Document Detail


Is a low transfusion threshold safe in critically ill patients with cardiovascular diseases?
MedLine Citation:
PMID:  11246298     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To compare a restrictive red blood cell transfusion strategy with a more liberal strategy in volume-resuscitated critically ill patients with cardiovascular disease. SETTING: Twenty-two academic and three community critical care units across Canada. STUDY DESIGN: Randomized controlled clinical trial. STUDY POPULATION: Three hundred fifty-seven critically ill patients with cardiovascular diseases from the Transfusion Requirements in Critical Care trial who had a hemoglobin concentration of <90 g/L within 72 hrs of admission to the intensive care unit. INTERVENTIONS: Patients were randomized to a restrictive strategy to receive allogeneic red blood cell transfusions at a hemoglobin concentration of 70 g/L (and maintained between 70 and 90 g/L) or a liberal strategy to receive red blood cells at 100 g/L (and maintained between 100 and 120 g/L). RESULTS: Baseline characteristics in the restrictive (n = 160) and the liberal group (n = 197) were comparable, except for the use of cardiac and anesthetic drugs (p <.02). Average hemoglobin concentrations (85 +/- 6.2 vs. 103 +/- 6.7 g/L; p <.01) and red blood cell units transfused (2.4 +/- 4.1 vs. 5.2 +/- 5.0 red blood cell units; p <.01) were significantly lower in the restrictive compared with the liberal group. Overall, all mortality rates were similar in both study groups, including 30-day (23% vs. 23%; p = 1.00), 60-day, hospital, and intensive care unit rates. Changes in multiple organ dysfunction from baseline scores were significantly less in the restrictive transfusion group overall (0.2 +/- 4.2 vs. 1.3 +/- 4.4; p =.02). In the 257 patients with severe ischemic heart disease, there were no statistically significant differences in all survival measures, but this is the only subgroup where the restrictive group had lower but nonsignificant absolute survival rates compared with the patients in the liberal group. CONCLUSION: A restrictive red blood cell transfusion strategy generally appears to be safe in most critically ill patients with cardiovascular disease, with the possible exception of patients with acute myocardial infarcts and unstable angina.
Authors:
P C Hébert; E Yetisir; C Martin; M A Blajchman; G Wells; J Marshall; M Tweeddale; G Pagliarello; I Schweitzer;
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Critical care medicine     Volume:  29     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2001 Feb 
Date Detail:
Created Date:  2001-03-14     Completed Date:  2001-04-05     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  227-34     Citation Subset:  AIM; IM    
Affiliation:
Critical Care Programs, University of Ottawa, Ottawa, ON, Canada.
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MeSH Terms
Descriptor/Qualifier:
APACHE
Aged
Anemia / complications*,  therapy*
Blood Transfusion / adverse effects*,  methods,  statistics & numerical data*
Cardiovascular Diseases / complications*
Cause of Death
Clinical Protocols / standards
Comorbidity
Critical Illness / mortality,  therapy*
Female
Hemoglobins / analysis
Humans
Intensive Care / methods,  standards
Length of Stay / statistics & numerical data
Logistic Models
Male
Middle Aged
Multiple Organ Failure / etiology,  mortality
Patient Selection*
Proportional Hazards Models
Safety*
Survival Analysis
Chemical
Reg. No./Substance:
0/Hemoglobins
Comments/Corrections
Comment In:
Crit Care Med. 2001 Feb;29(2):442-4   [PMID:  11246329 ]
Crit Care Med. 2002 May;30(5):1182-3   [PMID:  12006836 ]

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


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