Recombinant human erythropoietin use in intensive care.
OBJECTIVE
To review the literature concerning the role of recombinant human erythropoietin (rHuEPO) in reducing the need for transfusion in critically ill patients.


METHODS
Articles were obtained through searches of the MEDLINE database (from 1990 to June 2001) using the key words erythropoietin, epoetin alfa, anemia, reticulocytes, hemoglobin, critical care, intensive care, critical illness, and blood transfusion. Additional references were found in the bibliographies of the articles cited. The Cochrane library was also consulted.


METHODS
Controlled, prospective, and randomized studies on the use of rHuEPO in critically ill adults were selected.


RESULTS
Anemia is a common complication in patients requiring intensive care. It is caused, in part, by abnormally low concentrations of endogenous erythropoietin and is mainly seen in patients with sepsis and multiple organ dysfunction syndrome, in whom inflammation mediator concentrations are often elevated. High doses of rHuEPO produce a rapid response in these patients, despite elevated cytokine concentrations. There have been 3 studies on rHuEPO administration in intensive care and 1 trial in acutely burned patients. Only 2 of these studies looked at the impact of rHuEPO administration on the need for transfusion.


CONCLUSIONS
Few randomized, controlled trials explore the role of rHuEPO in critical care. Only 1 was a large, randomized clinical trial, but it presents many limitations. Future outcome and safety studies comparing rHuEPO with placebo must include clinical endpoints such as end-organ morbidity, mortality, transfusion criteria, and pharmacoeconomic analysis. rHuEPO appears to provide an erythropoietic response. Optimal dosage and the real impact of rHuEPO on the need for transfusion in intensive care remain to be determined. Currently, based on the evidence available from the literature, rHuEPO cannot be recommended to reduce the need for red blood cell transfusions in anemic, critically ill patients.
Darveau
Martin
M
Faculty of Pharmacy, University of Montreal and Cité de la Santé de Laval, Québec, Canada. martin_darveau@ssss.gouv.qc.ca
Notebaert
Eric
E
Denault
André Y
AY
Bélisle
Sylvain
S
D000740:Anemia / Q000188:drug therapy* / Q000628:therapy*; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D003422:Critical Care; D016638:Critical Illness; D004921:Erythropoietin / Q000627:therapeutic use*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins
D011994:Recombinant Proteins; D004921:Erythropoietin