Hébert P C, Wells G, Martin C, Tweeddale M, Marshall J, Blajchman M, Pagliarello G, Schweitzer I, Calder L
Critical Care Program, University of Ottawa, ON, Canada.
Crit Care Med. 1998 Mar;26(3):482-7. doi: 10.1097/00003246-199803000-00019.
To characterize the contemporary red cell transfusion practice in the critically ill and to define clinical factors that influence these practices.
Scenario-based national survey.
Canadian critical care practitioners.
We evaluated transfusion thresholds before transfusion and the number of red cell units ordered, under the given conditions. Of 254 Canadian critical care physicians, 193 (76%) responded to the survey. The primary specialty of most respondents was internal medicine (56%). Internal medicine respondents were in practice for an average of 8.4 +/- 5.7 (SD) yrs, and worked most often in combined medical/surgical intensive care units. Baseline hemoglobin transfusion thresholds averaged from 8.3 +/- 1.0 g/dL in a scenario involving a young stable trauma victim to 9.5 +/- 1.0 g/dL for an older patient after gastrointestinal bleeding. Transfusion thresholds differed significantly (p< .0001) between all four separate scenarios. With the exception of congestive heart failure (p> .05), all clinical factors (including age, Acute Physiology and Chronic Health Evaluation II score, preoperative status, hypoxemia, shock, lactic acidosis, coronary ischemia, and chronic anemia) significantly (p< .0001) modified the transfusion thresholds. A statistically significant (p< .01) difference in baseline transfusion thresholds was noted across four major regions (with a maximum of five academic centers per region) of the country. Low physician numbers in two of the regions did not allow for further investigation of regional variations.
There is significant variation in critical care transfusion practice, with many intensivists adhering to a 10.0-g/dL threshold, while other physicians described a much more restrictive approach to red cell transfusion. Also, many physicians opted to administer multiple units, despite published guidelines to the contrary. Additionally, the administration of red cells was strongly influenced by a number of clinical factors, many unique to intensive care unit patients. There is a need for prospective studies to define optimal practice in the critically ill.
描述危重症患者当前的红细胞输血实践情况，并确定影响这些实践的临床因素。
基于场景的全国性调查。
加拿大重症监护从业者。
我们评估了在给定条件下输血前的输血阈值以及订购的红细胞单位数量。在254名加拿大重症监护医生中，193名（76%）回复了调查。大多数受访者的主要专业是内科（56%）。内科受访者的平均从业年限为8.4±5.7（标准差）年，最常在内科/外科综合重症监护病房工作。在涉及年轻稳定创伤受害者的场景中，基线血红蛋白输血阈值平均为8.3±1.0 g/dL，而在胃肠道出血后的老年患者中为9.5±1.0 g/dL。所有四个不同场景之间的输血阈值差异显著（p<0.0001）。除充血性心力衰竭外（p>0.05），所有临床因素（包括年龄、急性生理与慢性健康状况评估II评分、术前状态、低氧血症、休克、乳酸酸中毒、冠状动脉缺血和慢性贫血）均显著（p<0.0001）改变了输血阈值。在该国四个主要地区（每个地区最多五个学术中心），基线输血阈值存在统计学显著差异（p<0.01）。其中两个地区的医生数量较少，无法进一步调查地区差异。
重症监护输血实践存在显著差异，许多重症监护医生坚持10.0 g/dL的阈值，而其他医生对红细胞输血的方法更为严格。此外，尽管有相反的已发表指南，许多医生仍选择输注多个单位。此外，红细胞的输注受到许多临床因素的强烈影响，其中许多因素是重症监护病房患者所特有的。需要进行前瞻性研究来确定危重症患者的最佳实践。
