TY - JOUR
T1 - Red Blood Cell Transfusion in the Intensive Care Unit
AU - Raasveld, Senta Jorinde
AU - de Bruin, Sanne
AU - Reuland, Merijn C
AU - van den Oord, Claudia
AU - Schenk, Jimmy
AU - Aubron, Cécile
AU - Bakker, Jan
AU - Cecconi, Maurizio
AU - Feldheiser, Aarne
AU - Meier, Jens
AU - Müller, Marcella C A
AU - Scheeren, Thomas W L
AU - McQuilten, Zoe
AU - Flint, Andrew
AU - Hamid, Tarikul
AU - Piagnerelli, Michaël
AU - Tomic Mahecic, Tina
AU - Benes, Jan
AU - Russell, Lene
AU - Aguirre-Bermeo, Hernan
AU - Triantafyllopoulou, Konstantina
AU - Chantziara, Vasiliki
AU - Gurjar, Mohan
AU - Myatra, Sheila Nainan
AU - Pota, Vincenzo
AU - Elhadi, Muhammed
AU - Gawda, Ryszard
AU - Mourisco, Mafalda
AU - Lance, Marcus
AU - Neskovic, Vojislava
AU - Podbregar, Matej
AU - Llau, Juan V
AU - Quintana-Diaz, Manual
AU - Cronhjort, Maria
AU - Pfortmueller, Carmen A
AU - Yapici, Nihan
AU - Nielsen, Nathan D
AU - Shah, Akshay
AU - de Grooth, Harm-Jan
AU - Vlaar, Alexander P J
N1 - Publisher Copyright:
© 2023 American Medical Association. All rights reserved.
PY - 2023/11/21
Y1 - 2023/11/21
N2 - IMPORTANCE: Red blood cell (RBC) transfusion is common among patients admitted to the intensive care unit (ICU). Despite multiple randomized clinical trials of hemoglobin (Hb) thresholds for transfusion, little is known about how these thresholds are incorporated into current practice.OBJECTIVE: To evaluate and describe ICU RBC transfusion practices worldwide.DESIGN, SETTING, AND PARTICIPANTS: International, prospective, cohort study that involved 3643 adult patients from 233 ICUs in 30 countries on 6 continents from March 2019 to October 2022 with data collection in prespecified weeks.EXPOSURE: ICU stay.MAIN OUTCOMES AND MEASURES: The primary outcome was the occurrence of RBC transfusion during ICU stay. Additional outcomes included the indication(s) for RBC transfusion (consisting of clinical reasons and physiological triggers), the stated Hb threshold and actual measured Hb values before and after an RBC transfusion, and the number of units transfused.RESULTS: Among 3908 potentially eligible patients, 3643 were included across 233 ICUs (median of 11 patients per ICU [IQR, 5-20]) in 30 countries on 6 continents. Among the participants, the mean (SD) age was 61 (16) years, 62% were male (2267/3643), and the median Sequential Organ Failure Assessment score was 3.2 (IQR, 1.5-6.0). A total of 894 patients (25%) received 1 or more RBC transfusions during their ICU stay, with a median total of 2 units per patient (IQR, 1-4). The proportion of patients who received a transfusion ranged from 0% to 100% across centers, from 0% to 80% across countries, and from 19% to 45% across continents. Among the patients who received a transfusion, a total of 1727 RBC transfusions were administered, wherein the most common clinical indications were low Hb value (n = 1412 [81.8%]; mean [SD] lowest Hb before transfusion, 7.4 [1.2] g/dL), active bleeding (n = 479; 27.7%), and hemodynamic instability (n = 406 [23.5%]). Among the events with a stated physiological trigger, the most frequently stated triggers were hypotension (n = 728 [42.2%]), tachycardia (n = 474 [27.4%]), and increased lactate levels (n = 308 [17.8%]). The median lowest Hb level on days with an RBC transfusion ranged from 5.2 g/dL to 13.1 g/dL across centers, from 5.3 g/dL to 9.1 g/dL across countries, and from 7.2 g/dL to 8.7 g/dL across continents. Approximately 84% of ICUs administered transfusions to patients at a median Hb level greater than 7 g/dL.CONCLUSIONS AND RELEVANCE: RBC transfusion was common in patients admitted to ICUs worldwide between 2019 and 2022, with high variability across centers in transfusion practices.
AB - IMPORTANCE: Red blood cell (RBC) transfusion is common among patients admitted to the intensive care unit (ICU). Despite multiple randomized clinical trials of hemoglobin (Hb) thresholds for transfusion, little is known about how these thresholds are incorporated into current practice.OBJECTIVE: To evaluate and describe ICU RBC transfusion practices worldwide.DESIGN, SETTING, AND PARTICIPANTS: International, prospective, cohort study that involved 3643 adult patients from 233 ICUs in 30 countries on 6 continents from March 2019 to October 2022 with data collection in prespecified weeks.EXPOSURE: ICU stay.MAIN OUTCOMES AND MEASURES: The primary outcome was the occurrence of RBC transfusion during ICU stay. Additional outcomes included the indication(s) for RBC transfusion (consisting of clinical reasons and physiological triggers), the stated Hb threshold and actual measured Hb values before and after an RBC transfusion, and the number of units transfused.RESULTS: Among 3908 potentially eligible patients, 3643 were included across 233 ICUs (median of 11 patients per ICU [IQR, 5-20]) in 30 countries on 6 continents. Among the participants, the mean (SD) age was 61 (16) years, 62% were male (2267/3643), and the median Sequential Organ Failure Assessment score was 3.2 (IQR, 1.5-6.0). A total of 894 patients (25%) received 1 or more RBC transfusions during their ICU stay, with a median total of 2 units per patient (IQR, 1-4). The proportion of patients who received a transfusion ranged from 0% to 100% across centers, from 0% to 80% across countries, and from 19% to 45% across continents. Among the patients who received a transfusion, a total of 1727 RBC transfusions were administered, wherein the most common clinical indications were low Hb value (n = 1412 [81.8%]; mean [SD] lowest Hb before transfusion, 7.4 [1.2] g/dL), active bleeding (n = 479; 27.7%), and hemodynamic instability (n = 406 [23.5%]). Among the events with a stated physiological trigger, the most frequently stated triggers were hypotension (n = 728 [42.2%]), tachycardia (n = 474 [27.4%]), and increased lactate levels (n = 308 [17.8%]). The median lowest Hb level on days with an RBC transfusion ranged from 5.2 g/dL to 13.1 g/dL across centers, from 5.3 g/dL to 9.1 g/dL across countries, and from 7.2 g/dL to 8.7 g/dL across continents. Approximately 84% of ICUs administered transfusions to patients at a median Hb level greater than 7 g/dL.CONCLUSIONS AND RELEVANCE: RBC transfusion was common in patients admitted to ICUs worldwide between 2019 and 2022, with high variability across centers in transfusion practices.
KW - Adult
KW - Anemia
KW - Cohort Studies
KW - Erythrocyte Transfusion/adverse effects
KW - Female
KW - Hemoglobins
KW - Humans
KW - Intensive Care Units/statistics & numerical data
KW - Male
KW - Middle Aged
KW - Prospective Studies
KW - Transfusion Medicine
U2 - 10.1001/jama.2023.20737
DO - 10.1001/jama.2023.20737
M3 - Article
C2 - 37824112
SN - 0098-7484
VL - 330
SP - 1852
EP - 1861
JO - JAMA
JF - JAMA
IS - 19
ER -