Transfusion practice in the non-bleeding critically ill: an international online survey—the TRACE survey

Background Over the last decade, multiple large randomized controlled trials have studied alternative transfusion strategies in critically ill patients, demonstrating the safety of restrictive transfusion strategies. Due to the lack of international guidelines specific for the intensive care unit (I...

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Veröffentlicht in:	Critical care (London, England) Jg. 23; H. 1; S. 309 - 8
Hauptverfasser:	de Bruin, Sanne, Scheeren, Thomas W. L., Bakker, Jan, van Bruggen, Robin, Vlaar, Alexander P. J.
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	London BioMed Central 11.09.2019 BioMed Central Ltd Springer Nature B.V BMC
Schlagworte:	Blood platelets Blood transfusion Blood Transfusion - methods Blood Transfusion - trends Blood transfusions Brain injuries Care and treatment Critical care Critical Care Medicine Critical Illness - therapy Critically ill Critically ill persons Emergency Medicine Erythrocytes Hemoglobins Hospital patients Humans Intensive Intensive care Intensive Care Units - organization & administration Intensive Care Units - statistics & numerical data Internet Medical practice Medicine Medicine & Public Health Methods Physicians Plasma Platelet transfusion Platelets Red blood cells Standard of Care - trends Surveys Surveys and Questionnaires Transfusion practice Chile Plasma Transfusion practice Red blood cells Platelets Critically ill
ISSN:	1364-8535, 1466-609X, 1364-8535, 1466-609X, 1366-609X
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Zusammenfassung:	Background Over the last decade, multiple large randomized controlled trials have studied alternative transfusion strategies in critically ill patients, demonstrating the safety of restrictive transfusion strategies. Due to the lack of international guidelines specific for the intensive care unit (ICU), we hypothesized that a large heterogeneity in transfusion practice in this patient population exists. The aims of this study were to describe the current transfusion practices and identify the knowledge gaps. Methods An online, anonymous, worldwide survey among ICU physicians was performed evaluating red blood cell, platelet and plasma transfusion practices. Furthermore, the presence of a hospital- or ICU-specific transfusion guideline was asked. Only completed surveys were analysed. Results Nine hundred forty-seven respondents filled in the survey of which 725 could be analysed. Hospital transfusion protocol available in their ICU was reported by 53% of the respondents. Only 29% of respondents used an ICU-specific transfusion guideline. The reported haemoglobin (Hb) threshold for the general ICU population was 7 g/dL (7–7). The highest reported variation in transfusion threshold was in patients on extracorporeal membrane oxygenation or with brain injury (8 g/dL (7.0–9.0)). Platelets were transfused at a median count of 20 × 10 9 cells/L IQR (10–25) in asymptomatic patients, but at a higher count prior to invasive procedures ( p < 0.001). In patients with an international normalized ratio (INR) > 3, 43% and 57% of the respondents would consider plasma transfusion without any upcoming procedures or prior to a planned invasive procedure, respectively. Finally, doctors with base specialty in anaesthesiology transfused critically ill patients more liberally compared to internal medicine physicians. Conclusion Red blood cell transfusion practice for the general ICU population is restrictive, while for different subpopulations, higher Hb thresholds are applied. Furthermore, practice in plasma and platelet transfusion is heterogeneous, and local transfusion guidelines are lacking in the majority of the ICUs.
Bibliographie:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23
ISSN:	1364-8535 1466-609X 1364-8535 1466-609X 1366-609X
DOI:	10.1186/s13054-019-2591-6