Critical Care: Miscellaneous Critical Care |

Transfusions in Noninvasive Ventilation FREE TO VIEW

Adam Hayek, DO; Chhaya Patel, MD; Peter Yau, MD; Eileen Stock, PhD; Alejandro Arroliga, MD; Shekhar Ghamande, MD
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Scott & White Hospital, Temple, TX

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):327A. doi:10.1016/j.chest.2016.08.340
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SESSION TITLE: Miscellaneous Critical Care

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Critically ill patients are at risk for microvascular and immunosuppressive complications as well as transfusion related acute lung injury and are at risk for progression into acute respiratory distress syndrome. A restrictive strategy for transfusion in critically ill patients is as effective as a liberal transfusion strategy. We hypothesized that patients with acute respiratory failure (ARF) managed with non-invasive ventilation (NIV) receiving pack red blood cell (PRBC) transfusion will have similar outcomes independent of the threshold of hemoglobin when they are transfused (≤ or > 7 g/dL).

METHODS: A prospective, observational study of consecutive patients requiring NIV during a nine-month period. Patients were categorized by their transfusion status (Yes vs No) and pretransfusion hemoglobin (≤ 7 vs >7). Additionally, clinical respiratory diagnoses were recorded. Outcomes analyzed included inpatient death, 28-day mortality, intubation, ICU admission, 30-day readmission, and hospital length of stay (LOS).

RESULTS: Among 1,957 patients using NIV, 647 patients met inclusion criteria. 54% were female, with an average age of 64 years and BMI of 34 and Charlson Comorbidity Index of 4.4 (SD=2.8). The inpatient mortality was 7%, 28-day mortality 10%, ICU admission 35%, intubation 13%, and 30-day readmission 19%, with an average LOS of 7 days. The majority of patients had COPD (39%), CHF (38%) and pneumonia (36%) with an average of 1.7 respiratory diagnoses per patient. Ninety-seven patients were transfused with a median of 2 (1-18) units of PRBC. Of those transfused, CHF (49%) was the most common diagnosis followed by COPD (31%). Patients transfused had longer LOS (median of 13 vs. 4 days), higher rates of intubation (25% vs. 11%), ICU admission (55% vs. 32%) and 28-day mortality (18% vs. 9%). Outcomes were unchanged if pre-transfusion hemoglobin was >7 g/dL vs ≤7 g/dL. Liberal transfusions (Hgb >7g/dl) occurred more often with the diagnosis of CHF (51%) and in the elderly (63.3 vs 67.3 p = 0.01).

CONCLUSIONS: Patients with ARF managed with NIV who were transfused had higher rates of intubation, ICU admission, 28-day mortality and a longer LOS. As seen in the TRICC trial, these outcomes were not statistically different with either restrictive (Hgb ≤7) or liberal (Hgb>7) pretransfusion hemoglobin.

CLINICAL IMPLICATIONS: This study adds transfusions to the growing literature of parameters associated with NIV failure when risk stratifying patients utilizing NIV.

DISCLOSURE: The following authors have nothing to disclose: Adam Hayek, Chhaya Patel, Peter Yau, Eileen Stock, Alejandro Arroliga, Shekhar Ghamande

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