Variation in red cell transfusion practice in the intensive care unit: a multicentre cohort study

Area of Science:

• Critical Care Medicine
• Transfusion Medicine
• Health Services Research

Background:

• Red blood cell transfusions are common in intensive care units (ICUs).
• Practices for red blood cell transfusion in critically ill patients may vary significantly between institutions.
• Understanding this variation is crucial for optimizing patient care and resource allocation.

Purpose of the Study:

• To quantify interinstitutional variation in red blood cell transfusion practices for critically ill patients.
• To identify the reasons behind red blood cell administration in this patient population.
• To assess adherence to established transfusion guidelines.

Main Methods:

• A multicentre cohort study involving 5298 critically ill patients across six tertiary ICUs.
• A cross-sectional survey administered to 223 physicians ordering red blood cell transfusions.
• Data collection included hemoglobin levels, transfusion triggers, reasons for transfusion, patient demographics, disease severity (APACHE II score), and outcomes.

Main Results:

• Twenty-five percent of critically ill patients received red blood cell transfusions.
• Significant interinstitutional variation in transfusion rates per patient-day was observed (P < 0.001).
• Transfusion thresholds were independently predicted by patient age, APACHE II score, and institution (P < 0.0001), with institutional effects persisting after adjustments.
• Physician surveys revealed 35% of pre-transfusion hemoglobin levels were 95-105 g/L, and 80% of orders were for two packed red cell units.
• Common transfusion reasons included acute bleeding (35%) and augmenting oxygen delivery (25%).

Conclusions:

• Substantial institutional variation exists in red blood cell transfusion practices within critical care settings.
• Many intensivists utilize a hemoglobin threshold around 100 g/L and administer multiple units, often contrary to current guidelines.
• Further prospective research is needed to establish optimal red blood cell transfusion strategies for critically ill patients.