title: The impact of packed red blood cell transfusion on clinical outcomes in patients with septic shock treated with early goal directed therapy.
abstract: BACKGROUND
  The optimal hemoglobin level and transfusion threshold in patients with septic shock treated with an early, goal oriented approach to resuscitation remains unknown.
  
  
  OBJECTIVE
  To assess the impact of packed red blood cell (PRBC) transfusion on clinically relevant outcomes in patients with septic shock treated with early goal directed therapy (EGDT).
  
  
  METHODS
  Retrospective cohort study of 93 patients who presented with septic shock, to a single center academic intensive care unit and received EGDT.
  
  
  METHODS
  Data were collected on patients identified via the Surviving Sepsis Campaign Chart Review database and linked to Project IMPACT database. The PRBC group and no PRBC group were compared by the Pearson chi-square and Fisher's exact test to analyze statistical significance.
  
  
  RESULTS
  The PRBC group had a mortality of 41.2% vs. 33.9% in the no PRBC transfusion group (P = NS). The PRBC group also had more mechanical ventilation days (11.2 days vs. 5.0 days, (P ≤ 0.05), longer hospital length of stay (25.9 days vs. 12.5 days, (P ≤ 0.05), and longer intensive care unit length of stay (11.4 days vs. 3.8 days, (P ≤ 0.05).
  
  
  CONCLUSIONS
  In this retrospective cohort study, transfusion of PRBCs was associated with worsened clinical outcomes in patients with septic shock treated with EGDT. Further studies are needed to determine the impact of transfusion of PRBC within the context of early resuscitation of patients with septic shock, as the beneficial effects gained by an early and goal oriented approach to resuscitation may be lost by the negative effects associated with PRBC transfusion.
authors.affiliation: Department of Anesthesiology, Division of Critical Care Medicine, and the Division of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Fuller
authors.forename: Mithil
authors.initials: M
authors.lastname: Gajera
authors.forename: Christa
authors.initials: C
authors.lastname: Schorr
authors.forename: David
authors.initials: D
authors.lastname: Gerber
authors.forename: R Phillip
authors.initials: RP
authors.lastname: Dellinger
authors.forename: Joseph
authors.initials: J
authors.lastname: Parrillo
authors.forename: Sergio
authors.initials: S
authors.lastname: Zanotti