Document Detail


A clinical scenario-based survey of transfusion decisions for intensive care patients with delayed weaning from mechanical ventilation.
MedLine Citation:
PMID:  19682335     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Despite evidence supporting the use of restrictive hemoglobin (Hb) transfusion triggers in critically ill patients, translation of this evidence into practice remains inconsistent. It was hypothesized that clinicians believe that longer-term ventilated patients require a higher Hb, particularly when ischemic heart disease coexists.
STUDY DESIGN AND METHODS: A scenario was developed describing an anemic patient recovering from multiple organ failure, but failing weaning trials after 6 days of mechanical ventilation. Clinicians were asked to state their Hb transfusion trigger and target Hb range assuming no history of ischemic heart disease (Scenario 1), known stable chronic ischemic heart disease (Scenario 2), or evidence of myocardial ischemia during weaning trials (Scenario 3). A prospective cross-sectional postal survey of clinicians practicing intensive care in the United Kingdom was undertaken.
RESULTS: A total of 184 responses were obtained (52% response rate), which varied widely. Median (first, third quartile) transfusion trigger Hb levels were 8 (7, 8), 9 (8, 9.5), and 9.5 (9, 9.5) g/dL for Scenarios 1 to 3, respectively (p < 0.001 across and between each group). The target Hb was more than 9 g/dL for 47, 80, and 94% of respondents for Scenarios 1 to 3, respectively, and more than 10 g/dL for 14, 44, and 65% of respondents for Scenarios 1 to 3, respectively (p < 0.001 across the groups).
CONCLUSIONS: In response to scenarios, clinicians in the United Kingdom believe that a more liberal transfusion practice is required for patients failing weaning trials after 6 days of mechanical ventilation than the current evidence base supports.
Authors:
Timothy S Walsh; Caroline R Maciver;
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Publication Detail:
Type:  Journal Article     Date:  2009-08-04
Journal Detail:
Title:  Transfusion     Volume:  49     ISSN:  1537-2995     ISO Abbreviation:  Transfusion     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2010-02-18     Completed Date:  2010-03-19     Revised Date:  2014-02-19    
Medline Journal Info:
Nlm Unique ID:  0417360     Medline TA:  Transfusion     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2661-7     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Anemia / therapy*
Blood Transfusion / utilization*
Critical Illness / therapy*
Cross-Sectional Studies
Decision Making
Great Britain
Health Care Surveys*
Hemoglobins / metabolism
Humans
Intensive Care / statistics & numerical data
Medicine*
Multiple Organ Failure / therapy
Professional Practice
Ventilator Weaning* / statistics & numerical data
Grant Support
ID/Acronym/Agency:
CZB/4/698//Chief Scientist Office
Chemical
Reg. No./Substance:
0/Hemoglobins

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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