Red blood cell transfusion and outcomes in patients with acute lung injury, sepsis and shockReport as inadecuate




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Critical Care

, 15:R221

First Online: 21 September 2011Received: 27 May 2011Revised: 25 July 2011Accepted: 21 September 2011

Abstract

IntroductionIn this study, we sought to determine the association between red blood cell RBC transfusion and outcomes in patients with acute lung injury ALI, sepsis and shock.

MethodsWe performed a secondary analysis of new-onset ALI patients enrolled in the Acute Respiratory Distress Syndrome Network Fluid and Catheter Treatment Trial 2000 to 2005 who had a documented ALI risk factor of sepsis or pneumonia and met shock criteria mean arterial pressure MAP < 60 mmHg or vasopressor use within 24 hours of randomization. Using multivariable logistic regression, we examined the association between RBC transfusion and 28-day mortality after adjustment for age, sex, race, randomization arm and Acute Physiology and Chronic Health Evaluation III score. Secondary end points included 90-day mortality and ventilator-free days VFDs. Finally, we examined these end points among the subset of subjects meeting prespecified transfusion criteria defined by five simultaneous indicators: hemoglobin < 10.2 g-dL, central or mixed venous oxygen saturation < 70%, central venous pressure ≥ 8 mmHg, MAP ≥ 65 mmHg, and vasopressor use.

ResultsWe identified 285 subjects with ALI, sepsis, shock and transfusion data. Of these, 85 also met the above prespecified transfusion criteria. Fifty-three 19% of the two hundred eighty-five subjects with shock and twenty 24% of the subset meeting the transfusion criteria received RBC transfusion within twenty-four hours of randomization. We found no independent association between RBC transfusion and 28-day mortality odds ratio = 1.49, 95% CI 95% confidence interval = 0.77 to 2.90; P = 0.23 or VFDs mean difference = -0.35, 95% CI = -4.03 to 3.32; P = 0.85. Likewise, 90-day mortality and VFDs did not differ by transfusion status. Among the subset of patients meeting the transfusion criteria, we found no independent association between transfusion and mortality or VFDs.

ConclusionsIn patients with new-onset ALI, sepsis and shock, we found no independent association between RBC transfusion and mortality or VFDs. The physiological criteria did not identify patients more likely to be transfused or to benefit from transfusion.

Keywordserythrocyte transfusion respiratory distress syndrome adult therapy sepsis therapy treatment outcome intensive care unit respiration artificial AbbreviationsALIacute lung injury

APACHE IIIAcute Physiology and Chronic Health Evaluation III

cVO2central venous oxygen saturation

FACTTFluid and Catheter Treatment Trial

MAPmean arterial pressure

mVO2mixed venous oxygen saturation

RBCred blood cell.

Electronic supplementary materialThe online version of this article doi:10.1186-cc10458 contains supplementary material, which is available to authorized users.

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Author: Elizabeth C Parsons - Catherine L Hough - Christopher W Seymour - Colin R Cooke - Gordon D Rubenfeld - Timothy R Watki

Source: https://link.springer.com/







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