title: Successful implementation of a packed red blood cell and fresh frozen plasma transfusion protocol in the surgical intensive care unit.
abstract: BACKGROUND
  Blood product transfusions are associated with increased morbidity and mortality. The purpose of this study was to determine if implementation of a restrictive protocol for packed red blood cell (PRBC) and fresh frozen plasma (FFP) transfusion safely reduces blood product utilization and costs in a surgical intensive care unit (SICU).
  
  
  METHODS
  We performed a retrospective, historical control analysis comparing before (PRE) and after (POST) implementation of a restrictive PRBC/FFP transfusion protocol for SICU patients. Univariate analysis was utilized to compare patient demographics and blood product transfusion totals between the PRE and POST cohorts. Multivariate logistic regression models were developed to determine if implementation of the restrictive transfusion protocol is an independent predictor of adverse outcomes after controlling for age, illness severity, and total blood products received.
  
  
  RESULTS
  829 total patients were included in the analysis (PRE, n=372; POST, n=457). Despite higher mean age (56 vs. 52 years, p=0.01) and APACHE II scores (12.5 vs. 11.2, p=0.006), mean units transfused per patient were lower for both packed red blood cells (0.7 vs. 1.2, p=0.03) and fresh frozen plasma (0.3 vs. 1.2, p=0.007) in the POST compared to the PRE cohort, respectively. There was no difference in inpatient mortality between the PRE and POST cohorts (7.5% vs. 9.2%, p=0.39). There was a decreased risk of urinary tract infections (OR 0.47, 95%CI 0.28-0.80) in the POST cohort after controlling for age, illness severity and amount of blood products transfused.
  
  
  CONCLUSIONS
  Implementation of a restrictive transfusion protocol can effectively reduce blood product utilization in critically ill surgical patients with no increase in morbidity or mortality.
authors.affiliation: Department of Surgery, University of Florida College of Medicine, Gainesville, FL, 32610, United States of America.
authors.forename: Benjamin E
authors.initials: BE
authors.lastname: Szpila
authors.affiliation: Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, 32610, United States of America.
authors.forename: Tezcan
authors.initials: T
authors.lastname: Ozrazgat-Baslanti
authors.affiliation: Department of Surgery, University of Florida College of Medicine, Gainesville, FL, 32610, United States of America.
authors.forename: Jianyi
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Surgery, University of Florida College of Medicine, Gainesville, FL, 32610, United States of America.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Lanz
authors.affiliation: Department of Surgery, University of Florida College of Medicine, Gainesville, FL, 32610, United States of America.
authors.forename: Ruth
authors.initials: R
authors.lastname: Davis
authors.affiliation: Department of Anesthesia, University of Kentucky College of Medicine, Lexington, KY, 40506, United States of America.
authors.forename: Annette
authors.initials: A
authors.lastname: Rebel
authors.affiliation: Department of Surgery, University of Florida College of Medicine, Gainesville, FL, 32610, United States of America.
authors.forename: Erin
authors.initials: E
authors.lastname: Vanzant
authors.affiliation: Department of Surgery, University of Florida College of Medicine, Gainesville, FL, 32610, United States of America.
authors.forename: Lori F
authors.initials: LF
authors.lastname: Gentile
authors.affiliation: Department of Surgery, University of Florida College of Medicine, Gainesville, FL, 32610, United States of America.
authors.forename: Alex G
authors.initials: AG
authors.lastname: Cuenca
authors.affiliation: Department of Surgery, University of South Florida, Tampa, FL, 33612, United States of America.
authors.forename: Darwin N
authors.initials: DN
authors.lastname: Ang
authors.affiliation: Department of Surgery, University of South Florida, Tampa, FL, 33612, United States of America.
authors.forename: Huazhi
authors.initials: H
authors.lastname: Liu
authors.affiliation: Department of Surgery, University of Florida College of Medicine, Gainesville, FL, 32610, United States of America.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Lottenberg
authors.affiliation: Department of Nursing, University of Florida College of Medicine, Gainesville, FL, 32610, United States of America.
authors.forename: Peggy
authors.initials: P
authors.lastname: Marker
authors.affiliation: Department of Medicine, University of Florida College of Medicine, Gainesville, FL, 32610, United States of America.
authors.forename: Marc
authors.initials: M
authors.lastname: Zumberg
authors.affiliation: Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, 32610, United States of America.
authors.forename: Azra
authors.initials: A
authors.lastname: Bihorac
authors.affiliation: Department of Surgery, University of Florida College of Medicine, Gainesville, FL, 32610, United States of America.
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Moore
authors.affiliation: Department of Surgery, University of Florida College of Medicine, Gainesville, FL, 32610, United States of America.
authors.forename: Scott
authors.initials: S
authors.lastname: Brakenridge
authors.affiliation: Department of Surgery, University of Florida College of Medicine, Gainesville, FL, 32610, United States of America.
authors.forename: Philip A
authors.initials: PA
authors.lastname: Efron
mesh_terms: D003422:Critical Care; D003710:Demography; D017707:Erythrocyte Transfusion / Q000379:methods*; D005260:Female; D006400:Hematocrit; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010949:Plasma / Q000378:metabolism*; D014552:Urinary Tract Infections / Q000097:blood