Marcel J Rauer1, Vanessa Neef2, Lorenzo Berra3. 1. Department of Anesthesiology, Intensive Care and Pain Medicine, Muenster University Hospital, University of Muenster, Muenster. 2. Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany. 3. Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Abstract
PURPOSE OF REVIEW: Severe bleeding events, which require blood transfusions, are a challenge faced by many critical care physicians on a daily basis. Current transfusion guidelines generally recommend rather strict transfusion thresholds and strategies, which can appear opposing to a patient in need for urgent transfusion at first sight. Moreover, applied guidelines are lacking evidence and specificity for the typical ICU patient population and its comorbidities. Transfusion decisions, which are pivotal for clinical outcome, are often unsatisfactorily based on hemoglobin levels only. RECENT FINDINGS: Recent publications generally support previous studies that a strict transfusion regimen is superior to a liberal one for the majority of cases. Newly developed and easily feasible techniques are currently in clinical trials and have the potential to become a valuable supplementation to hemoglobin-guided decision-making. In addition to the choice of the ideal transfusion strategy, physiological status and comorbidities were found to have a major impact on the outcome of severe bleedings in the ICU. SUMMARY: The body of evidence for ICU-specific transfusion guidelines is scarce. Critical care physicians should properly evaluate their patient's comorbidities and consider extended point-of-care testing for transfusion decisions in indistinct anemic situations. A strict transfusion strategy should, however, be applied whenever possible.
PURPOSE OF REVIEW: Severe bleeding events, which require blood transfusions, are a challenge faced by many critical care physicians on a daily basis. Current transfusion guidelines generally recommend rather strict transfusion thresholds and strategies, which can appear opposing to a patient in need for urgent transfusion at first sight. Moreover, applied guidelines are lacking evidence and specificity for the typical ICU patient population and its comorbidities. Transfusion decisions, which are pivotal for clinical outcome, are often unsatisfactorily based on hemoglobin levels only. RECENT FINDINGS: Recent publications generally support previous studies that a strict transfusion regimen is superior to a liberal one for the majority of cases. Newly developed and easily feasible techniques are currently in clinical trials and have the potential to become a valuable supplementation to hemoglobin-guided decision-making. In addition to the choice of the ideal transfusion strategy, physiological status and comorbidities were found to have a major impact on the outcome of severe bleedings in the ICU. SUMMARY: The body of evidence for ICU-specific transfusion guidelines is scarce. Critical care physicians should properly evaluate their patient's comorbidities and consider extended point-of-care testing for transfusion decisions in indistinct anemic situations. A strict transfusion strategy should, however, be applied whenever possible.
Authors: Elke Schmitt; Patrick Meybohm; Vanessa Neef; Peter Baumgarten; Alexandra Bayer; Suma Choorapoikayil; Patrick Friederich; Jens Friedrich; Christof Geisen; Erdem Güresir; Matthias Grünewald; Martin Gutjahr; Philipp Helmer; Eva Herrmann; Markus Müller; Diana Narita; Ansgar Raadts; Klaus Schwendner; Erhard Seifried; Patrick Stark; Andrea U Steinbicker; Josef Thoma; Markus Velten; Henry Weigt; Christoph Wiesenack; Maria Wittmann; Kai Zacharowski; Florian Piekarski Journal: Acta Neurochir (Wien) Date: 2022-02-26 Impact factor: 2.216