Transfusion in critical care – a UK regional audit of current practice

SummaryA consistent message within critical care publications has been that a restrictive transfusion strategy is non‐inferior, and possibly superior, to a liberal strategy for stable, non‐bleeding critically ill patients. Translation into clinical practice has, however, been slow. Here, we describe the degree of adherence to UK best practice guidelines in a regional network of nine intensive care units within Wessex. All transfusions given during a 2‐month period were included (n = 444). Those given for active bleeding or within 24 h of major surgery, trauma or gastrointestinal bleeding were excluded (n = 148). The median (IQR [range]) haemoglobin concentration before transfusion was 73 (68–77 [53–106]) g.l−1, with only 34% of transfusion episodes using a transfusion threshold of < 70 g.l−1. In a subgroup analysis that did not study patients with a history of cardiac disease (n = 42), haemoglobin concentration before transfusion was 72 (68–77 [50–98]) g.l−1, with only 36% of transfusion episodes using a threshold of < 70 g.l−1 (see Fig. 3). Most blood transfusions given to critically ill patients who were not bleeding in this audit used a haemoglobin threshold > 70 g.l−1. The reason why recommendations on transfusion triggers have not translated into clinical practice is unclear. With a clear national drive to decrease usage of blood products and clear evidence that a threshold of 70 g.l−1 is non‐inferior, it is surprising that a scarce a...
Source: Anaesthesia - Category: Anesthesiology Authors: Tags: Original Article Source Type: research