Transfusion in the ICU

Anemia in ICU Patients: How Much Can They Tolerate?Anemia is quite frequent in the intensive care unit (ICU).Depending on the hemoglobin concentration (Hb) used to define anemia, up to 77% of patients will experience anemia during their ICU stay. 1,2Many patients will already be anemic when admitted to the ICU.In the recent ABC study (anemia and blood transfusion in the critically ill) involving more than 3,500 patients in 146 western Europeans ICUs, Vincent et al. found that 63% of the patients had an ICU admission Hb less than 12 g/dL and 29% a Hb less than 10 g/dL. 1 Accordingly, allogeneic red blood cell transfusions are frequently administered in ICU patients.Vincent et al. reported a 37% transfusion rate in the ABC study. 1 This figure increased to 50% for patients who spent more than 2 days in the ICU and to 67% for those with a stay longer than 7 days.Corwin et al. found similar results in US ICUs. 2 For a long time, a Hb transfusion threshold of 10 g/dL has been recommended, based primarily on theoretical calculations of a maximal oxygen delivery to peripheral organs.This maximal oxygen delivery would result from an optimal compromise between the reduction in blood viscosity and the recruitment of cardiac output.Concerns regarding potential side effects of transfusion, but also the prospect of an ever-decreasing blood supply have questioned this long accepted transfusion trigger, resulting in the formulation of red cell transfusion guidelines by different organizations.However, for the most part, these guidelines have not addressed how and when red blood cell should be administered in ICU patients.On the one hand, ICU patients often present with complex diseases involving cardiovascular, respiratory and metabolic processes that decrease their tolerance to acute anemia.Indeed, anemia is associated with increased morbidity and mortality in ICU patients, particularly in patients with pre-existing cardiac disease limiting their ability to compensate for the fall in blood oxygen carrying capacities. 3 In the ABC study, decreased physiologic reserve was the indication for transfusion in about one third of the cases. 1 On the other hand, critically ill patients may be at increased risk for blood-

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.