A descriptive evaluation of transfusion practices in patients receiving mechanical ventilation.
OBJECTIVE
To characterize and compare transfusion practices in a broad sample of patients receiving mechanical ventilation (MV) and not receiving MV in the ICU.


METHODS
Retrospective subgroup analysis from the prospective, multicenter, observational CRIT study.


METHODS
Two hundred eighty-four medical, surgical, or medical/surgical ICUs.


METHODS
Critically ill adults.


RESULTS
Of the 4,892 patients enrolled in the CRIT study, 60% were receiving MV on ICU admission or within 48 h after admission for a median of 4 days. Patients receiving MV had higher baseline APACHE (acute physiology and chronic health evaluation) II scores than patients not receiving MV (22.8 +/- 7.8 and 14.9 +/- 6.4, respectively [mean +/- SD]; p < 0.0001). Despite similar baseline hemoglobin levels (11.0 +/- 2.3 g/dL and 10.9 +/- 2.5 g/dL, p = 0.17), more patients receiving MV underwent transfusions (49% vs 33%, p < 0.0001), and they received significantly more RBCs than patients not receiving MV (p < 0.0001). The principal reason for transfusion in both groups was low hemoglobin level (78.4% and 84.6%, respectively); however, patients receiving MV had higher pretransfusion hemoglobin levels (8.7 +/- 1.7 g/dL) than patients not receiving MV (8.2 +/- 1.7 g/dL, p < 0.0001). Notably, 40.1% of all transfusions in patients receiving MV were administered after day 3 of the ICU stay, compared to 21.2% in patients not receiving MV (p < 0.0001), and a higher percentage of patients receiving MV remaining in the ICU after day 3 underwent transfusions (33.4% vs 18.3%, p < 0.0001). Mortality was higher (17.2% vs 4.5%, p < 0.0001) and mean hospital (15 days vs 10 days, p < 0.0001) and ICU stays (9 days vs 4 days, p < 0.0001) were longer in the subgroup receiving MV.


CONCLUSIONS
Mechanical ventilation appears to be an easily identifiable early marker for allogeneic blood exposure risk in ICU patients. While the longer ICU stays account for much of this risk, patients receiving MV also appear to undergo transfusions at higher hemoglobin thresholds than patients not receiving MV, at least early in the ICU stay. Justification of this relatively liberal transfusion practice in patients receiving MV will require further study.
Levy
Mitchell M
MM
Brown University School of Medicine, Division of Pulmonary and Critical Care Medicine, Rhode Island Hospital, 593 Eddy St, Main 7, Providence, RI, 02903, USA. mitchell_levy@brown.edu
Abraham
Edward
E
Zilberberg
Marya
M
MacIntyre
Neil R
NR
D018806:APACHE; D000740:Anemia / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D016638:Critical Illness; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data*; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial
D006454:Hemoglobins