Transfusion Thresholds Should Be Conservative for Patients with Septic Shock

October 9, 2014

Transfusion Thresholds Should Be Conservative for Patients with Septic Shock

  1. Patricia Kritek, MD

Transfusion thresholds of 7 g/dL or 9 g/dL yielded similar outcomes.

  1. Patricia Kritek, MD

Patients with septic shock are treated with early antibiotics, rapid fluid resuscitation, vasopressor/inotrope support, and blood transfusions. The Surviving Sepsis guidelines' recommendation for a transfusion hemoglobin target of 7 to 9 g/dL reflects the lack of evidence on an optimal threshold value for such patients.

Scandinavian investigators randomized 998 adults with septic shock in 32 intensive care units (ICUs) to a transfusion hemoglobin threshold of 7 g/dL (conservative) or 9 g/dL (liberal). The cohort included patients with chronic cardiovascular disease (53%), chronic lung disease (21%), and hematologic malignancy (7%) but excluded those with acute coronary syndrome or life-threatening bleeding. About half the patients had undergone surgery, and most (69%) were supported with mechanical ventilation. Median time to randomization was ≈24 hours after ICU admission.

Red cell transfusions were given during the ICU stay to 63.9% of the conservative group and 98.8% of the liberal group; median transfused units were 1 and 4, respectively. Ischemic events, requisite life support (i.e., mechanical ventilation, vasopressor/inotrope administration, or renal replacement therapy), and 90-day mortality (44%) were similar between groups. No between-group differences were exposed in prespecified analyses of older patients (age, ≥70), sicker patients (Simplified Acute Physiology Score, >53) and patients with chronic cardiovascular disease.

Comment

Although these researchers didn't look at the very early resuscitation time frame (i.e., first 6 hours), their results provide strong support for a more-conservative transfusion threshold. The time has come to include septic patients with other critically ill patients and set the transfusion threshold at 7 g/dL.

Editor Disclosures at Time of Publication

  • Disclosures for Patricia Kritek, MD at time of publication Speaker’s Bureau American College of Chest Physicians (Critical Care Board Review Course) Editorial boards Scientific American Medicine (Pulmonary and Critical Care Section Editor)

Citation(s):

Reader Comments (1)

JOHN GRAY Physician, Family Medicine/General Practice

Transfused blood remains in the body for many weeks and conservative transfusion shows increasing benefit over several months (90-180 days). How long were these patients followed?

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