title: Liberal Versus Restrictive Transfusion Strategy in Critically Ill Oncologic Patients: The Transfusion Requirements in Critically Ill Oncologic Patients Randomized Controlled Trial.
abstract: OBJECTIVE
  To assess whether a restrictive strategy of RBC transfusion reduces 28-day mortality when compared with a liberal strategy in cancer patients with septic shock.
  
  
  METHODS
  Single center, randomized, double-blind controlled trial.
  
  
  METHODS
  Teaching hospital.
  
  
  METHODS
  Adult cancer patients with septic shock in the first 6 hours of ICU admission.
  
  
  METHODS
  Patients were randomized to the liberal (hemoglobin threshold, < 9 g/dL) or to the restrictive strategy (hemoglobin threshold, < 7 g/dL) of RBC transfusion during ICU stay.
  
  
  RESULTS
  Patients were randomized to the liberal (n = 149) or to the restrictive transfusion strategy (n = 151) group. Patients in the liberal group received more RBC units than patients in the restrictive group (1 [0-3] vs 0 [0-2] unit; p < 0.001). At 28 days after randomization, mortality rate in the liberal group (primary endpoint of the study) was 45% (67 patients) versus 56% (84 patients) in the restrictive group (hazard ratio, 0.74; 95% CI, 0.53-1.04; p = 0.08) with no differences in ICU and hospital length of stay. At 90 days after randomization, mortality rate in the liberal group was lower (59% vs 70%) than in the restrictive group (hazard ratio, 0.72; 95% CI, 0.53-0.97; p = 0.03).
  
  
  CONCLUSIONS
  We observed a survival trend favoring a liberal transfusion strategy in patients with septic shock when compared with the restrictive strategy. These results went in the opposite direction of the a priori hypothesis and of other trials in the field and need to be confirmed.
authors.affiliation: 1Intensive Care Unit and Department of Anesthesiology, Instituto do Cancer, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil. 2Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy. 3Department of Infectious Diseases, Hospital Infection Control and Infectious Diseases Unit, Instituto do Cancer do Estado de São Paulo, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil. 4Department of Cardiopneumology, Instituto do Coracao, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil.
authors.forename: Fabricio S
authors.initials: FS
authors.lastname: Bergamin
authors.forename: Juliano P
authors.initials: JP
authors.lastname: Almeida
authors.forename: Giovanni
authors.initials: G
authors.lastname: Landoni
authors.forename: Filomena R B G
authors.initials: FRBG
authors.lastname: Galas
authors.forename: Julia T
authors.initials: JT
authors.lastname: Fukushima
authors.forename: Evgeny
authors.initials: E
authors.lastname: Fominskiy
authors.forename: Clarice H L
authors.initials: CHL
authors.lastname: Park
authors.forename: Eduardo A
authors.initials: EA
authors.lastname: Osawa
authors.forename: Maria P E
authors.initials: MPE
authors.lastname: Diz
authors.forename: Gisele Q
authors.initials: GQ
authors.lastname: Oliveira
authors.forename: Rafael A
authors.initials: RA
authors.lastname: Franco
authors.forename: Rosana E
authors.initials: RE
authors.lastname: Nakamura
authors.forename: Elisangela M
authors.initials: EM
authors.lastname: Almeida
authors.forename: Edson
authors.initials: E
authors.lastname: Abdala
authors.forename: Maristela P
authors.initials: MP
authors.lastname: Freire
authors.forename: Roberto K
authors.initials: RK
authors.lastname: Filho
authors.forename: Jose Otavio C
authors.initials: JOC
authors.lastname: Auler
authors.forename: Ludhmila A
authors.initials: LA
authors.lastname: Hajjar
mesh_terms: D000368:Aged; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000401:mortality; D004311:Double-Blind Method; D017707:Erythrocyte Transfusion / Q000379:methods*; D005260:Female; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy*; D013997:Time Factors