Abstract
OBJECTIVES: To determine the degree of interinstitutional transfusion practice variation and reasons why red cells are administered in critically ill patients. STUDY DESIGN: Multicentre cohort study combined with a cross-sectional survey of physicians requesting red cell transfusions for patients in the cohort. STUDY POPULATION: The cohort included 5298 consecutive patients admitted to six tertiary level intensive care units in addition to administering a survey to 223 physicians requesting red cell transfusions in these units. MEASUREMENTS: Haemoglobin concentrations were collected, along with the number and reasons for red cell transfusions plus demographic, diagnostic, disease severity (APACHE II score), intensive care unit (ICU) mortality and lengths of stay in the ICU. RESULTS: Twenty five per cent of the critically ill patients in the cohort study received red cell transfusions. The overall number of transfusions per patient-day in the ICU averaged 0.95 +/- 1.39 and ranged from 0.82 +/- 1.69 to 1.08 +/- 1.27 between institutions (P < 0.001). Independent predictors of transfusion thresholds (pre-transfusion haemoglobin concentrations) included patient age, admission APACHE II score and the institution (P < 0.0001). A very significant institution effect (P < 0.0001) persisted even after multivariate adjustments for age, APACHE II score and within four diagnostic categories (cardiovascular disease, respiratory failure, major surgery and trauma) (P < 0.0001). The evaluation of transfusion practice using the bedside survey documented that 35% (202 of 576) of pre-transfusion haemoglobin concentrations were in the range of 95-105 g/l and 80% of the orders were for two packed cell units. The most frequent reasons for administering red cells were acute bleeding (35%) and the augmentation of O2 delivery (25%). CONCLUSIONS: There is significant institutional variation in critical care transfusion practice, many intensivists adhering to a 100g/l threshold, and opting to administer multiple units despite published guidelines to the contrary. There is a need for prospective studies to define optimal practice in the critically ill.
Highlights
Physicians commonly used a threshold of 100 g/l as the level for transfusion of allogeneic red cells
Presented in part at the Annual International Scientific Assembly of the American College of Chest Physicians held in New Orleans LA, from October 30th to November 3rd, 1994 and the 63rd Annual Meeting of the Royal College of Physicians and Surgeons of Canada held in Toronto, Canada from September 14th to 19th 1994
We enrolled 5298 consecutive patients from six tertiary level intensive care units (ICUs) in the cohort study; 3079 patients were identified by a retrospective review of health records and 2219 patients were prospectively enrolled at the time of ICU admission
Summary
Physicians commonly used a threshold of 100 g/l (haematocrit of 30%) as the level for transfusion of allogeneic red cells. Adams and Lundy [1], in 1941, recommended the administration of red cells for haemoglobin concentrations ranging from 80 to 100 g/l in the perioperative period. 58 Critical Care 1999, Vol 3 No 2 transfusion-related infections, recent guidelines emphasize that the decision to transfuse should not be determined by a single haemoglobin concentration [4,5,6]. Surveys of transfusion practices have repeatedly documented the importance attributed to haemoglobin triggers. In 1982, 88% of anaesthesiologists surveyed believed preoperative haemoglobin levels of 90 g/l to be mandatory [7]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
