PURPOSE: Restrictive blood transfusion strategies improve outcomes in intensive care unit (ICU) patients yet the 2004 CRIT trial reported that while 44% of ICU patients receive transfusions, only <8% were at the recommended hemoglobin concentration (Hgb) <7g/dL. The objective of this study was to describe current transfusion practices and determine if adherence with guidelines has improved over time.
METHODS: We performed a retrospective multicenter analysis of quarterly ICU blood transfusion data from the eICU® Program Network database over 3 years (1/05 to 12/07). Patients with hemorrhage, trauma, acute coronary syndrome, burns or admission to a neurocritical care unit were excluded. A transfusion (defined as each unit of blood administered) was considered appropriate if the lowest Hgb in the 24 hrs preceding each transfusion was <7g/dL. The primary outcome was the percentage of appropriate transfusions. The secondary outcome was the trend in appropriate transfusions over time. A subgroup analysis compared transfusion practices between community and academic hospitals. Negative binomial regression was used to examine trends and Chi-square to compare groups.
RESULTS: 46,283 patients from 175 hospitals and 316 ICUs received 128,231 blood transfusions between 2005 and 2007. Of these transfusions, 11.8% were appropriate (Hgb <7g/dL) while 65.6% were associated with a Hgb <9g/dL. Between 1/05 and 12/07, appropriate transfusions increased at a rate of 5.9% per quarter (6.9% to 15.2%; p<0.0001). 15.2% of transfusions were appropriate in academic hospitals compared with 9.5% in community hospitals (p<0.0001).
CONCLUSION: Restrictive transfusion strategies are not widely followed, however, in this population adherence has more than doubled between 2005 and 2007. Transfusions administered in academic hospitals were more likely to be associated with a Hgb <7g/dL.
CLINICAL IMPLICATIONS: Adoption of guidelines is increasing but the majority of transfusions still occur with a Hgb >7 g/dL. Further strategies are needed to reduce the number of transfusions associated with a Hgb >7g/dL in both academic and community hospitals.
DISCLOSURE: Jeannette Ploetz, Employee Dr. Badawi: VISICU employee; Dr. Rosenfeld: VISICU employee; No Product/Research Disclosure Information