Skip to main content
Top
Published in: Critical Care 3/2010

01-06-2010 | Commentary

Red cell transfusion triggers in critically ill patients: time for some new TRICCs?

Author: Timothy S Walsh

Published in: Critical Care | Issue 3/2010

Login to get access

Abstract

Current evidence suggests that critically ill patients tolerate anaemia well and that blood transfusions may increase the risk of adverse outcomes. Dr Sakr and colleagues present a contradictory analysis of a surgical ICU cohort, finding an association between blood transfusions and lower hospital mortality after adjustment for a range of potential confounders. Analyses of this kind are interesting and provocative, but are limited by residual confounding and bias by indication. The data emphasise the need for additional high quality trials of transfusion practice in critical care.
Literature
1.
go back to reference Sakr Y, Lobo S, Knuepfer S, Esser E, Bauer M, Settmacher U, Barz D, Reinhart K: Anemia and blood transfusion in a surgical intensive care unit. Crit Care 2010, 14: R92. 10.1186/cc9026PubMedCentralCrossRefPubMed Sakr Y, Lobo S, Knuepfer S, Esser E, Bauer M, Settmacher U, Barz D, Reinhart K: Anemia and blood transfusion in a surgical intensive care unit. Crit Care 2010, 14: R92. 10.1186/cc9026PubMedCentralCrossRefPubMed
2.
go back to reference Marik PE, Corwin HL: Efficacy of red blood cell transfusion in the critically ill: a systematic review of the literature. Crit Care Med 2008, 36: 2667-2674. 10.1097/CCM.0b013e3181844677CrossRefPubMed Marik PE, Corwin HL: Efficacy of red blood cell transfusion in the critically ill: a systematic review of the literature. Crit Care Med 2008, 36: 2667-2674. 10.1097/CCM.0b013e3181844677CrossRefPubMed
3.
go back to reference Hébert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, Tweeddale M, Schweitzer I, Yetisir E: A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. N Engl J Med 1999, 340: 409-417. 10.1056/NEJM199902113400601CrossRefPubMed Hébert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, Tweeddale M, Schweitzer I, Yetisir E: A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. N Engl J Med 1999, 340: 409-417. 10.1056/NEJM199902113400601CrossRefPubMed
4.
go back to reference Carson JL, Reynolds RC, Klein HG: Bad bad blood? Crit Care Med 2008, 36: 2707-2708. 10.1097/CCM.0b013e3181843ee7CrossRefPubMed Carson JL, Reynolds RC, Klein HG: Bad bad blood? Crit Care Med 2008, 36: 2707-2708. 10.1097/CCM.0b013e3181843ee7CrossRefPubMed
5.
go back to reference Vincent JL, Sakr Y, Sprung C, Harboe S, Damas P: Are blood transfusions associated with greater mortality rates? Results of the Sepsis Occurrence in Acutely Ill Patients study. Anesthesiology 2008, 108: 31-39. 10.1097/01.anes.0000296070.75956.40CrossRefPubMed Vincent JL, Sakr Y, Sprung C, Harboe S, Damas P: Are blood transfusions associated with greater mortality rates? Results of the Sepsis Occurrence in Acutely Ill Patients study. Anesthesiology 2008, 108: 31-39. 10.1097/01.anes.0000296070.75956.40CrossRefPubMed
6.
go back to reference Nuttall GA, Houle TT: Liars, damn liars, and propensity scores. Anesthesiology 2008, 108: 3-4. 10.1097/01.anes.0000296718.35703.20CrossRefPubMed Nuttall GA, Houle TT: Liars, damn liars, and propensity scores. Anesthesiology 2008, 108: 3-4. 10.1097/01.anes.0000296718.35703.20CrossRefPubMed
7.
go back to reference Hébert PC, Blajchman MA, Cook DJ, Yetisir E, Wells G, Marshall J, Schweitzer I, Transfusion Requirements in Critical Care Investigators for the Canadian Critical Care Trials Group: Do blood transfusions improve outcomes related to mechanical ventilation? Chest 2001, 119: 1850-1857. 10.1378/chest.119.6.1850CrossRefPubMed Hébert PC, Blajchman MA, Cook DJ, Yetisir E, Wells G, Marshall J, Schweitzer I, Transfusion Requirements in Critical Care Investigators for the Canadian Critical Care Trials Group: Do blood transfusions improve outcomes related to mechanical ventilation? Chest 2001, 119: 1850-1857. 10.1378/chest.119.6.1850CrossRefPubMed
8.
go back to reference McIntyre L, Hebert PC, Wells G, Fergusson D, Marshall J, Yetisir E, Blajchman MJ, Canadian Critical Care Trials Group: Is a restrictive transfusion strategy safe for resuscitated and critically ill trauma patients? J Trauma 2004, 57: 563-568. 10.1097/01.TA.0000136158.93864.54CrossRefPubMed McIntyre L, Hebert PC, Wells G, Fergusson D, Marshall J, Yetisir E, Blajchman MJ, Canadian Critical Care Trials Group: Is a restrictive transfusion strategy safe for resuscitated and critically ill trauma patients? J Trauma 2004, 57: 563-568. 10.1097/01.TA.0000136158.93864.54CrossRefPubMed
9.
go back to reference Hébert PC, Yetisir E, Martin C, Blajchman MA, Wells G, Marshall J, Tweeddale M, Pagliarello G, Schweitzer I, Transfusion Requirements in Critical Care Investigators for the Canadian Critical Care Trials Group: Is a low transfusion threshold safe in critically ill patients with cardiovascular diseases? Crit Care Med 2001, 29: 227-234. 10.1097/00003246-200102000-00001CrossRefPubMed Hébert PC, Yetisir E, Martin C, Blajchman MA, Wells G, Marshall J, Tweeddale M, Pagliarello G, Schweitzer I, Transfusion Requirements in Critical Care Investigators for the Canadian Critical Care Trials Group: Is a low transfusion threshold safe in critically ill patients with cardiovascular diseases? Crit Care Med 2001, 29: 227-234. 10.1097/00003246-200102000-00001CrossRefPubMed
10.
go back to reference Deans KJ, Minneci PC, Suffredini AF, Danner RL, Hoffman WD, Ciu X, Klein HG, Schechter AN, Banks SM, Eichacker PQ, Natanson C: Randomisation in clinical trials of titrated therapies: unintended consequences of using fixed treatment protocols. Crit Care Med 2007, 35: 1509-1516. 10.1097/01.CCM.0000266584.40715.A6CrossRefPubMed Deans KJ, Minneci PC, Suffredini AF, Danner RL, Hoffman WD, Ciu X, Klein HG, Schechter AN, Banks SM, Eichacker PQ, Natanson C: Randomisation in clinical trials of titrated therapies: unintended consequences of using fixed treatment protocols. Crit Care Med 2007, 35: 1509-1516. 10.1097/01.CCM.0000266584.40715.A6CrossRefPubMed
11.
go back to reference Napolitano LM, Kurek S, Luchette FA, Corwin HL, Barie PS, Tisherman SA, Hebert PC, Anderson GL, Bard MR, Bromberg W, Chiu WC, Cipolle MD, Clancy KD, Diebel L, Hoff S, Hughes KM, Munshi I, Nayduch D, Sandhu R, Yelon JA, American College of Critical Care Medicine of the Society of Critical Care Medicine; Eastern Association for the Surgery of Trauma Practice Management Workgroup: Clinical practice guideline: red blood cell transfusion in adult trauma and critical care. Crit Care Med 2009, 37: 3124-3157. 10.1097/CCM.0b013e3181b39f1bCrossRefPubMed Napolitano LM, Kurek S, Luchette FA, Corwin HL, Barie PS, Tisherman SA, Hebert PC, Anderson GL, Bard MR, Bromberg W, Chiu WC, Cipolle MD, Clancy KD, Diebel L, Hoff S, Hughes KM, Munshi I, Nayduch D, Sandhu R, Yelon JA, American College of Critical Care Medicine of the Society of Critical Care Medicine; Eastern Association for the Surgery of Trauma Practice Management Workgroup: Clinical practice guideline: red blood cell transfusion in adult trauma and critical care. Crit Care Med 2009, 37: 3124-3157. 10.1097/CCM.0b013e3181b39f1bCrossRefPubMed
12.
go back to reference Hill SR, Carless PA, Henry DA, Carson JL, Hebert PC, Henderson KM: Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database Syst Rev 2002, CD002042. Hill SR, Carless PA, Henry DA, Carson JL, Hebert PC, Henderson KM: Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database Syst Rev 2002, CD002042.
13.
go back to reference Walsh TS, Maciver CR: A clinical scenario-based survey of transfusion decisions for intensive care patients with delayed weaning from mechanical ventilation. Transfusion 2009, 49: 2661-2667. 10.1111/j.1537-2995.2009.02336.xCrossRefPubMed Walsh TS, Maciver CR: A clinical scenario-based survey of transfusion decisions for intensive care patients with delayed weaning from mechanical ventilation. Transfusion 2009, 49: 2661-2667. 10.1111/j.1537-2995.2009.02336.xCrossRefPubMed
14.
go back to reference Hébert PC, Fergusson D, Blajchman MA, Wells GA, Kmetic A, Coyle D, Heddle N, Germain M, Goldman M, Toye B, Schweitzer I, vanWalraven C, Devine D, Sher GD, Leukoreduction Study Investigators: Clinical outcomes following institution of the Canadian universal leukoreduction program for red blood cell transfusions. JAMA 2003, 289: 1941-1949. 10.1001/jama.289.15.1941CrossRefPubMed Hébert PC, Fergusson D, Blajchman MA, Wells GA, Kmetic A, Coyle D, Heddle N, Germain M, Goldman M, Toye B, Schweitzer I, vanWalraven C, Devine D, Sher GD, Leukoreduction Study Investigators: Clinical outcomes following institution of the Canadian universal leukoreduction program for red blood cell transfusions. JAMA 2003, 289: 1941-1949. 10.1001/jama.289.15.1941CrossRefPubMed
15.
go back to reference Zimrin AB, Hess JR: Current issues relating to the transfusion of stored red blood cells. Vox Sanguinis 2009, 96: 93-103. 10.1111/j.1423-0410.2008.01117.xCrossRefPubMed Zimrin AB, Hess JR: Current issues relating to the transfusion of stored red blood cells. Vox Sanguinis 2009, 96: 93-103. 10.1111/j.1423-0410.2008.01117.xCrossRefPubMed
Metadata
Title
Red cell transfusion triggers in critically ill patients: time for some new TRICCs?
Author
Timothy S Walsh
Publication date
01-06-2010
Publisher
BioMed Central
Published in
Critical Care / Issue 3/2010
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc9043

Other articles of this Issue 3/2010

Critical Care 3/2010 Go to the issue