PURPOSE: Patients needing prolonged mechanical ventilation (MV) often develop anemia and receive packed red blood cell (pRBC) transfusions.(1) Although clinical trial data suggest that routine transfusions may not improve outcomes in MV patients,(2) it is unclear if medical practice has changed in response to those data. Additionally, little is known about transfusion practices among those on prolonged MV.
METHODS: A retrospective analysis of a large integrated claims database covering a 5-year period (Jan. 2000 -Dec. 2005) was conducted on adult patients on prolonged MV (defined via ICD-9 codes for ≥96 hours of MV). Primary and secondary endpoints were frequency of pRBC transfusion and pretransfusion Hb, respectively. Transfusion data were obtained from linked blood bank records.
RESULTS: Study cohort included 4,344 hospitalized patients on prolonged MV (55% male, mean age: 61.5 ± 16.4 years). Tracheotomy and hospital mortality rates were 71.2% and 29.5%, respectively. Although Hb upon admission was >10g/dL in 75% of patients, 67% (N=2,912) received at least one pRBC transfusion with a mean of 9.1 ± 12.0 units of blood transfused per patient. Of the 7,787 total transfusion episodes occurring in this population during the study period, the mean pretransfusion Hb was 8.2 ± 1.4 g/dL. Only 12% of transfusions were given at Hb <7 g/dL and 7% at Hb >10 g/dL.
CONCLUSION: Critically ill patients on prolonged MV are still frequently transfused. Despite evidence indicating that these patients may tolerate a Hb of 7 g/dL without compromising outcomes,(2) the pretransfusion Hb is often well above this threshold.
CLINICAL IMPLICATIONS: Prolonged MV patients are at high risk for transfusion and may need alternative strategies to reduce that risk given current practice.Refs:1.Levy MM et al. Chest 2005;127:928-935.2.Hebert PC et al Chest 2001;119:1850-1857.
DISCLOSURE: Marya Zilberberg, Grant monies (from industry related sources) This study was supported by Ortho Biotech Clinical Affairs, LLC.; Employee Marya D. Zilberberg is an employee of Ortho Biotech Clinical Affairs, LLC.