title: Red blood cell transfusion practices in acute lung injury: what do patient factors contribute?
abstract: OBJECTIVE
  To describe red blood cell (RBC) transfusion practices and evaluate the association between patient-related factors and pretransfusion hemoglobin concentration in acute lung injury (ALI).
  
  
  METHODS
  Secondary analysis of prospectively collected data.
  
  
  METHODS
  Nine intensive care units (ICUs) in three teaching hospitals in Baltimore, MD.
  
  
  METHODS
  Two hundred forty-nine consecutive patients with ALI requiring mechanical ventilation.
  
  
  METHODS
  None.
  
  
  RESULTS
  Simple and multiple linear regression analyses were used to evaluate the association between the nadir hemoglobin concentration on the day of initial RBC transfusion and 20 patient-level demographic, clinical and ICU treatment factors as well as ICU type. Of 249 patients with ALI, 47% received an RBC transfusion in the ICU without evidence of active hemorrhage or acute cardiac ischemia. The mean (sd) nadir hemoglobin on the day of first transfusion was 7.7 (1.1) g/dL with 67%, 36%, 15%, and 5% of patients transfused at >7, >8, >9, and >10 g/dL, respectively. Transfused patients received a mean (sd) of 5 (6) RBC units from ALI diagnosis to ICU discharge. Prehospital use of iron or erythropoietin and platelet transfusion in the ICU were independently associated with lower pretransfusion hemoglobin concentrations. No patient factors were associated with higher hemoglobin concentrations. Admission to a surgical (vs. medical) ICU was independently associated with a 0.6 g/dL (95% confidence interval 0.1-1.1 g/dL) higher pretransfusion hemoglobin.
  
  
  CONCLUSIONS
  Patients with ALI commonly receive RBC transfusions in the ICU. The pretransfusion hemoglobin observed in our study was lower than earlier studies, but a restrictive strategy was not universally adopted. Patient factors do not explain the gap between clinical trial evidence and routine transfusion practices. Future studies should further explore ICU- and physician-related factors as a source of variability in transfusion practice.
authors.affiliation: Division of Pulmonary/Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Murphy
authors.forename: David
authors.initials: D
authors.lastname: Howard
authors.forename: Angela
authors.initials: A
authors.lastname: Muriithi
authors.forename: Pedro
authors.initials: P
authors.lastname: Mendez-Tellez
authors.forename: Jonathan
authors.initials: J
authors.lastname: Sevransky
authors.forename: Carl
authors.initials: C
authors.lastname: Shanholtz
authors.forename: Giora
authors.initials: G
authors.lastname: Netzer
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Pronovost
authors.forename: Dale M
authors.initials: DM
authors.lastname: Needham
mesh_terms: D055371:Acute Lung Injury / Q000097:blood / Q000628:therapy*; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data*; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D006454:Hemoglobins