Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
Department of Epidemiology and Data Science, Amsterdam University Medical Centre, Amsterdam Public Health, University of Amsterdam, Amsterdam, the Netherlands.
JAMA. 2023 Nov 21;330(19):1852-1861. doi: 10.1001/jama.2023.20737.
Red blood cell (RBC) transfusion is common among patients admitted to the intensive care unit (ICU). Despite multiple randomized clinical trials of hemoglobin (Hb) thresholds for transfusion, little is known about how these thresholds are incorporated into current practice.
To evaluate and describe ICU RBC transfusion practices worldwide.
DESIGN, SETTING, AND PARTICIPANTS: International, prospective, cohort study that involved 3643 adult patients from 233 ICUs in 30 countries on 6 continents from March 2019 to October 2022 with data collection in prespecified weeks.
ICU stay.
The primary outcome was the occurrence of RBC transfusion during ICU stay. Additional outcomes included the indication(s) for RBC transfusion (consisting of clinical reasons and physiological triggers), the stated Hb threshold and actual measured Hb values before and after an RBC transfusion, and the number of units transfused.
Among 3908 potentially eligible patients, 3643 were included across 233 ICUs (median of 11 patients per ICU [IQR, 5-20]) in 30 countries on 6 continents. Among the participants, the mean (SD) age was 61 (16) years, 62% were male (2267/3643), and the median Sequential Organ Failure Assessment score was 3.2 (IQR, 1.5-6.0). A total of 894 patients (25%) received 1 or more RBC transfusions during their ICU stay, with a median total of 2 units per patient (IQR, 1-4). The proportion of patients who received a transfusion ranged from 0% to 100% across centers, from 0% to 80% across countries, and from 19% to 45% across continents. Among the patients who received a transfusion, a total of 1727 RBC transfusions were administered, wherein the most common clinical indications were low Hb value (n = 1412 [81.8%]; mean [SD] lowest Hb before transfusion, 7.4 [1.2] g/dL), active bleeding (n = 479; 27.7%), and hemodynamic instability (n = 406 [23.5%]). Among the events with a stated physiological trigger, the most frequently stated triggers were hypotension (n = 728 [42.2%]), tachycardia (n = 474 [27.4%]), and increased lactate levels (n = 308 [17.8%]). The median lowest Hb level on days with an RBC transfusion ranged from 5.2 g/dL to 13.1 g/dL across centers, from 5.3 g/dL to 9.1 g/dL across countries, and from 7.2 g/dL to 8.7 g/dL across continents. Approximately 84% of ICUs administered transfusions to patients at a median Hb level greater than 7 g/dL.
RBC transfusion was common in patients admitted to ICUs worldwide between 2019 and 2022, with high variability across centers in transfusion practices.
红细胞（RBC）输血在入住重症监护病房（ICU）的患者中很常见。尽管有多项关于输血血红蛋白（Hb）阈值的随机临床试验，但对于这些阈值如何纳入当前实践知之甚少。
评估和描述全球 ICU 的 RBC 输血实践。
设计、地点和参与者：这是一项国际性、前瞻性队列研究，涉及 2019 年 3 月至 2022 年 10 月期间来自 6 大洲 30 个国家的 3643 名成年患者，在预先指定的几周内收集数据。
入住 ICU。
主要结局是 ICU 住院期间发生 RBC 输血。其他结局包括 RBC 输血的指征（包括临床原因和生理触发因素）、输血前和输血后规定的 Hb 阈值和实际测量的 Hb 值，以及输血量。
在 3908 名潜在合格患者中，共有 3643 名患者分布在 30 个国家的 233 个 ICU 中（每个 ICU 的中位数为 11 名患者[IQR，5-20]）。参与者的平均（SD）年龄为 61（16）岁，62%为男性（2267/3643），序贯器官衰竭评估评分中位数为 3.2（IQR，1.5-6.0）。共有 894 名患者（25%）在 ICU 期间接受了 1 次或多次 RBC 输血，每位患者的中位输血量为 2 单位（IQR，1-4）。接受输血的患者比例在中心之间从 0%到 100%不等，在国家之间从 0%到 80%不等，在大洲之间从 19%到 45%不等。在接受输血的患者中，共进行了 1727 次 RBC 输血，其中最常见的临床指征是低 Hb 值（n=1412[81.8%]；输血前最低 Hb 值的平均值[SD]为 7.4[1.2]g/dL）、活动性出血（n=479[27.7%]）和血流动力学不稳定（n=406[23.5%]）。在有生理触发因素的事件中，最常报告的触发因素是低血压（n=728[42.2%]）、心动过速（n=474[27.4%]）和乳酸水平升高（n=308[17.8%]）。接受 RBC 输血的日子，Hb 水平最低的中位数范围为中心之间的 5.2 g/dL 至 13.1 g/dL，国家之间的 5.3 g/dL 至 9.1 g/dL，大洲之间的 7.2 g/dL 至 8.7 g/dL。大约 84%的 ICU 在 Hb 水平大于 7 g/dL 时给患者输血。
2019 年至 2022 年间，全球 ICU 入院患者的 RBC 输血很常见，中心之间的输血实践存在很大差异。
