Department of Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
Department of Pneumology and Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany.
BMJ Open Respir Res. 2022 Jun;9(1). doi: 10.1136/bmjresp-2022-001228.
The role of haemoglobin (Hb) value and red blood cell (RBC) transfusions in prolonged weaning from mechanical ventilation (MV) is still controversial. Pathophysiological considerations recommend a not too restrictive transfusion strategy, whereas adverse effects of transfusions are reported. We aimed to investigate the association between Hb value, RBC transfusion and clinical outcome of patients undergoing prolonged weaning from MV.
We performed a retrospective, single-centred, observational study including patients being transferred to a specialised weaning unit. Data on demographic characteristics, comorbidities, current and past medical history and the current course of treatment were collected. Weaning failure and mortality were chosen as primary and secondary endpoint, respectively. Differences between transfused and non-transfused patients were analysed. To evaluate the impact of different risk factors including Hb value and RBC transfusion on clinical outcome, a multivariate logistic regression analysis was used.
184 patients from a specialised weaning unit were analysed, of whom 36 (19.6%) failed to be weaned successfully. In-hospital mortality was 18.5%. 90 patients (48.9%) required RBC transfusion during the weaning process, showing a significantly lower Hb value (g/L) (86.3±5.3) than the non-transfusion group (95.8±10.5). In the multivariate regression analysis (OR 3.24; p=0.045), RBC transfusion was associated with weaning failure. However, the transfusion group had characteristics indicating that these patients were still in a more critical state of disease.
In our analysis, the need for RBC transfusion was independently associated with weaning failure. However, it is unclear whether the transfusion itself should be considered an independent risk factor or an additional symptom of a persistent critical patient condition.
血红蛋白（Hb）值和红细胞（RBC）输血在延长机械通气（MV）撤机中的作用仍存在争议。病理生理学考虑建议采用不过于限制的输血策略，而输血的不良反应也有报道。我们旨在研究 Hb 值、RBC 输血与接受延长 MV 撤机患者临床结局的关系。
我们进行了一项回顾性、单中心、观察性研究，纳入了转至专门的撤机病房的患者。收集了人口统计学特征、合并症、当前和既往病史以及当前治疗过程的数据。撤机失败和死亡率分别作为主要和次要终点。分析了输血和未输血患者之间的差异。为了评估包括 Hb 值和 RBC 输血在内的不同危险因素对临床结局的影响，我们使用了多变量逻辑回归分析。
对专门的撤机病房的 184 例患者进行了分析，其中 36 例（19.6%）未能成功撤机。院内死亡率为 18.5%。90 例（48.9%）患者在撤机过程中需要输血，其 Hb 值（g/L）（86.3±5.3）明显低于未输血组（95.8±10.5）。在多变量回归分析中（OR 3.24；p=0.045），输血与撤机失败相关。然而，输血组具有表明这些患者仍处于更危急疾病状态的特征。
在我们的分析中，RBC 输血的需求与撤机失败独立相关。然而，尚不清楚输血本身是否应被视为独立的危险因素，还是持续危重患者病情的附加症状。
