https://jamanetwork.com/journals/jama/fullarticle/2810759?guestAccessKey=ad1e6adb-4eba-41b1-b7bd-9076959cdac1&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jama&utm_content=etoc&utm_term=112123&utm_adv=000003682674

• Objective: Evaluating and describing ICU RBC transfusion practices worldwide.
• Design and Participants: International prospective cohort study including 3,643 adult patients from 233 ICUs across 30 countries on 6 continents (March 2019 to October 2022).
• Main Outcomes: Occurrence of RBC transfusion during ICU stay, indications for transfusion (clinical reasons and physiological triggers), Hb thresholds, Hb values before and after transfusion, and number of units transfused.
• Results:
  • 25% of patients received RBC transfusions during ICU stay.
  • Common indications: low Hb value (81.8%), active bleeding (27.7%), hemodynamic instability (23.5%).
  • Frequent triggers: hypotension (42.2%), tachycardia (27.4%), increased lactate levels (17.8%).
  • High variability in transfusion practices across centers and regions.
  • Hb levels at transfusion varied significantly, with a median lowest Hb level from 5.2 to 13.1 g/dL across centers.
• Conclusions: RBC transfusion is common in ICUs with considerable variability in practices. The main reasons and triggers for transfusion overlap across regions.

Key Takeaways

• RBC Transfusion Prevalence: RBC transfusion is frequent in ICU settings, indicating its critical role in patient care.
• Variability in Practice: Significant differences exist in transfusion practices, thresholds, and clinical reasoning across different centers and countries.
• Restrictive vs. Liberal Thresholds: The study highlights a global trend towards more restrictive transfusion thresholds, aligning with recent RCT findings.

Strengths

• Global Scope: Involves a wide array of countries and ICUs, providing a comprehensive global perspective.
• Detailed Data Collection: Extensive data on clinical reasons, triggers, and outcomes of transfusions.

Areas for Improvement/Future Research

• Standardization of Practices: The observed variability suggests a need for more standardized guidelines and practices.
• Focus on Personalized Thresholds: Exploring the feasibility of individualized RBC transfusion thresholds and triggers, given the inconclusive results of different markers and methods.
• Implementation of Guidelines: Assessing the impact of recent guidelines by the European Society of Intensive Medicine on transfusion management.

Discussion