Effects of red blood cell transfusions given to non-septic critically ill patients: a propensity score matched study

Frequency and predictors of red blood cell transfusion in the pediatric intensive care unit: a prospective observational study

Red blood cell (RBC) transfusion is crucial in treating anemia in the pediatric intensive care unit (PICU), though safety and necessity concerns persist. This prospective observational study examined the frequency and predictors of RBC transfusions among critically ill children, highlighting implications for low- and middle-income countries (LMICs). A single-center observational study enrolled 104 children admitted to a PICU from January to September 2021. Demographic details, past medical history, Pediatric Index of Mortality-3 scores, sedation, inotrope administration, ventilator-associated pneumonia (VAP), new-onset shock, respiratory failure, sepsis, renal failure, new or progressive multiple organ dysfunction syndrome (MODS), and duration of ventilation were recorded. Our results showed that 37 patients (35.6%) received RBC transfusions. The mean pre-transfusion hemoglobin level was 6.58 grams per deciliter (g/dl) (SD 1.71). The transfused group required more sedation (P < .001) and vasoactive agents (P < .001), had longer PICU stays (P = .013), and developed VAP (P = .037), new-onset shock (P = .025), respiratory failure (P = .021), and MODS (P = .023) more often than the non-transfused group. Logistic regression analysis showed that hemoglobin >10 g/dl at admission reduced the odds of RBC transfusion [odds ratio (OR) = 0.57, confidence interval (CI) = 0.43-0.74], while sepsis at admission increased the odds (OR = 3.24, CI = 1.09-9.60). The current study demonstrates that about one-third of critically ill children received RBC transfusions. Hemoglobin above 10 g/dl at admission was associated with significantly lower odds of RBC transfusion, while sepsis at admission significantly increased the odds. These findings are particularly relevant for LMICs, where resource constraints necessitate careful evaluation of transfusion practices to optimize patient outcomes and resource utilization.

Adherence to a restrictive red blood cell transfusion strategy in critically ill patients: An observational study

BACKGROUND

Randomized controlled trials relatively consistently show that restrictive red blood cell (RBC) transfusion strategies are safe and associated with similar outcomes compared to liberal transfusion strategies in critically ill patients. Based on these data, the general threshold for RBC transfusion was changed to 70 g/L at a 9-bed tertiary level intensive care unit in September 2020. Implementation measures included lectures, webinars and feedback during clinical practice. The aim of this study was to investigate how implementation of a restrictive transfusion strategy influenced RBC usage, haemoglobin trigger levels and adherence to prescribed trigger levels.

METHODS

In this registry-based, observational study, critically ill adult patients without massive bleeding were included and divided into a pre-cohort, with admissions prior to the change of transfusion strategy, and a post-cohort, with admissions following the change of transfusion strategy. These cohorts were compared regarding key RBC transfusion-related variables.

RESULTS

In total 5626 admissions were included in the analyses (pre-cohort n = 4373, post-cohort n = 1253). The median volume (interquartile range, IQR) of RBC transfusions per 100 admission days, in the pre-cohort was 6120 (4110-8110) mL versus 3010 (2890-4970) mL in the post-cohort (p < .001). This corresponds to an estimated median saving of 1128 € per 100 admission days after a restrictive RBC transfusion strategy was implemented. In total, 26% of the admissions in the pre-cohort and 19% in the post-cohort (p < .001) received RBC transfusion(s) during days 0-10. Both median (IQR) prescribed trigger levels (determined by intensivist) and actual haemoglobin trigger levels (i.e., levels prior to actual administration of transfusion) were higher in the pre- versus post-cohort (90 [80-100] vs. 80 [72-90] g/L, p < .001 and 89 [82-96] g/L vs. 83 [79-94], p < .001, respectively). Percentage of days without compliance with the prescribed transfusion trigger was higher in the pre-cohort than in the post-cohort (23% vs. 14%, p < .001). Sensitivity analyses, excluding patients with traumatic brain injury, ischemic heart disease and COVID-19 demonstrated similar results.

CONCLUSIONS

Implementation of a restrictive transfusion trigger in a critical care setting resulted in lasting decreased RBC transfusion use and costs, decreased prescribed and actual haemoglobin trigger levels and improved adherence to prescribed haemoglobin trigger levels.

Announcing new members of the Advisory Editorial Board

We on the Editorial Board of "Anaesthesiology Intensive Therapy" are committed to continuous improvement of the quality of our journal, and thus we are excited that two excellent clinician-scientists have joined us in this endeavour. It is our great honour to announce that Doctor Thomas Kander of Lund University (Sweden) and Doctor Dan Drzymal-ski of Tufts Medical Center (Boston, Massachusetts) have become members of the Advisory Editorial Board of "Anaesthesio-logy Intensive Therapy".