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01-04-2020 | Editorial

Transfusion thresholds: the dangers of guidelines based on randomized controlled trials

Author: Jean-Louis Vincent

Published in: Intensive Care Medicine | Issue 4/2020

Excerpt

A task force of the European Society of Intensive Care Medicine (ESICM) recently reported its consensus recommendations on optimal blood transfusion practices [1]. This was a challenging exercise for them: On the one hand, randomized controlled trials (RCTs) are supposed to give the most reliable answer to any question related to optimal treatments; on the other hand, RCTs that use a strategy based only on hemoglobin (Hb) thresholds cannot provide a sufficient guide. The authors preferred not to offer a clinical perspective, but rather to review the literature that indicates that strategies based on different Hb concentrations do not result in different mortality rates. …

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Nakamura RE, Vincent JL, Fukushima JT, de Almeida JP, Franco RA, Lee PC, Osawa EA, Pinto Silva CM, Costa Auler JOJ et al (2015) A liberal strategy of red blood cell transfusion reduces cardiogenic shock in elderly patients undergoing cardiac surgery. J Thorac Cardiovasc Surg 150:1314–1320CrossRef

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Holst LB, Haase N, Wetterslev J, Wernerman J, Guttormsen AB, Karlsson S, Johansson PI, Aneman A, Vang ML et al (2014) Lower versus higher hemoglobin threshold for transfusion in septic shock. N Engl J Med 371:1381–1391CrossRef

11.

Bergamin FS, Almeida JP, Landoni G, Galas FRBG, Fukushima JT, Fominskiy E, Park CHL, Osawa EA, Diz MPE et al (2017) Liberal versus restrictive transfusion strategy in critically ill oncologic patients: the transfusion requirements in critically ill oncologic patients randomized controlled trial. Crit Care Med 45:766–773CrossRef

12.

Park DW, Chun BC, Kwon SS, Yoon YK, Choi WS, Sohn JW, Peck KR, Kim YS, Choi YH et al (2012) Red blood cell transfusions are associated with lower mortality in patients with severe sepsis and septic shock: a propensity-matched analysis. Crit Care Med 40:3140–3145CrossRef

13.

Vincent JL, Sakr Y, Sprung C, Harboe S, Damas P (2008) Are blood transfusions associated with greater mortality rates? Results of the sepsis occurrence in acutely ill patients study. Anesthesiology 108:31–39CrossRef

14.

Vincent JL, Jaschinski U, Wittebole X, Lefrant JY, Jakob SM, Almekhlafi GA, Pellis T, Tripathy S, Rubatto Birri PN et al (2018) Worldwide audit of blood transfusion practice in critically ill patients. Crit Care 22:102CrossRef

Title: Transfusion thresholds: the dangers of guidelines based on randomized controlled trials
Author: Jean-Louis Vincent
Publication date: 01-04-2020
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 4/2020
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-019-05889-3

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Transfusion thresholds: the dangers of guidelines based on randomized controlled trials

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Keynote webinar | Spotlight on medication adherence

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