TY - JOUR
T1 - Red blood cell transfusion practices in acute lung injury
T2 - What do patient factors contribute?
AU - Murphy, David J.
AU - Howard, David
AU - Muriithi, Angela
AU - Mendez-Tellez, Pedro
AU - Sevransky, Jonathan
AU - Shanholtz, Carl
AU - Netzer, Giora
AU - Pronovost, Peter J.
AU - Needham, Dale M.
N1 - Funding Information:
Supported, in part, by National Institutes of Health (NIH) Acute Lung Injury SCCOR Grant (P50HL73994) (to PJP), an institutional training grant from the NIH (T32 HL007534) (to DJM), a Mentored Patient-Oriented Research Career Development Award from the NIH (KM GM071399) (to JS), a Clinical Research Career Development Award form the NIH (K12RR023250) (to GN), and a Clinician-Scientist Award from the Canadian Institutes of Health Research (to DMN).
PY - 2009/5
Y1 - 2009/5
N2 - Objective: To describe red blood cell (RBC) transfusion practices and evaluate the association between patient-related factors and pretransfusion hemoglobin concentration in acute lung injury (ALI). Design: Secondary analysis of prospectively collected data. Setting: Nine intensive care units (ICUs) in three teaching hospitals in Baltimore, MD. Patients: Two hundred forty-nine consecutive patients with ALI requiring mechanical ventilation. Interventions: None. Measurements and main results: Simple and multiple linear regression analyses were used to evaluate the association between the nadir hemoglobin concentration on the day of initial RBC transfusion and 20 patient-level demographic, clinical and ICU treatment factors as well as ICU type. Of 249 patients with ALI, 47% received an RBC transfusion in the ICU without evidence of active hemorrhage or acute cardiac ischemia. The mean (sd) nadir hemoglobin on the day of first transfusion was 7.7 (1.1) g/dL with 67%, 36%, 15%, and 5% of patients transfused at >7, >8, >9, and >10g/dL, respectively. Transfused patients received a mean (sd) of 5 (6) RBC units from ALI diagnosis to ICU discharge. Prehospital use of iron or erythropoietin and platelet transfusion in the ICU were independently associated with lower pretransfusion hemoglobin concentrations. No patient factors were associated with higher hemoglobin concentrations. Admission to a surgical (vs. medical) ICU was independently associated with a 0.6 g/dL (95% confidence interval 0.1-1.1 g/dL) higher pretransfusion hemoglobin. Conclusions: Patients with ALI commonly receive RBC transfusions in the ICU. The pretransfusion hemoglobin observed in our study was lower than earlier studies, but a restrictive strategy was not universally adopted. Patient factors do not explain the gap between clinical trial evidence and routine transfusion practices. Future studies should further explore ICU- and physician-related factors as a source of variability in transfusion practice.
AB - Objective: To describe red blood cell (RBC) transfusion practices and evaluate the association between patient-related factors and pretransfusion hemoglobin concentration in acute lung injury (ALI). Design: Secondary analysis of prospectively collected data. Setting: Nine intensive care units (ICUs) in three teaching hospitals in Baltimore, MD. Patients: Two hundred forty-nine consecutive patients with ALI requiring mechanical ventilation. Interventions: None. Measurements and main results: Simple and multiple linear regression analyses were used to evaluate the association between the nadir hemoglobin concentration on the day of initial RBC transfusion and 20 patient-level demographic, clinical and ICU treatment factors as well as ICU type. Of 249 patients with ALI, 47% received an RBC transfusion in the ICU without evidence of active hemorrhage or acute cardiac ischemia. The mean (sd) nadir hemoglobin on the day of first transfusion was 7.7 (1.1) g/dL with 67%, 36%, 15%, and 5% of patients transfused at >7, >8, >9, and >10g/dL, respectively. Transfused patients received a mean (sd) of 5 (6) RBC units from ALI diagnosis to ICU discharge. Prehospital use of iron or erythropoietin and platelet transfusion in the ICU were independently associated with lower pretransfusion hemoglobin concentrations. No patient factors were associated with higher hemoglobin concentrations. Admission to a surgical (vs. medical) ICU was independently associated with a 0.6 g/dL (95% confidence interval 0.1-1.1 g/dL) higher pretransfusion hemoglobin. Conclusions: Patients with ALI commonly receive RBC transfusions in the ICU. The pretransfusion hemoglobin observed in our study was lower than earlier studies, but a restrictive strategy was not universally adopted. Patient factors do not explain the gap between clinical trial evidence and routine transfusion practices. Future studies should further explore ICU- and physician-related factors as a source of variability in transfusion practice.
KW - Blood transfusion
KW - Erythrocyte indices
KW - Intensive care units
KW - Outcome and process assessment (health care)
KW - Respiratory distress syndrome, adult
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U2 - 10.1097/CCM.0b013e3181a0022d
DO - 10.1097/CCM.0b013e3181a0022d
M3 - Article
C2 - 19384204
AN - SCOPUS:66449118016
SN - 0090-3493
VL - 37
SP - 1935
EP - 1940
JO - Critical care medicine
JF - Critical care medicine
IS - 6
ER -