Red Blood Cell Transfusion in the Intensive Care Unit
Author:
Raasveld Senta Jorinde1, de Bruin Sanne1, Reuland Merijn C.1, van den Oord Claudia1, Schenk Jimmy12, Aubron Cécile3, Bakker Jan456, Cecconi Maurizio7, Feldheiser Aarne8, Meier Jens9, Müller Marcella C. A.1, Scheeren Thomas W. L.10, McQuilten Zoe11, Flint Andrew1112, Hamid Tarikul13, Piagnerelli Michaël14, Tomić Mahečić Tina15, Benes Jan16, Russell Lene171819, Aguirre-Bermeo Hernan20, Triantafyllopoulou Konstantina21, Chantziara Vasiliki22, Gurjar Mohan23, Myatra Sheila Nainan24, Pota Vincenzo25, Elhadi Muhammed26, Gawda Ryszard27, Mourisco Mafalda28, Lance Marcus29, Neskovic Vojislava30, Podbregar Matej31, Llau Juan V.32, Quintana-Diaz Manual33, Cronhjort Maria34, Pfortmueller Carmen A.35, Yapici Nihan36, Nielsen Nathan D.37, Shah Akshay38, de Grooth Harm-Jan1, Vlaar Alexander P. J.1, Higgins Alisa39, Serpa Neto Ary39, Brady Karina39, Wood Erica39, Poole Alexis39, Trapani Tony39, Young Meredith39, Cooper Jamie39, Secombe Paul39, Reece Graham39, Marella Prashanti39, Brewster David39, Rashid Alan39, Suwandarathne Ruwan39, Azad Raman39, Barrett Jonathan39, Turner Elisha39, Poulter Amber-Louise39, Chen Lixian39, Biradar Vishwanath39, Whitehead Christina39, Peake Sandra39, Tabah Alexis39, O'Connor Stephanie39, Reade Michael39, Janssen Guido39, McAllister Richard39, Triplett Katherine39, Bowen David39, Buscher Hergen39, Santamaria John39, Parmar Dinesh39, Power Paul39, French Craig39, Mac Partlin Matthew39, Islam Md Motiul39, Haque Injamam Ull39, Roman Alain39, Haentjens Lionel39, Ikic Višnja39, Kvolik Slavica39, Bojčić Robert39, Juričić Kazimir39, Duksa Martin39, Bílek Lukáš39, Satinsky Igor39, Zatloukal Jan39, Russell Lene39, Bestle Morten H.39, Meyhoff Christian S.39, Diaz-Medina Ana Maria39, Llumiquinga Verónica39, Aguirre-Bermeo Hernán39, Gonzabay-Campos Heinert Enmanuel39, Elbahnasawy Mohamed39, Chapalain Xavier39, Le Moal Charlène39, Egreteau Pierre-Yves39, Launey Yoann39, Reizine Florian39, Boissier Florence39, Jean Reignier39, Ehrmann Stephan39, Lebas Eddy39, Corno Gaelle39, Cailliez Pauline39, Garçon Pierre39, Carteaux Guillaume39, Kimmoun Antoine39, Theodoulou Danai39, ALOIZOS STAVROS39, Papadakis Eleftherios39, TSAKALIS KONSTANTINOS39, Marinakis Giorgos39, Georgakas Ioannis39, Tripolitsioti Paraskevi39, Nikolakopoulou Sofia39, Papathanakos Georgios39, Sklavou Chrysanthi39, Tsika Evangelia39, Mousafiri Ourania39, Prekates Athanasios39, Micha Georgia39, Lavrentieva Athina39, Aslanidis Theodoros39, Palaiologou Athina39, Bostantzoglou Clementine39, Dikoudi Evangelia39, Karaouli Silia39, Pouriki Sophia39, Vijayakumaran Swapna39, Rathod Darshana39, KOLA VENKAT RAMAN39, Jeswani Deepak39, Gopalakrishna Kadarapura Nanjundaiah39, Hartalkar Amol39, Mahmoodpoor Ata39, Abdulkhaleq Marwah39, Ippolito Mariachiara39, Cotoia Antonella39, Covotta Marco39, Filippo Sanfilippo39, Ishteiwy Ehab39, Benzarti Hebtallah39, Bouhuwaish Ahmed Elmabri Mohammed39, Abdalhadi Alya39, Buimsaedah Ahmad39, Abdulwahed Eman Ali39, Tamoos Khalil39, Younes Eman39, Alkamkhe Asma Abubakr Saleh39, Biala Marwa39, Hwili Hajer Abdalla Mohammed39, Ben Hasan Najat Shaban39, Almiqlash Bushray Alhadi39, Altair Mawadda39, Otman Rema39, Al Gharyani Mohamed Fathi39, Alkeelani Omlez Mohammed39, Bakeer Hibah39, Omar Affat Azah Mukhtar39, Aween Husayn39, Benamwor Aihab39, Alsori Mohamed39, Abdelrahim Najwa39, Abdelilah GHANNAM39, Parke Rachael39, Chen Yan39, Mehrtens Jan39, Twardowski Pawel39, Freebairn Ross39, Song Rima39, Gibson Charles39, Chen Jonathan39, Moore Richard39, Sol Cruz Mary Rose39, Wludarczyk Anna39, Krzych Łukasz39, Szczukocka Marta39, Kubiak Marcin39, Molsa Maciej39, Wujtewicz Magdalena39, Wieczorek Agnieszka39, Misiewska-Kaczur Agnieszka39, Maslicki Marek39, Onichimowski Dariusz39, Mazur Jakub39, Zatorski Pawel39, Mota Ana Marta39, Fernandes Joana39, Castro Diana39, Coelho Elisabete39, Paula Alexandra39, Guimarães Teresa39, Adrião Diana39, Mark Igor39, Mušič Elizabeta39, Mirković Tomislav39, Markota Andrej39, Krope Natalija39, Kmet Marko39, Forjan Petra39, Savli Tomaž39, Aguilar Gerardo39, González-Celdrán Rebeca39, Martínez-González Estefanía39, Díaz Agustín39, Colomina María José39, Hidalgo Francisco39, Ferrando Carlos39, Ferrandis Raquel39, Ferrer Carolina39, Cegarra Virginia39, Gómez-Luque Aurelio39, Henman Stina39, Blomstrand Disa39, Risberg Emelie39, Johansen Natalie39, Rajala Henrik39, Layous Natalie39, Vlot Eline A.39, Erkamp Michiel39, Juffermans Nicole39, van Wonderen Stefan39, Kuznecova-Keppel Hesselink Lidija39, van Bochove Victor39, Acarel Murat39, Senturk Evren39, Karahan Mahmut Alp39, Camkiran Firat Aynur39, Yildiz Yahya39, Ekinci Osman39, Ozgultekin Asu39, Arikan Huseyin39, Kucukosman Gamze39, Aydin Bengu Gulhan39, Yavuz Mehmet39, Oztas Alev39, Kavrut Ozturk Nilgun39, Kasapoglu Umut Sabri39, Miniksar Hakan39, Tuncay Eylem39, Indelen Cenk39, Ogus Halide39, Erdivanli Basar39, Sahin Ayca Sultan39, Yilmaz Mehmet39, Sayan Erken39, Yilmaz Canan39, Goksu Senay39, Basaran Betul39, Kutahya Emine39, Gok Ayfer Kaya39, Ozcan Ayse39, Kara Iskender39, Kartal Seyfi39, Saracoglu Kemal Tolga39, Bilir Yeliz39, Eyupoglu Selin39, Ertugrul Oruc Nigar39, Issever Kubilay39, Patel Jamie39, Clarke Jayson39, Ma Louise39, Lawton Tom39, Sloan Brendan39, Kannan Santhana39, Innes Richard39, Carpenter Mark39, Newey Luke39, Alwagih Hazem39, Acott Chris39, Hormis Anil39, Herdman James39, Akrama Osama39, Baumber Rachel39, Khomenko Olena39, Khan Akram39, Hasan Zubair39, Raval Jay S.39, Sutherland Lauren39,
Affiliation:
1. Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, the Netherlands 2. Department of Epidemiology and Data Science, Amsterdam University Medical Centre, Amsterdam Public Health, University of Amsterdam, Amsterdam, the Netherlands 3. Médecine Intensive Réanimation, CHU de Brest, Université de Bretagne Occidentale, Brest, France 4. Department of Pulmonary and Critical Care, New York University and Columbia University New York 5. Department of Intensive Care Adults, Erasmus MC University Medical Centers, Rotterdam, the Netherlands 6. Department of Intensive Care, Pontificia Universidad Católica de Chile, Santiago, Chile 7. Department of Anesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, Milan, Italy 8. Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, EvangKliniken Essen-Mitte, Huyssens-Stiftung/Knappschaft, Essen, Germany 9. Department of Anesthesiology and Intensive Care, Kepler University Clinic, Kepler University, Linz, Austria 10. Department of Anesthesiology, University Medical Center Groningen, Groningen, the Netherlands 11. School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia 12. The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia 13. Department of Critical Care, Asgar Ali Hospital, Dhaka, Bangladesh 14. Department of Intensive Care, CHU Charleroi Marie Curie, Université Libre de Brussels, Charleroi, Belgium 15. Department of Anesthesiology and Intensive Care, University Clinical Hospital Center Zagreb, Croatia 16. Department of Anesthesiology and Intensive Care Medicine, University Hospital and Faculty of Medicine in Plzen–Charles University, Plzen, Czech Republic 17. Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet Copenhagen, Copenhagen, Denmark 18. Department of Anesthesia and Intensive Care Medicine, Copenhagen University Hospital–Gentofte, Hellerup, Denmark 19. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark 20. Unidad de Cuidados Intensivos, Hospital Vicente Corral Moscoso, Cuenca, Ecuador 21. Department of Cardiothoracic Surgery, European Interbalkan Medical Center, Thessaloniki, Greece 22. Intensive Care Unit, First Department of Respiratory Medicine, National and Kapodistrian University of Athens, Sotiria Chest Hospital, Athens, Greece 23. Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India 24. Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India 25. Department of Child, General and Specialistic Surgery, University of Campania, Luigi Vanvitelli, Naples, Italy 26. Faculty of Medicine, University of Tripoli, Tripoli, Libya 27. Department of Anesthesiology and Intensive Care, Institute of Medical Sciences, University of Opole, Opole, Poland 28. Department of Intensive Care, Centro Hospitalar de Entro o Douro e Vouga, Santa Maria da Feira, Portugal 29. Department of Anesthesiology, Aga Khan University Hospital, Nairobi, Kenya 30. Department of Anesthesia and Intensive Care, Military Medical Academy Belgrade, Belgrade, Serbia 31. Department for Internal Intensive Care, General Hospital Celje, Medical Faculty, University of Ljubljana, Slovenia 32. Department of Anesthesiology and Post-surgical Critical Care, University Hospital Doctor Peset, Valencia, Spain 33. Intensive Care Service, Hospital Universitario La Paz, Madrid, Spain 34. Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden 35. Department of Intensive Care, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland 36. Department of Anesthesiology and Reanimation, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Center, University of Health Sciences, Istanbul, Turkey 37. Division of Pulmonary, Critical Care and Sleep Medicine, and Section of Transfusion Medicine and Therapeutic Pathology, University of New Mexico School of Medicine, Albuquerque 38. Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom 39. for the InPUT Study Group
Abstract
ImportanceRed 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.ObjectiveTo evaluate and describe ICU RBC transfusion practices worldwide.Design, Setting, and ParticipantsInternational, 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.ExposureICU stay.Main Outcomes and MeasuresThe 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.ResultsAmong 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 RelevanceRBC transfusion was common in patients admitted to ICUs worldwide between 2019 and 2022, with high variability across centers in transfusion practices.
Publisher
American Medical Association (AMA)
Cited by
15 articles.
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