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Transfusion practice in the intensive care unit: a 10-year analysis
Giora Netzer1, Xinggang Liu, Anthony D Harris
1From the Division of Pulmonary and Critical Care Medicine, the Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA. gnetzer@medicine.umaryland.edu
Transfusion
|June 18, 2010
Summary
Physician transfusion practices in intensive care units (ICUs) shifted towards restrictive strategies between 1997 and 2007. This involved fewer transfusions, lower pretransfusion hemoglobin levels, and reduced hemoglobin levels in non-transfused patients.
Area of Science:
- Critical Care Medicine
- Hematology
- Transfusion Medicine
Background:
- Clinical guidelines advocate for restrictive transfusion strategies in critically ill patients without active hemorrhage.
- Adherence to these guidelines is crucial for optimizing patient outcomes and resource utilization.
Purpose of the Study:
- To analyze trends in physician transfusion practices within a medical intensive care unit (MICU) over a decade.
- To assess changes in transfusion rates, hemoglobin thresholds, and transfusion volumes in response to evolving clinical guidelines.
Main Methods:
- A retrospective observational study was conducted on 3533 patients admitted to a medical intensive care unit.
- Data were analyzed from 1997 to 2007, excluding patients with acute coronary syndromes, hemorrhage, or hemoglobinopathy.
Main Results:
- The proportion of transfused patients significantly decreased from 31.0% to 18.0% (p<0.001).
- Mean pretransfusion hemoglobin levels declined from 7.9±1.3 to 7.3±1.3 g/dL (p<0.001), and mean nadir hemoglobin in non-transfused patients decreased from 11.2±2.2 to 10.4±2.3 g/dL (p<0.001).
- The proportion of single-unit transfusions increased, indicating a more conservative approach.
Conclusions:
- Significant and sustained changes in transfusion practices were observed in the MICU between 1997 and 2007.
- These changes reflect a successful implementation of restrictive transfusion strategies, reducing overall transfusion rates and volumes.
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