PURPOSE: To prospectively define the incidence of anemia and use of red blood cell (RBC) transfusions in critically ill patients and to explore the potential benefits and risks associated with transfusion in the ICU.
METHODS: Single center Interventional Prospective Quasi-randomized controlled study conducted between April 1st 2008 and April 1st 2009 at Henry Ford medical center in Detroit Michigan. This study included a total of 408 patients that met inclusion criteria were randomized to one of two groups (PODs) by bed assignment, 183 Patients were admitted to POD 1, (interventional group) and 218 patients were admitted to POD 2 (Control) Interventions 1. Use of blood conserving device VAMP on arterial and central lines 2. Routine use of Pediatrics Phlebotomy tubes. 3. Standardized transfusion triggers -Trigger for blood transfusion in non bleeding stable patients <7g/dl -In Septic patients as part of the resuscitation Bundle >10g/dl -Anemia and Myocardial infarction Co-existing >10g/dl -In acutely bleeding patients will be transfused to Hb of 10g/dl
RESULTS: The Transfusion rate during the ICU period was 31.1% in the intervention group vs. 41.7% in the control group, (p 0.029), and the mean total of parked red cell units transfused is 0.8 vs. 1.4 units representing a 42% decrease (p 0.012), there was no difference in hospital mortality but there was a clear trend towards improved hospital mortality 19.1% vs. 26.6% (p 0.077). there was no difference between the 2 groups in utilization of Aranesp or Epogen.
CONCLUSIONS: Utilization of our anemia bundle in the ICU resulted in a significant reduction in the incidence of anemia and the amount of blood transfused in the ICU, there was also a trend towards improved hospital mortality.
CLINICAL IMPLICATIONS: Combination of multiple strategies in an anemia bundle resulted in a significant reduction in the incidence of anemia and blood transfusion in the medical intensive care unit.
DISCLOSURE: The following authors have nothing to disclose: Razaq Badamosi, Bruno DiGiovine, Haris Rana, Juan Iribarren, Beth McClellan
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