A national clinical scenario-based survey of clinicians' attitudes towards fresh frozen plasma transfusion for critically ill patients.
BACKGROUND
It is known that 20-30% of fresh frozen plasma (FFP) is used in intensive care units (ICUs), but little is known about variations in decision making between clinicians in relation to coagulopathy management. Our aim was to describe ICU clinicians' beliefs and practice in relation to FFP treatment of non-bleeding coagulopathic critically ill patients.


METHODS
Two patient-based scenarios were developed and sent to 2700 members of two UK intensive care professional societies. Scenario 1 was a non-bleeding septic patient with coagulopathy; scenario 2 was a non-bleeding critically ill patient with hepatic cirrhosis and coagulopathy. Responses were sought in relation to FFP prophylaxis, and prior to central venous cannulation. A supplementary question asked clinicians' view of prophylaxis in relation to other ICU procedures.


RESULTS
Two-thousand-and-seven-hundred clinicians were surveyed from whom 601 responses were received (22·3% response rate). For scenario 1 52% of respondents stated that they would never routinely administer prophylactic FFP, but this decreased to 9% when central venous cannulation was planned (P < 0·01). There was wide variation in the 'trigger' INR (international normalised ratio) value used prior to central vein cannulation, the most common range being 2·0-2·4. For scenario 2, responses were very similar. More than 80% of clinicians stated that they would routinely treat coagulopathy prior to lumbar puncture, epidural catheterisation, intracranial pressure monitoring and tracheostomy; and 54% prior to chest drain insertion.


CONCLUSIONS
Our survey demonstrated a wide range of responses consistent with important variations in clinical practice and substantial clinical uncertainty in relation to FFP treatment for non-bleeding ICU patients.
Better Blood Transfusion, Scottish National Blood Transfusion Service, Glasgow, UK. douglaswatson@nhs.net
D M
DM
Watson
S J
SJ
Stanworth
D
D
Wyncoll
D F
DF
McAuley
G D
GD
Perkins
D
D
Young
K J
KJ
Biggin
T S
TS
Walsh
D001291:Attitude of Health Personnel; D001778:Blood Coagulation Disorders / Q000628:therapy; D016913:Blood Component Transfusion / Q000191:economics / Q000523:psychology* / Q000706:statistics & numerical data; D058731:Blood Safety; D002405:Catheterization, Central Venous; D015505:Chest Tubes; D003422:Critical Care / Q000191:economics / Q000379:methods* / Q000523:psychology / Q000706:statistics & numerical data; D016638:Critical Illness / Q000628:therapy*; D003625:Data Collection; D003953:Diagnosis-Related Groups; D006801:Humans; D007362:Intensive Care Units; D019934:International Normalized Ratio; D007427:Intracranial Pressure; D010820:Physicians / Q000523:psychology*; D010949:Plasma; D011364:Professional Practice; D011677:Punctures; D014139:Tracheostomy