title: The future of observational research and randomized controlled trials in red blood cell transfusion medicine.
abstract: Red blood cell (RBC) transfusions are commonplace in the intensive care unit (ICU) with at least 30% of ICU patients receiving a RBC transfusion at some point during their ICU stay. However, which patients should be transfused and what transfusion trigger(s) should be used remains unclear. RBC transfusion can be associated with adverse effects, but anemia is also associated with worse outcomes. Observational studies and randomized controlled trials (RCTs) have been conducted to try and answer some of the questions surrounding blood transfusion in critically ill patients. The need for blood transfusion and the benefit/risk ratio vary according to individual patient characteristics, including age and comorbidities, so large-scale RCTs in heterogeneous groups of patients may not be the most appropriate tool to investigate these issues; smaller RCTs in carefully defined patient groups may provide more useful information. Rigorous statistical analysis of large, carefully conducted observational studies will also help enhance our evidence-base in this field.
authors.affiliation: *Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium; and †Department of Anesthesiology and Intensive Care, Uniklinikum Jena, Jena, Germany.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vincent
authors.forename: Yasser
authors.initials: Y
authors.lastname: Sakr
authors.forename: Christophe
authors.initials: C
authors.lastname: Lelubre
mesh_terms: D001803:Blood Transfusion / Q000379:methods*; D003422:Critical Care / Q000379:methods; D017707:Erythrocyte Transfusion / Q000379:methods* / Q000639:trends; D006470:Hemorrhage / Q000628:therapy; D006801:Humans; D007362:Intensive Care Units; D064887:Observational Studies as Topic; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D012769:Shock / Q000628:therapy; D016896:Treatment Outcome