Red Blood Cell Transfusion in the Intensive Care Unit.
Authors
Senta Jorinde Raasveld, Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
Sanne de Bruin, Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
Merijn C. Reuland, Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
Claudia van den Oord, Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
Jimmy Schenk, Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, the Netherlands. Department of Epidemiology and Data Science, Amsterdam University Medical Centre, Amsterdam Public Health, University of Amsterdam, Amsterdam, the Netherlands.
Cécile Aubron, Médecine Intensive Réanimation, CHU de Brest, Université de Bretagne Occidentale, Brest, France.
Jan Bakker, Department of Pulmonary and Critical Care, New York University and Columbia University New York. Department of Intensive Care Adults, Erasmus MC University Medical Centers, Rotterdam, the Netherlands. Department of Intensive Care, Pontificia Universidad Católica de Chile, Santiago, Chile.
Maurizio Cecconi, Department of Anesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, Milan, Italy.
Aarne Feldheiser, Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, EvangKliniken Essen-Mitte, Huyssens-Stiftung/Knappschaft, Essen, Germany.
Jens Meier, Department of Anesthesiology and Intensive Care, Kepler University Clinic, Kepler University, Linz, Austria.
Marcella CA Müller, Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
Thomas WL Scheeren, Department of Anesthesiology, University Medical Center Groningen, Groningen, the Netherlands.
Zoe McQuilten, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Andrew Flint, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Tarikul Hamid, Department of Critical Care, Asgar Ali Hospital, Dhaka, Bangladesh.
Michaël Piagnerelli, Department of Intensive Care, CHU Charleroi Marie Curie, Université Libre de Brussels, Charleroi, Belgium.
Tina Tomic Mahecic, Department of Anesthesiology and Intensive Care, University Clinical Hospital Center Zagreb, Croatia.
Jan Benes, Department of Anesthesiology and Intensive Care Medicine, University Hospital and Faculty of Medicine in Plzen-Charles University, Plzen, Czech Republic.
Lene Russell, Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet Copenhagen, Copenhagen, Denmark. Department of Anesthesia and Intensive Care Medicine, Copenhagen University Hospital-Gentofte, Hellerup, Denmark. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Hernan Aguirre-Bermeo, Unidad de Cuidados Intensivos, Hospital Vicente Corral Moscoso, Cuenca, Ecuador.
Konstantina Triantafyllopoulou, Department of Cardiothoracic Surgery, European Interbalkan Medical Center, Thessaloniki, Greece.
Vasiliki Chantziara, Intensive Care Unit, First Department of Respiratory Medicine, National and Kapodistrian University of Athens, Sotiria Chest Hospital, Athens, Greece.
Mohan Gurjar, Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Sheila Nainan Myatra, Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
Vincenzo Pota, Department of Child, General and Specialistic Surgery, University of Campania, Luigi Vanvitelli, Naples, Italy.
Muhammed Elhadi, Faculty of Medicine, University of Tripoli, Tripoli, Libya.
Ryszard Gawda, Department of Anesthesiology and Intensive Care, Institute of Medical Sciences, University of Opole, Opole, Poland.
Mafalda Mourisco, Department of Intensive Care, Centro Hospitalar de Entro o Douro e Vouga, Santa Maria da Feira, Portugal.
Marcus Lance, Department of Anesthesiology, Aga Khan University Hospital, Nairobi, Kenya.
Vojislava Neskovic, Department of Anesthesia and Intensive Care, Military Medical Academy Belgrade, Belgrade, Serbia.
Matej Podbregar, Department for Internal Intensive Care, General Hospital Celje, Medical Faculty, University of Ljubljana, Slovenia.
Juan V. Llau, Department of Anesthesiology and Post-surgical Critical Care, University Hospital Doctor Peset, Valencia, Spain.
Manual Quintana-Diaz, Intensive Care Service, Hospital Universitario La Paz, Madrid, Spain.
Maria Cronhjort, Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
Carmen A. Pfortmueller, Department of Intensive Care, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
Nihan Yapici, Department of Anesthesiology and Reanimation, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Center, University of Health Sciences, Istanbul, Turkey.
Nathan D. Nielsen, Division of Pulmonary, Critical Care and Sleep Medicine, and Section of Transfusion Medicine and Therapeutic Pathology, University of New Mexico School of Medicine, Albuquerque.
Akshay Shah, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
Harm-Jan de Grooth, Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
Alexander PJ Vlaar, Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
Publication Date
11-21-2023
Abstract
IMPORTANCE: Red blood cell (RBC) transfusion is common among patients admitted to the intensive care unit (ICU). Despite multiple randomized clinical trials of hemoglobin (Hb) thresholds for transfusion, little is known about how these thresholds are incorporated into current practice.
OBJECTIVE: To evaluate and describe ICU RBC transfusion practices worldwide.
DESIGN, SETTING, AND PARTICIPANTS: International, prospective, cohort study that involved 3643 adult patients from 233 ICUs in 30 countries on 6 continents from March 2019 to October 2022 with data collection in prespecified weeks.
EXPOSURE: ICU stay.
MAIN OUTCOMES AND MEASURES: The primary outcome was the occurrence of RBC transfusion during ICU stay. Additional outcomes included the indication(s) for RBC transfusion (consisting of clinical reasons and physiological triggers), the stated Hb threshold and actual measured Hb values before and after an RBC transfusion, and the number of units transfused.
RESULTS: Among 3908 potentially eligible patients, 3643 were included across 233 ICUs (median of 11 patients per ICU [IQR, 5-20]) in 30 countries on 6 continents. Among the participants, the mean (SD) age was 61 (16) years, 62% were male (2267/3643), and the median Sequential Organ Failure Assessment score was 3.2 (IQR, 1.5-6.0). A total of 894 patients (25%) received 1 or more RBC transfusions during their ICU stay, with a median total of 2 units per patient (IQR, 1-4). The proportion of patients who received a transfusion ranged from 0% to 100% across centers, from 0% to 80% across countries, and from 19% to 45% across continents. Among the patients who received a transfusion, a total of 1727 RBC transfusions were administered, wherein the most common clinical indications were low Hb value (n = 1412 [81.8%]; mean [SD] lowest Hb before transfusion, 7.4 [1.2] g/dL), active bleeding (n = 479; 27.7%), and hemodynamic instability (n = 406 [23.5%]). Among the events with a stated physiological trigger, the most frequently stated triggers were hypotension (n = 728 [42.2%]), tachycardia (n = 474 [27.4%]), and increased lactate levels (n = 308 [17.8%]). The median lowest Hb level on days with an RBC transfusion ranged from 5.2 g/dL to 13.1 g/dL across centers, from 5.3 g/dL to 9.1 g/dL across countries, and from 7.2 g/dL to 8.7 g/dL across continents. Approximately 84% of ICUs administered transfusions to patients at a median Hb level greater than 7 g/dL.
CONCLUSIONS AND RELEVANCE: RBC transfusion was common in patients admitted to ICUs worldwide between 2019 and 2022, with high variability across centers in transfusion practices.
Recommended Citation
Raasveld SJ, de Bruin S, Reuland MC, van den Oord C, Schenk J, Aubron C, Bakker J, Cecconi M, Feldheiser A, Meier J, Müller MCA, Scheeren TWL, McQuilten Z, Flint A, Hamid T, Piagnerelli M, Tomic Mahecic T, Benes J, Russell L, Aguirre-Bermeo H, Triantafyllopoulou K, Chantziara V, Gurjar M, Myatra SN, Pota V, Elhadi M, Gawda R, Mourisco M, Lance M, Neskovic V, Podbregar M, Llau JV, Quintana-Diaz M, Cronhjort M, Pfortmueller CA, Yapici N, Nielsen ND, Shah A, de Grooth HJ, Vlaar APJ; InPUT Study Group. Red Blood Cell Transfusion in the Intensive Care Unit. JAMA. 2023 Nov 21;330(19):1852-1861. doi: 10.1001/jama.2023.20737. PMID: 37824112; PMCID: PMC10570913.
