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Practice Guideline
. 2021 Dec;47(12):1368-1392.
doi: 10.1007/s00134-021-06531-x. Epub 2021 Oct 22.

Transfusion strategies in bleeding critically ill adults: a clinical practice guideline from the European Society of Intensive Care Medicine

Alexander P J Vlaar #  1 , Joanna C Dionne #  2   3   4   5 , Sanne de Bruin  6 , Marije Wijnberge  6   7 , S Jorinde Raasveld  6 , Frank E H P van Baarle  6 , Massimo Antonelli  8   9 , Cecile Aubron  10 , Jacques Duranteau  11 , Nicole P Juffermans  12   13 , Jens Meier  14 , Gavin J Murphy  15 , Riccardo Abbasciano  15 , Marcella C A Müller  6 , Marcus Lance  16 , Nathan D Nielsen  17 , Herbert Schöchl  18   19 , Beverley J Hunt  20 , Maurizio Cecconi  21   22 , Simon Oczkowski  2   3   4
Affiliations
Practice Guideline

Transfusion strategies in bleeding critically ill adults: a clinical practice guideline from the European Society of Intensive Care Medicine

Alexander P J Vlaar et al. Intensive Care Med. 2021 Dec.

Abstract

Purpose: To develop evidence-based clinical practice recommendations regarding transfusion practices and transfusion in bleeding critically ill adults.

Methods: A taskforce involving 15 international experts and 2 methodologists used the GRADE approach to guideline development. The taskforce addressed three main topics: transfusion support in massively and non-massively bleeding critically ill patients (transfusion ratios, blood products, and point of care testing) and the use of tranexamic acid. The panel developed and answered structured guideline questions using population, intervention, comparison, and outcomes (PICO) format.

Results: The taskforce generated 26 clinical practice recommendations (2 strong recommendations, 13 conditional recommendations, 11 no recommendation), and identified 10 PICOs with insufficient evidence to make a recommendation.

Conclusions: This clinical practice guideline provides evidence-based recommendations for the management of massively and non-massively bleeding critically ill adult patients and identifies areas where further research is needed.

Keywords: Bleeding; Coagulopathy; Critically ill; Guideline; Intensive care; Plasma; Platelets; Point of care; Red blood cells; Tranexamic acid; Transfusion.

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Conflict of interest statement

None.

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