Monday November 3, 2008
Impact of Transfusion in Intensive Care Unit

Paul Marik in the article published in Critical care Medicine assessed the independent effect of RBC transfusion on patient outcomes. From 571 articles screened, 45 met inclusion criteria and were included for data extraction.

Study Design: Retrospective study reviews and metaanalysis.

Forty-five studies including 272,596 patients were identified. The overall risks vs. benefits of RBC transfusion on patient outcome in each study were classified as (i) risks outweigh benefits, (ii) neutral risk, and (iii) benefits outweigh risks.

Results:

• In 42 of the 45 studies the risks of RBC transfusion outweighed the benefits.
• The risk was neutral in two studies with the benefits outweighing the risks in a subgroup of a single study (elderly patients with an acute myocardial infarction and a hematocrit <30%).>
• Seventeen of 18 studies demonstrated that RBC transfusions were an independent predictor of death. The pooled odds ratio (12 studies) was 1.7 (95% confidence interval, 1.4-1.9).
• Twenty-two studies examined the association between RBC transfusion and nosocomial infection; in all these studies blood transfusion was an independent risk factor for infection. The pooled odds ratio (nine studies) for developing an infectious complication was 1.8 (95% confidence interval, 1.5-2.2).
• RBC transfusions similarly increased the risk of developing multi-organ dysfunction syndrome (three studies) and ARDS (six studies). The pooled odds ratio for developing acute respiratory distress syndrome was 2.5 (95% confidence interval, 1.6-3.3).

Conclusions: Despite the inherent limitations in the analysis of cohort studies, our analysis suggests that in adult, intensive care unit, trauma, and surgical patients, RBC transfusions are associated with increased morbidity and mortality and therefore, current transfusion practices may require reevaluation. The risks and benefits of RBC transfusion should be assessed in every patient before transfusion.



Reference: click to get article

Marik P, Corwin HL. Efficacy of red blood cell transfusion in the critically ill: A systematic review of the literature. Critical Care Medicine 2008, 36(9): 2667-2674