SESSION TYPE: ICU Safety and Improvement Strategies
PRESENTED ON: Tuesday, October 23, 2012 at 02:45 PM - 04:15 PM
PURPOSE: Blood products are an expensive and scarce resource. The objective of this study was to analyze the transfusion practices in an oncologic ICU focusing on patients within 48 hours of death.
METHODS: Using ICU and hospital blood-bank reports, we determined the quantity of transfused blood products (RBC-Red Blood Cells, FFP-Fresh Frozen Plasma, and platelets) among patients within 48 hours of death in a 20-bed adult medical-surgical ICU between January 2010 and March 2011. We further analyzed the association of a DNR order and blood product administration.
RESULTS: 760 (58.8%) of 1293 ICU admissions received blood products during their ICU stay. A mean of 2.9 units of RBCs, 2.7 units of platelets and 1.3 units of FFP were transfused per admission. 169 (22%) of the transfused patients died in the ICU. Of those, 69 (40. 8%) received blood products within 48 hours of death (51 (74%) received RBCs, 27 (40%) received platelets, and 15 (22%) received FFP). 48 patients (70% of those who received blood products within 48 hours of death) had a DNR order.
CONCLUSIONS: We demonstrate a significant utilization of blood products among critically ill cancer patients at the end-of-life, even in the presence of a DNR order. Further studies are needed to determine the appropriate use of blood products for these patients.
CLINICAL IMPLICATIONS: Clinicians should carefully weigh the use of blood products among cancer patients near the end-of-life in the ICU.
DISCLOSURE: The following authors have nothing to disclose: Hala Moukhachen, Kaye Hale, Stephen Pastores, Quentin Miller, Khy Huynh, Timothy Neville, Neil Halpern
No Product/Research Disclosure InformationCritical Care Medicine Service, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY