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. 2009 Jun;37(6):1935-40.
doi: 10.1097/CCM.0b013e3181a0022d.

Red blood cell transfusion practices in acute lung injury: what do patient factors contribute?

David J Murphy  1 , David Howard, Angela Muriithi, Pedro Mendez-Tellez, Jonathan Sevransky, Carl Shanholtz, Giora Netzer, Peter J Pronovost, Dale M Needham
Affiliations

Red blood cell transfusion practices in acute lung injury: what do patient factors contribute?

David J Murphy et al. Crit Care Med. 2009 Jun.

Abstract

Objective: To describe red blood cell (RBC) transfusion practices and evaluate the association between patient-related factors and pretransfusion hemoglobin concentration in acute lung injury (ALI).

Design: Secondary analysis of prospectively collected data.

Setting: Nine intensive care units (ICUs) in three teaching hospitals in Baltimore, MD.

Patients: Two hundred forty-nine consecutive patients with ALI requiring mechanical ventilation.

Interventions: None.

Measurements and main results: Simple and multiple linear regression analyses were used to evaluate the association between the nadir hemoglobin concentration on the day of initial RBC transfusion and 20 patient-level demographic, clinical and ICU treatment factors as well as ICU type. Of 249 patients with ALI, 47% received an RBC transfusion in the ICU without evidence of active hemorrhage or acute cardiac ischemia. The mean (sd) nadir hemoglobin on the day of first transfusion was 7.7 (1.1) g/dL with 67%, 36%, 15%, and 5% of patients transfused at >7, >8, >9, and >10 g/dL, respectively. Transfused patients received a mean (sd) of 5 (6) RBC units from ALI diagnosis to ICU discharge. Prehospital use of iron or erythropoietin and platelet transfusion in the ICU were independently associated with lower pretransfusion hemoglobin concentrations. No patient factors were associated with higher hemoglobin concentrations. Admission to a surgical (vs. medical) ICU was independently associated with a 0.6 g/dL (95% confidence interval 0.1-1.1 g/dL) higher pretransfusion hemoglobin.

Conclusions: Patients with ALI commonly receive RBC transfusions in the ICU. The pretransfusion hemoglobin observed in our study was lower than earlier studies, but a restrictive strategy was not universally adopted. Patient factors do not explain the gap between clinical trial evidence and routine transfusion practices. Future studies should further explore ICU- and physician-related factors as a source of variability in transfusion practice.

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Figures

Figure 1
Figure 1
Enrollment of study participants ALI, acute lung injury; RBC, red blood cell
Figure 2
Figure 2
Distribution of nadir hemoglobin on the day of first RBC transfusion for 117 acute lung injury patients RBC, red blood cell
See this image and copyright information in PMC

Comment in

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