Transfusion in the ICU
Bibliographic record
Abstract
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.1,2 Many 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-
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.008 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".