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Impact of national transfusion indicators on appropriate blood usage in critically ill patients
Santiago Ramón Leal-Noval1, Victoria Arellano-Orden, Antonio Maestre-Romero
1Critical Care Division, Hospital Universitario Virgen del Rocío, Seville, Spain. sramon@cica.es
Insights
National blood transfusion indicators (NBTIs) showed variable impact on appropriate blood component use in critical care. Adherence improved for platelet transfusions but remained poor for fresh-frozen plasma, indicating a need for further guideline refinement.
Area of Science:
- Critical Care Medicine
- Transfusion Medicine
- Health Services Research
Background:
- Assessing the appropriateness of blood component transfusions is crucial in critical care settings.
- National Blood Transfusion Indicators (NBTIs) were developed to guide transfusion practices for critically ill patients.
Purpose of the Study:
- To investigate the impact of implementing NBTIs on the appropriate use of blood components in the intensive care unit (ICU).
Main Methods:
- A prospective, single-center study involving 1808 ICU patients over one year.
- Four 90-day periods were used: a control period, followed by periods with NBTI introduction and evaluation of early and late impacts.
- Data collected on transfusions of red blood cells, platelet concentrates, and fresh-frozen plasma.
Main Results:
- Red blood cell transfusion adherence to NBTIs showed no significant change, with 13% deviation from protocols.
- Adherence to NBTI guidelines for platelet concentrate transfusions significantly improved from 36% to 52% (p < 0.01).
- High and stable non-adherence (74%) to NBTI guidelines was observed for fresh-frozen plasma transfusions, often due to absence of severe bleeding.
Conclusions:
- NBTI guidelines had a variable impact on blood component transfusion appropriateness in critically ill patients.
- While platelet transfusion adherence improved, significant challenges remain for fresh-frozen plasma and red blood cell transfusions.
- Further strategies may be needed to optimize NBTI implementation and improve transfusion practices in critical care.
Background:
The objective was to investigate the impact of three national blood transfusion indicators (NBTIs) specifically designed for critical care regarding the appropriate blood transfusion indications.
Study Design And Methods:
This was a prospective, single-center study, carried out at a university hospital. A total of 1808 patients admitted to the intensive care unit (ICU) in 1 year were included.
Results:
The study consisted of four 90-day periods (P). P1 was a control period with no intervention. P2 followed the inclusion of NBTIs into the ICU database, aimed at reinforcing NBTI knowledge. After presenting and discussing the results of P1 and P2, the early (P3) and late (P4) impacts of NBTI knowledge were evaluated. All patients who were transfused with at least 1 unit of any blood component (33.3%) were included. Thirteen percent of red blood cell transfusions (RBCTs) were given outside of NBTI protocols (13% deviation of NBTIs for RBCTs) without a significant change throughout the duration of the study. Most RBCTs (95%) were prescribed for a hemoglobin threshold of less than 90 g/L. There was a steady and significant improvement in the adherence to NBTI guidelines for platelet concentrate transfusions (PCTs) from 36% (P1) to 52% (P4; p < 0.01). In contrast, the lack of adherence to NBTI guidelines for fresh-frozen plasma transfusions (FFPTs) remained high (74%) and stable throughout the study period. The most frequent reason for inappropriate use of FFPTs or PCTs was absence of severe bleeding.
Conclusion:
The introduction of NBTI guidelines demonstrated a variable impact on the appropriateness of blood component transfusions in critically ill patients.
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