Anemia, transfusions and hospital outcomes among critically ill patients on prolonged acute mechanical ventilation: a retrospective cohort studyReport as inadecuate




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Critical Care

, 12:R60

First Online: 28 April 2008Received: 13 March 2008Revised: 23 April 2008Accepted: 28 April 2008

Abstract

IntroductionPatients requiring prolonged acute mechanical ventilation PAMV represent one-third of those who need mechanical ventilation, but they utilize two-thirds of hospital resources devoted to mechanical ventilation. Measures are needed to optimize the efficiency of care in this population. Both duration of intensive care unit stay and mechanical ventilation are associated with anemia and increased rates of packed red blood cell pRBC transfusion. We hypothesized that transfusions among patients receiving PAMV are common and associated with worsened clinical and economic outcomes.

MethodsA retrospective analysis of a large integrated claims database covering a 5-year period January 2000 to December 2005 was conducted in adult patients receiving PAMV mechanical ventilation for ≥ 96 hours. The incidence of pRBC transfusions was examined as the main exposure variable, and hospital mortality served as the primary outome, with hospital length of stay and costs being secondary outcomes.

ResultsThe study cohort included 4,344 hospitalized patients receiving PAMV 55% male, mean age 61.5 ± 16.4 years. Although hemoglobin level upon admission was above 10 g-dl in 75% of patients, 67% n = 2,912 received at least one transfusion, with a mean of 9.1 ± 12.0 units of pRBCs transfused per patient over the course of hospitalization. In regression models adjusting for confounders, exposure to pRBCs was associated with a 21% increase in the risk for hospital death 95% confidence interval CI = 1.00 to 1.48, and marginal increases in length of stay 6.3 days, 95% CI = 5.1 to 7.6 and cost $48,972, 95% CI = $45,581 to $52,478.

ConclusionPatients receiving PAMV are at high likelihood of being transfused with multiple units of blood at relatively high hemoglobin levels. Transfusions independently contribute to increased risk for hospital death, length of stay, and costs. Reducing exposure of PAMV patients to blood may represent an attractive target for efforts to improve quality and efficiency of health care delivery in this population.

AbbreviationsALIacute lung injury

ARDSacute respiratory distress syndrome

BSIblood stream infection

CIconfidence interval

HAPhospital-acquired pneumonia

HFHSHenry Ford Health System

ICD-9 = International Classification of Diseasesninth revision

ICUintensive care unit

LOSlength of stay

MVmechanical ventilation

ORodds ratio

PAMVprolonged acute mechanical ventilation

pRBCpacked red blood cell.

Electronic supplementary materialThe online version of this article doi:10.1186-cc6885 contains supplementary material, which is available to authorized users.

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Author: Marya D Zilberberg - Lee S Stern - Daniel P Wiederkehr - John J Doyle - Andrew F Shorr

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







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