Levy Mitchell M, Abraham Edward, Zilberberg Marya, MacIntyre Neil R
Brown University School of Medicine, Division of Pulmonary and Critical Care Medicine, Rhode Island Hospital, 593 Eddy St, Main 7, Providence, RI, 02903, USA.
Chest. 2005 Mar;127(3):928-35. doi: 10.1378/chest.127.3.928.
To characterize and compare transfusion practices in a broad sample of patients receiving mechanical ventilation (MV) and not receiving MV in the ICU.
Retrospective subgroup analysis from the prospective, multicenter, observational CRIT study.
Two hundred eighty-four medical, surgical, or medical/surgical ICUs.
Critically ill adults.
Of the 4,892 patients enrolled in the CRIT study, 60% were receiving MV on ICU admission or within 48 h after admission for a median of 4 days. Patients receiving MV had higher baseline APACHE (acute physiology and chronic health evaluation) II scores than patients not receiving MV (22.8 +/- 7.8 and 14.9 +/- 6.4, respectively [mean +/- SD]; p < 0.0001). Despite similar baseline hemoglobin levels (11.0 +/- 2.3 g/dL and 10.9 +/- 2.5 g/dL, p = 0.17), more patients receiving MV underwent transfusions (49% vs 33%, p < 0.0001), and they received significantly more RBCs than patients not receiving MV (p < 0.0001). The principal reason for transfusion in both groups was low hemoglobin level (78.4% and 84.6%, respectively); however, patients receiving MV had higher pretransfusion hemoglobin levels (8.7 +/- 1.7 g/dL) than patients not receiving MV (8.2 +/- 1.7 g/dL, p < 0.0001). Notably, 40.1% of all transfusions in patients receiving MV were administered after day 3 of the ICU stay, compared to 21.2% in patients not receiving MV (p < 0.0001), and a higher percentage of patients receiving MV remaining in the ICU after day 3 underwent transfusions (33.4% vs 18.3%, p < 0.0001). Mortality was higher (17.2% vs 4.5%, p < 0.0001) and mean hospital (15 days vs 10 days, p < 0.0001) and ICU stays (9 days vs 4 days, p < 0.0001) were longer in the subgroup receiving MV.
Mechanical ventilation appears to be an easily identifiable early marker for allogeneic blood exposure risk in ICU patients. While the longer ICU stays account for much of this risk, patients receiving MV also appear to undergo transfusions at higher hemoglobin thresholds than patients not receiving MV, at least early in the ICU stay. Justification of this relatively liberal transfusion practice in patients receiving MV will require further study.
对重症监护病房（ICU）中接受机械通气（MV）和未接受机械通气的广泛患者样本的输血情况进行特征描述和比较。
来自前瞻性、多中心、观察性CRIT研究的回顾性亚组分析。
284个内科、外科或内科/外科ICU。
危重症成人。
在CRIT研究纳入的4892例患者中，60%在ICU入院时或入院后48小时内接受MV，中位时间为4天。接受MV的患者基线急性生理与慢性健康状况评估（APACHE）II评分高于未接受MV的患者（分别为22.8±7.8和14.9±6.4[均值±标准差]；p<0.0001）。尽管基线血红蛋白水平相似（11.0±2.3g/dL和10.9±2.5g/dL，p = 0.17），但接受MV的患者输血比例更高（49%对33%，p<0.0001），且他们接受的红细胞显著多于未接受MV的患者（p<0.0001）。两组输血的主要原因均为血红蛋白水平低（分别为78.4%和84.6%）；然而，接受MV的患者输血前血红蛋白水平（8.7±1.7g/dL）高于未接受MV的患者（8.2±1.7g/dL，p<0.0001）。值得注意的是，接受MV的患者中40.1%的输血发生在ICU住院第3天之后，而未接受MV的患者为21.2%（p<0.0001），且在ICU住院第3天之后仍留在ICU的接受MV的患者输血比例更高（33.4%对18.3%，p<0.0001）。接受MV的亚组患者死亡率更高（17.2%对4.5%，p<0.0001），平均住院时间（15天对10天，p<0.0001）和ICU住院时间（9天对4天，p<0.0001）更长。
机械通气似乎是ICU患者异体血暴露风险的一个易于识别的早期标志物。虽然较长的ICU住院时间是造成这种风险的主要原因，但接受MV的患者似乎也比未接受MV的患者在更高的血红蛋白阈值时接受输血，至少在ICU住院早期是这样。对接受MV的患者这种相对宽松的输血做法的合理性需要进一步研究。
