Revisiting transfusion practices in critically ill patients.
OBJECTIVE
The objective of this study was to characterize contemporary red cell transfusion practice in the critically ill and to examine changes in practice over time.


METHODS
The authors conducted a scenario-based national survey.


METHODS
This study consisted of Canadian critical care practitioners.


METHODS
The authors evaluated transfusion thresholds in four hypothetical scenarios.


RESULTS
Of 343 eligible Canadian critical care physicians, 235 (68.5%) responded to the survey. Most respondents were general internists (57%) who had been in practice for an average of 11.1 (+/-7.1) yrs and worked most often in combined medical/surgical intensive care units. Transfusion thresholds differed significantly among the four scenarios (p < .0001). The proportion of respondents adopting a threshold of 70 g/L was 63% and 70% in the hypothetical scenarios of trauma and septic shock compared with 16% and 3% who adopted the same threshold for scenarios involving patients with stable gastrointestinal hemorrhage and postoperative myocardial infarction, respectively. Fifteen percent of respondents identified transfusion thresholds exceeding 100 g/L for the postoperative myocardial infarction scenario, and 7% identified this threshold for the gastrointestinal hemorrhage scenario. Only 0.4% of respondents adopted a 100-g/L threshold for the two remaining scenarios. There was a significant decrease in transfusion thresholds in all four scenarios (p < .001) since the administration of a previous survey in 1993. The reported use of single-unit transfusions was 56% in 2002 vs. 10% in 1993. Eighty-five percent of physicians stated that they had modified their approach to transfusion, primarily in response to the publication of a major Canadian clinical trial and institutional guidelines.


CONCLUSIONS
Canadian physicians appear to have adopted lower transfusion triggers and an increase in the use of single-unit red cell transfusion.
Hébert
Paul C
PC
Centre for Transfusion and Clinical Epidemiology Program, University of Ottawa, 501 Smyth Road, Box 201, Ottawa, Ontario, K1H 8L6, Canada.
Fergusson
Dean A
DA
Stather
David
D
McIntyre
Lauralyn
L
Martin
Claudio
C
Doucette
Steve
S
Blajchman
Morris
M
Graham
Ian D
ID
D018806:APACHE; D000328:Adult; D000368:Aged; D001810:Blood Volume / Q000502:physiology; D002170:Canada; D003422:Critical Care / Q000706:statistics & numerical data*; D017723:Drug Utilization Review / Q000706:statistics & numerical data; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000097:blood / Q000628:therapy*; D006452:Hemoglobinometry; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000097:blood / Q000628:therapy*; D009203:Myocardial Infarction / Q000097:blood / Q000628:therapy*; D012151:Resuscitation; D012772:Shock, Septic / Q000097:blood / Q000628:therapy*