Department of Intensive Care Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
Department of Blood Cell Research, Sanquin Research, and Landsteiner Laboratory, University of Amsterdam, Amsterdam, The Netherlands.
Transfusion. 2022 Feb;62(2):324-335. doi: 10.1111/trf.16789. Epub 2021 Dec 31.
Transfusion is very common in the intensive care unit (ICU), but practice is highly variable, as has recently been shown in non-bleeding critically ill patients practices survey. Bleeding patients in ICU require different blood products across a range of specific patient categories. We hypothesize that a large variety in transfusion practice exists in bleeding patients.
An international online survey was performed among physicians working in the ICU. Transfusion practice in massively and non-massively bleeding patients was examined, including transfusion ratios, thresholds, and the presence of transfusion guidelines.
Six hundred eleven respondents filled in the survey of which 401 could be analyzed, representing 64 countries. Among the respondents, 52% had a massive transfusion protocol (MTP) available at their ICU. In massively bleeding patients, 46% of the respondents used fixed transfusion component ratios. Of those who used fixed blood ratios, the 1:1:1 ratio (red blood cell [RBC] concentrates: plasma: platelet concentrates) was most commonly used (33%). The presence of an MTP was associated with a more frequent use of fixed ratios (p < .001). For RBC transfusion in the general non-massively bleeding ICU population, a hemoglobin (Hb) threshold of 7.0[7.0-7.3] g/dl was reported. In the general ICU population, a platelet count threshold of 50[26-50] × 10 /L was applied.
Half of the centers had no massive transfusion protocol available. Transfusion practice in massively bleeding critically ill patients is highly variable and driven by the presence of an MTP. In the general non-massively bleeding ICU population restrictive transfusion triggers were chosen.
输血在重症监护病房（ICU）中非常常见，但实践情况差异很大，最近在非出血危重患者的实践调查中也有所体现。ICU 中的出血患者需要在一系列特定患者类别中使用不同的血液制品。我们假设出血患者的输血实践存在很大差异。
对在 ICU 工作的医生进行了一项国际在线调查。检查了大量出血和非大量出血患者的输血实践，包括输血比例、阈值和输血指南的存在。
611 名受访者填写了调查，其中 401 名可以进行分析，代表 64 个国家。在受访者中，52%的 ICU 有大量输血方案（MTP）。在大量出血的患者中，46%的受访者使用固定的输血成分比例。在使用固定血液比例的人群中，最常使用 1:1:1 比例（红细胞[RBC]浓缩物：血浆：血小板浓缩物）（33%）。存在 MTP 与更频繁地使用固定比例相关（p <.001）。对于一般非大量出血 ICU 人群的 RBC 输血，报告的血红蛋白（Hb）阈值为 7.0[7.0-7.3]g/dl。在一般 ICU 人群中，血小板计数阈值为 50[26-50]×10 /L。
一半的中心没有大量输血方案。大量出血危重患者的输血实践差异很大，主要取决于是否存在 MTP。在一般非大量出血的 ICU 人群中，选择了限制性输血触发值。
