title: Should we restrict erythrocyte transfusion in early goal directed protocols?
abstract: BACKGROUND
  Early goal-directed therapy has been endorsed in the guidelines of the Surviving Sepsis Campaign as a key strategy among patients presenting with severe sepsis or septic shock. But more importantly, early goal-directed therapy also became standard care for non-septic critically ill patients and was adopted for high-risk surgical patients.
  
  
  CONCLUSIONS
  Importantly, transfusion of red blood cells is a central part of many protocols of early goal-directed therapy to indicate the need for use of inotropes and red blood cells, as both central venous saturation and hematocrit are used as transfusion triggers. However, burgeoning data has strongly linked transfusion with worse clinical outcomes. If correct, could these early goal-directed therapy 'bundles' have better outcome if a restrictive transfusion practice is adopted?
  
  
  CONCLUSIONS
  Early goal-directed therapy has evolved as standard care for most of critically ill patients, and many protocols contain transfusion of red blood cells targeting high hemoglobin level as a key element. As red blood cell transfusions are associated with increased morbidity and mortality, transfusion thresholds need to be more individualized.
authors.affiliation: Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany. patrick.meybohm@kgu.de.
authors.forename: Patrick
authors.initials: P
authors.lastname: Meybohm
authors.affiliation: Department of Anesthesiology and Critical Care and Hyperbaric Medicine, Englewood Hospital and Medical Center, Anesthesiology and Critical Care and Hyperbaric Medicine, Englewood, NJ, USA. Aryeh.Shander@ehmc.com.
authors.forename: Aryeh
authors.initials: A
authors.lastname: Shander
authors.affiliation: Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany. kai.zacharowski@kgu.de.
authors.forename: Kai
authors.initials: K
authors.lastname: Zacharowski
mesh_terms: D002985:Clinical Protocols; D016638:Critical Illness / Q000628:therapy*; D017707:Erythrocyte Transfusion / Q000379:methods*; D006040:Goals; D006801:Humans; D010347:Patient Care Planning; D018805:Sepsis / Q000628:therapy; D012772:Shock, Septic / Q000628:therapy; D014184:Transplantation, Homologous; D019564:Unnecessary Procedures