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Red Blood Cell Transfusion in the Intensive Care Unit
SJ. Raasveld, S. de Bruin, MC. Reuland, C. van den Oord, J. Schenk, C. Aubron, J. Bakker, M. Cecconi, A. Feldheiser, J. Meier, MCA. Müller, TWL. Scheeren, Z. McQuilten, A. Flint, T. Hamid, M. Piagnerelli, T. Tomic Mahecic, J. Benes, L. Russell,...
Jazyk angličtina Země Spojené státy americké
Typ dokumentu časopisecké články, práce podpořená grantem
NLK
Open Access Digital Library
od 1998-01-01 do Před 6 měsíci
Medline Complete (EBSCOhost)
od 1998-01-07 do Před 1 měsícem
PubMed
37824112
DOI
10.1001/jama.2023.20737
Knihovny.cz E-zdroje
- MeSH
- anemie * MeSH
- dospělí MeSH
- hemoglobiny MeSH
- jednotky intenzivní péče statistika a číselné údaje MeSH
- kohortové studie MeSH
- lidé středního věku MeSH
- lidé MeSH
- prospektivní studie MeSH
- transfuze erytrocytů škodlivé účinky statistika a číselné údaje MeSH
- transfuzní lékařství * MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
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.
Department of Anesthesia and Intensive Care Military Medical Academy Belgrade Belgrade Serbia
Department of Anesthesiology Aga Khan University Hospital Nairobi Kenya
Department of Anesthesiology and Intensive Care IRCCS Humanitas Research Hospital Milan Italy
Department of Anesthesiology and Intensive Care University Clinical Hospital Center Zagreb Croatia
Department of Anesthesiology University Medical Center Groningen Groningen the Netherlands
Department of Cardiothoracic Surgery European Interbalkan Medical Center Thessaloniki Greece
Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
Department of Clinical Science and Education Södersjukhuset Karolinska Institutet Stockholm Sweden
Department of Critical Care Asgar Ali Hospital Dhaka Bangladesh
Department of Intensive Care Adults Erasmus MC University Medical Centers Rotterdam the Netherlands
Department of Intensive Care Amsterdam University Medical Centers Amsterdam the Netherlands
Department of Intensive Care Pontificia Universidad Católica de Chile Santiago Chile
Department of Pulmonary and Critical Care New York University and Columbia University New York
Faculty of Medicine University of Tripoli Tripoli Libya
Intensive Care Service Hospital Universitario La Paz Madrid Spain
Médecine Intensive Réanimation CHU de Brest Université de Bretagne Occidentale Brest France
Nuffield Department of Clinical Neurosciences University of Oxford Oxford United Kingdom
School of Public Health and Preventive Medicine Monash University Melbourne Australia
Unidad de Cuidados Intensivos Hospital Vicente Corral Moscoso Cuenca Ecuador
Citace poskytuje Crossref.org
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- $a 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.
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