PURPOSE: A strategy of restrictive blood transfusion is accepted in the intensive care unit (ICU) setting. Optimal hemoglobin concentration for patients undergoing prolonged mechanical ventilation (PMV) is unknown. We evaluated hemoglobin replacement strategies in subjects undergoing prolonged mechanical ventilation (PMV).
METHODS: Chart review of red cell transfusion data in 135 subjects between March 1, 2002–February 28, 2003. Demographic and mechancial ventilation data has been previously reported in this cohort.
RESULTS: Twenty-seven percent (36/135) of subjects received red cell transfusions. Transfused subjects had lower hemoglobin (10.3±1.3 vs. 10.8±1.1 g/dl, p=0.04), lower serum albumin (2.0±0.5 versus 2.3±0.5 g/dl, p=0.008) and higher serum creatinine (1.29±0.7 versus 0.97±0.5 mg/dl, p=0.003) compared with non-transfused subjects. Subjects treated with epoetin alpha were more likely to receive a blood transfusion compared with those not receiving epoetin alpha (p=0.0007). Forty-seven percent (n=17) of transfused subjects required multiple red cell transfusions (range of red cell units transfused: 2–22) and had lower admission hemoglobin (9.9±1.3 versus 10.8±1.2 g/dl, p=0.04) and albumin (1.8±0.5 versus 2.2±0.3 g/dl, p=0.01) compared with those receiving a single red cell transfusion. There was no significant association between red cell transfusion and either ventilator associated pneumonia (p=0.12) or decannulation (p=0.15). There was a trend towards increased mortality in transfused subjects (p=0.06) compared with non-transfused subjects. Subjects undergoing transfusion had a longer length of stay (74 days, 45:158 vs. 49, 24:91, p=0.01, values expressed as median, first quartile:third quartile) and increased median cost of care ($62227, $30980:$128075 vs. $36036, $20297:$72668, p=0.04).
CONCLUSION: Subjects who received transfusions in an LTAC had significantly decreased hemoglobin, albumin, and renal function on admission compared with non-transfused subjects. Chronic critically ill subjects undergoing PMV required ongoing hemoglobin replacement, either in the form of erythropoetic agents or transfusions, and either treatment was associated with a longer length of stay and cost of care.
CLINICAL IMPLICATIONS: Evidence based practice guidelines are needed to assist in the use of hemoglobin replacement therapy in chronic critically ill patients undergoing prolonged mechanical ventilation.
DISCLOSURE: Heidi O Connor, No Financial Disclosure Information; No Product/Research Disclosure Information