Corwin H L, Parsonnet K C, Gettinger A
Critical Care Service, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
Chest. 1995 Sep;108(3):767-71. doi: 10.1378/chest.108.3.767.
To evaluate RBC transfusion practice in the ICU.
Retrospective chart review.
Multidisciplinary ICU in a tertiary care center.
All patients admitted to the ICU with a length of stay of greater than 1 week.
A total of 23% of all patients admitted to the ICU had a length of stay of greater than 1 week (19.6 +/- 1.6 days). Of these patients, 85% received blood transfusions (9.5 +/- 0.8 U per patient). These transfusions were not solely a function of acute blood loss. Patients were transfused a constant 2 to 3 U/wk. Patients receiving blood transfusions were phlebotomized on average 61 to 70 mL per day. Phlebotomy accounted for 49% of the variation in amount of RBCs transfused. No indication for blood transfusion was identified for 29% of transfusion events. A low hematocrit (< 25%) was the only identifiable indication in an additional 19% of events. Almost one third of all RBCs transfused were without a clear transfusion indication.
The long-term ICU population receive a large number of blood transfusions. Phlebotomy contributes significantly to these transfusions. There is no clear indication for a large number of the blood transfusions given. Many blood transfusions appear to be administered because of an arbitrary "transfusion trigger" rather than a physiologic need for blood. Blood conservation and adherence to transfusion guidelines could significantly reduce RBC transfusion in the ICU.
评估重症监护病房（ICU）中的红细胞输血实践。
回顾性病历审查。
三级医疗中心的多学科ICU。
所有入住ICU且住院时间超过1周的患者。
入住ICU的所有患者中，共有23%的患者住院时间超过1周（19.6±1.6天）。在这些患者中，85%接受了输血（每位患者9.5±0.8单位）。这些输血并非仅仅是急性失血的结果。患者每周固定输注2至3单位血液。接受输血的患者平均每天采血61至70毫升。采血占红细胞输血量变化的49%。29%的输血事件未发现输血指征。在另外19%的事件中，唯一可识别的指征是血细胞比容低（<25%）。几乎三分之一的红细胞输血没有明确的输血指征。
长期入住ICU的患者接受大量输血。采血对这些输血有显著影响。大量输血没有明确指征。许多输血似乎是由于任意的“输血触发因素”而非对血液的生理需求而进行的。节约用血并遵守输血指南可显著减少ICU中的红细胞输血。
