: 0.78-1.09; p=0.44]), even after adjustment for several confounders. In the higher threshold group, approximately twice as many transfusions were given (3088 vs. 1545 units transfused, p<0.001)...
Source: Minerva Anestesiologica - Category: Anesthesiology Tags: Minerva Anestesiol Source Type: research