OBJECTIVES: To characterize the contemporary red cell transfusion practice in the critically ill and to define clinical factors that influence these practices. DESIGN: Scenario-based national survey. STUDY POPULATION: Canadian critical care practitioners. MEASUREMENTS AND MAIN RESULTS: We evaluated transfusion thresholds before transfusion and the number of red cell units ordered, under the given conditions. Of 254 Canadian critical care physicians, 193 (76%) responded to the survey. The primary specialty of most respondents was internal medicine (56%). Internal medicine respondents were in practice for an average of 8.4 +/- 5.7 (SD) yrs, and worked most often in combined medical/surgical intensive care units. Baseline hemoglobin transfusion thresholds averaged from 8.3 +/- 1.0 g/dL in a scenario involving a young stable trauma victim to 9.5 +/- 1.0 g/dL for an older patient after gastrointestinal bleeding. Transfusion thresholds differed significantly (p< .0001) between all four separate scenarios. With the exception of congestive heart failure (p> .05), all clinical factors (including age, Acute Physiology and Chronic Health Evaluation II score, preoperative status, hypoxemia, shock, lactic acidosis, coronary ischemia, and chronic anemia) significantly (p< .0001) modified the transfusion thresholds. A statistically significant (p< .01) difference in baseline transfusion thresholds was noted across four major regions (with a maximum of five academic centers per region) of the country. Low physician numbers in two of the regions did not allow for further investigation of regional variations. CONCLUSIONS: There is significant variation in critical care transfusion practice, with many intensivists adhering to a 10.0-g/dL threshold, while other physicians described a much more restrictive approach to red cell transfusion. Also, many physicians opted to administer multiple units, despite published guidelines to the contrary. Additionally, the administration of red cells was strongly influenced by a number of clinical factors, many unique to intensive care unit patients. There is a need for prospective studies to define optimal practice in the critically ill.
OBJECTIVES: To characterize the contemporary red cell transfusion practice in the critically ill and to define clinical factors that influence these practices. DESIGN: Scenario-based national survey. STUDY POPULATION: Canadian critical care practitioners. MEASUREMENTS AND MAIN RESULTS: We evaluated transfusion thresholds before transfusion and the number of red cell units ordered, under the given conditions. Of 254 Canadian critical care physicians, 193 (76%) responded to the survey. The primary specialty of most respondents was internal medicine (56%). Internal medicine respondents were in practice for an average of 8.4 +/- 5.7 (SD) yrs, and worked most often in combined medical/surgical intensive care units. Baseline hemoglobin transfusion thresholds averaged from 8.3 +/- 1.0 g/dL in a scenario involving a young stable trauma victim to 9.5 +/- 1.0 g/dL for an older patient after gastrointestinal bleeding. Transfusion thresholds differed significantly (p< .0001) between all four separate scenarios. With the exception of congestive heart failure (p> .05), all clinical factors (including age, Acute Physiology and Chronic Health Evaluation II score, preoperative status, hypoxemia, shock, lactic acidosis, coronary ischemia, and chronic anemia) significantly (p< .0001) modified the transfusion thresholds. A statistically significant (p< .01) difference in baseline transfusion thresholds was noted across four major regions (with a maximum of five academic centers per region) of the country. Low physician numbers in two of the regions did not allow for further investigation of regional variations. CONCLUSIONS: There is significant variation in critical care transfusion practice, with many intensivists adhering to a 10.0-g/dL threshold, while other physicians described a much more restrictive approach to red cell transfusion. Also, many physicians opted to administer multiple units, despite published guidelines to the contrary. Additionally, the administration of red cells was strongly influenced by a number of clinical factors, many unique to intensive care unit patients. There is a need for prospective studies to define optimal practice in the critically ill.
Authors: Martin David Berger; Bernhard Gerber; Kornelius Arn; Oliver Senn; Urs Schanz; Georg Stussi Journal: Haematologica Date: 2011-09-20 Impact factor: 9.941
Authors: Peter C Minneci; Peter Q Eichacker; Robert L Danner; Steven M Banks; Charles Natanson; Katherine J Deans Journal: Intensive Care Med Date: 2008-01-23 Impact factor: 17.440
Authors: Lavanya Yohanathan; Natalie G Coburn; Robin S McLeod; Daniel J Kagedan; Emily Pearsall; Francis S W Zih; Jeannie Callum; Yulia Lin; Stuart McCluskey; Julie Hallet Journal: J Gastrointest Surg Date: 2016-03-29 Impact factor: 3.452
Authors: Tina L Palmieri; James H Holmes; Brett Arnoldo; Michael Peck; Bruce Potenza; Amalia Cochran; Booker T King; William Dominic; Robert Cartotto; Dhaval Bhavsar; Nathan Kemalyan; Edward Tredget; Francois Stapelberg; David Mozingo; Bruce Friedman; David G Greenhalgh; Sandra L Taylor; Brad H Pollock Journal: Ann Surg Date: 2017-10 Impact factor: 12.969
Authors: Meredith Mealer; Jacqueline Jones; Julia Newman; Kim K McFann; Barbara Rothbaum; Marc Moss Journal: Int J Nurs Stud Date: 2011-10-05 Impact factor: 5.837
Authors: Katherine J Deans; Peter C Minneci; Robert L Danner; Peter Q Eichacker; Charles Natanson Journal: Anesth Analg Date: 2010-08 Impact factor: 5.108
Authors: Jill J Francis; Alan Tinmouth; Simon J Stanworth; Jeremy M Grimshaw; Marie Johnston; Chris Hyde; Charlotte Stockton; Jamie C Brehaut; Dean Fergusson; Martin P Eccles Journal: Implement Sci Date: 2009-10-24 Impact factor: 7.327