M. Sethi1, C. T. Wilson1, P. R. Ayoung-Chee1, G. Marshall1, S. G. Frangos1, H. Diaz1, S. R. Todd1 1New York University School Of Medicine,Surgery,New York, NY, USA
Introduction:
Restrictive packed red blood cell (PRBC) transfusion practices (hemoglobin transfusion trigger < 7g/dl) are as effective if not superior to liberal transfusion practices in critically ill patients. A 2004 study noted compliance with this recommendation in less than 10% of ICU transfusions. Similarly, a 2012 prospective study performed at this Level 1 Trauma Center demonstrated that 52% of PRBC transfusions in SICU patients with hemoglobin > 7g/dl were clinically inappropriate. The objective of this study was to evaluate the efficacy of a PRBC Transfusion Guideline instituted in the SICU. We hypothesized that with the dissemination of this new guideline to clinical faculty and staff, the number of inappropriate PRBC transfusions would decrease.
Methods:
This was a prospective study of patients receiving PRBC transfusions in the SICU since the implementation of the PRBC Transfusion Guideline compared with the 2012 historic controls prior to its implementation. The PRBC Transfusion Guideline was developed based on best evidence and local expert opinion. Data evaluated included patient demographics, details surrounding the PRBC transfusions, and clinical outcomes.
Results:
Over 3 months, 32 SICU patients received 63 distinct PRBC transfusions for a total of 81 units. The study patients compared to historic controls were similar in age (51±18 years vs. 55±18, p=0.05), gender (62% male vs. 64% male, p=0.30) and APACHE II score (17.1±8.7 vs. 15±8.7, p=0.05). Following implementation of the PRBC Transfusion Guideline, pre-transfusion hemoglobin decreased from 7.6 to 7.4 (p=0.34). PRBC transfusions for hemoglobin > 7g/dl decreased from 64% to 57% (p=0.38). The percentage of clinically inappropriate transfusions in all SICU patients decreased from 31% to 17% (p=0.05).
Conclusion:
The implementation of a PRBC Transfusion Guideline decreased clinically inappropriate PRBC transfusions in the SICU. However, at 17%, the rate remains high. Numerous clinical factors alter such practices, despite a lack of supporting evidence. Education is needed to further decrease this rate.