TY - JOUR
T1 - Transfusion practice in the non-bleeding critically ill: an international online survey-the TRACE survey
AU - de Bruin, Sanne
AU - Scheeren, Thomas W. L.
AU - Bakker, Jan
AU - van Bruggen, Robin
AU - Vlaar, Alexander P. J.
AU - Cardiovascular Dynamics Section and Transfusion Guideline Task Force of the ESICM
AU - Antonelli, Massimo
AU - Aubron, Cecile
AU - Cecconi, Maurizio
AU - Dionne, Joanna C.
AU - Duranteau, Jacques
AU - Juffermans, Nicole P.
AU - de Korte, Dirk
AU - Meier, Jens
AU - Murphy, Gavin
AU - Oczkowski, Simon
AU - Perner, Anders
AU - Walsh, Timothy
PY - 2019
Y1 - 2019
N2 - BACKGROUND: Over the last decade, multiple large randomized controlled trials have studied alternative transfusion strategies in critically ill patients, demonstrating the safety of restrictive transfusion strategies. Due to the lack of international guidelines specific for the intensive care unit (ICU), we hypothesized that a large heterogeneity in transfusion practice in this patient population exists. The aims of this study were to describe the current transfusion practices and identify the knowledge gaps. METHODS: An online, anonymous, worldwide survey among ICU physicians was performed evaluating red blood cell, platelet and plasma transfusion practices. Furthermore, the presence of a hospital- or ICU-specific transfusion guideline was asked. Only completed surveys were analysed. RESULTS: Nine hundred forty-seven respondents filled in the survey of which 725 could be analysed. Hospital transfusion protocol available in their ICU was reported by 53% of the respondents. Only 29% of respondents used an ICU-specific transfusion guideline. The reported haemoglobin (Hb) threshold for the general ICU population was 7 g/dL (7-7). The highest reported variation in transfusion threshold was in patients on extracorporeal membrane oxygenation or with brain injury (8 g/dL (7.0-9.0)). Platelets were transfused at a median count of 20 × 109 cells/L IQR (10-25) in asymptomatic patients, but at a higher count prior to invasive procedures (p < 0.001). In patients with an international normalized ratio (INR) > 3, 43% and 57% of the respondents would consider plasma transfusion without any upcoming procedures or prior to a planned invasive procedure, respectively. Finally, doctors with base specialty in anaesthesiology transfused critically ill patients more liberally compared to internal medicine physicians. CONCLUSION: Red blood cell transfusion practice for the general ICU population is restrictive, while for different subpopulations, higher Hb thresholds are applied. Furthermore, practice in plasma and platelet transfusion is heterogeneous, and local transfusion guidelines are lacking in the majority of the ICUs.
AB - BACKGROUND: Over the last decade, multiple large randomized controlled trials have studied alternative transfusion strategies in critically ill patients, demonstrating the safety of restrictive transfusion strategies. Due to the lack of international guidelines specific for the intensive care unit (ICU), we hypothesized that a large heterogeneity in transfusion practice in this patient population exists. The aims of this study were to describe the current transfusion practices and identify the knowledge gaps. METHODS: An online, anonymous, worldwide survey among ICU physicians was performed evaluating red blood cell, platelet and plasma transfusion practices. Furthermore, the presence of a hospital- or ICU-specific transfusion guideline was asked. Only completed surveys were analysed. RESULTS: Nine hundred forty-seven respondents filled in the survey of which 725 could be analysed. Hospital transfusion protocol available in their ICU was reported by 53% of the respondents. Only 29% of respondents used an ICU-specific transfusion guideline. The reported haemoglobin (Hb) threshold for the general ICU population was 7 g/dL (7-7). The highest reported variation in transfusion threshold was in patients on extracorporeal membrane oxygenation or with brain injury (8 g/dL (7.0-9.0)). Platelets were transfused at a median count of 20 × 109 cells/L IQR (10-25) in asymptomatic patients, but at a higher count prior to invasive procedures (p < 0.001). In patients with an international normalized ratio (INR) > 3, 43% and 57% of the respondents would consider plasma transfusion without any upcoming procedures or prior to a planned invasive procedure, respectively. Finally, doctors with base specialty in anaesthesiology transfused critically ill patients more liberally compared to internal medicine physicians. CONCLUSION: Red blood cell transfusion practice for the general ICU population is restrictive, while for different subpopulations, higher Hb thresholds are applied. Furthermore, practice in plasma and platelet transfusion is heterogeneous, and local transfusion guidelines are lacking in the majority of the ICUs.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85072120683&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/31511083
U2 - https://doi.org/10.1186/s13054-019-2591-6
DO - https://doi.org/10.1186/s13054-019-2591-6
M3 - Article
C2 - 31511083
SN - 1364-8535
VL - 23
SP - 309
JO - Critical care (London, England)
JF - Critical care (London, England)
IS - 1
ER -