A clinical scenario-based survey of transfusion decisions for intensive care patients with delayed weaning from mechanical ventilation.
BACKGROUND
Despite evidence supporting the use of restrictive hemoglobin (Hb) transfusion triggers in critically ill patients, translation of this evidence into practice remains inconsistent. It was hypothesized that clinicians believe that longer-term ventilated patients require a higher Hb, particularly when ischemic heart disease coexists.


METHODS
A scenario was developed describing an anemic patient recovering from multiple organ failure, but failing weaning trials after 6 days of mechanical ventilation. Clinicians were asked to state their Hb transfusion trigger and target Hb range assuming no history of ischemic heart disease (Scenario 1), known stable chronic ischemic heart disease (Scenario 2), or evidence of myocardial ischemia during weaning trials (Scenario 3). A prospective cross-sectional postal survey of clinicians practicing intensive care in the United Kingdom was undertaken.


RESULTS
A total of 184 responses were obtained (52% response rate), which varied widely. Median (first, third quartile) transfusion trigger Hb levels were 8 (7, 8), 9 (8, 9.5), and 9.5 (9, 9.5) g/dL for Scenarios 1 to 3, respectively (p < 0.001 across and between each group). The target Hb was more than 9 g/dL for 47, 80, and 94% of respondents for Scenarios 1 to 3, respectively, and more than 10 g/dL for 14, 44, and 65% of respondents for Scenarios 1 to 3, respectively (p < 0.001 across the groups).


CONCLUSIONS
In response to scenarios, clinicians in the United Kingdom believe that a more liberal transfusion practice is required for patients failing weaning trials after 6 days of mechanical ventilation than the current evidence base supports.
Walsh
Timothy S
TS
Anaesthetics, Critical Care and Pain Medicine, Edinburgh Royal Infirmary, and Orthopaedic Surgery, University of Edinburgh, Little France Crescent, Edinburgh, Scotland. twalsh@staffmail.ed.ac.uk
Maciver
Caroline R
CR
D000740:Anemia / Q000628:therapy*; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D003422:Critical Care / Q000706:statistics & numerical data; D016638:Critical Illness / Q000628:therapy*; D003430:Cross-Sectional Studies; D003657:Decision Making; D019538:Health Care Surveys; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008511:Medicine; D009102:Multiple Organ Failure / Q000628:therapy; D011364:Professional Practice; D006113:United Kingdom; D015300:Ventilator Weaning / Q000706:statistics & numerical data
D006454:Hemoglobins