Lower versus higher hemoglobin threshold for transfusion in septic shock.
@article{Holst2014LowerVH, title={Lower versus higher hemoglobin threshold for transfusion in septic shock.}, author={Lars Broks{\o} Holst and Nicolai Haase and J{\o}rn Wetterslev and Jan Wernerman and Anne Berit Guttormsen and Sari Karlsson and P{\"a}r Ingemar Johansson and Anders {\AA}neman and Marianne Lauridsen Vang and Robert Winding and Lars Nebrich and Helle Lykkeskov Nibro and Bodil Steen Rasmussen and Johnny Rene Meilstrup Lauridsen and Jane Stab Nielsen and Anders Oldner and Ville Pettil{\"a} and Maria Cronhjort and Lasse H{\o}gh Andersen and Ulf G{\o}ttrup Pedersen and Nanna Reiter and J{\o}rgen Wiis and Jonathan O White and Lene Russell and Klaus J Thornberg and Peter Buhl Hjortrup and Rasmus G. M{\"u}ller and Morten Hylander M{\o}ller and Morten Steensen and Inga Tj{\"a}der and Kristina Kilsand and Suzanne Odeberg-Wernerman and Brit {\AA}. Sj{\o}b{\o} and Helle Bundgaard and Maria A Thy{\o} and D Lodahl and Rikke M{\ae}rkedahl and Carsten Albeck and Dorte G Illum and Mary Murphy Kruse and Per Winkel and Anders Perner}, journal={The New England journal of medicine}, year={2014}, volume={371 15}, pages={ 1381-91 } }
BACKGROUND
Blood transfusions are frequently given to patients with septic shock. However, the benefits and harms of different hemoglobin thresholds for transfusion have not been established.
METHODS
In this multicenter, parallel-group trial, we randomly assigned patients in the intensive care unit (ICU) who had septic shock and a hemoglobin concentration of 9 g per deciliter or less to receive 1 unit of leukoreduced red cells when the hemoglobin level was 7 g per deciliter or less (lower…
654 Citations
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Transfusion at a hemoglobin concentration of 8 g/dl, as compared with a hemochemistry concentration of 10 g /dl, was not associated with an increase in 28-day mortality in adults with ARDS, however, a transfusion in the lower-threshold group was associated with a lower chance for successful weaning from the ventilator during the first 28 days after ARDS onset.
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Red blood cell transfusion increased central venous oxygen saturation and decreased lactate levels in patients with hypoperfusion regardless of their baseline hemoglobin levels and did not appear to impair these variables in patients without hypoperFusion.
Effects of red blood cell transfusions given to non-septic critically ill patients: a propensity score matched study.
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Low-grade RBC-transfusions given to non-septic critically ill patients without significant anaemia were associated with increased mortality, increased kidney, circulatory, and respiratory failure, as well as higher SOFA-max score.
Benefits and harms of red blood cell transfusions in patients with septic shock in the intensive care unit.
- Medicine, BiologyDanish medical journal
- 2016
The TRISS trial provided evidence for the safe use of 7 g/dl as transfusion trigger in patients with septic shock and reduced the number of units transfused with about half.
Relationship between low hemoglobin levels and mortality in patients with septic shock
- Medicine, BiologyAcute and critical care
- 2019
Low hemoglobin levels (<9.0 g/dl) were observed in approximately 20% of patients with septic shock, and the severity of decrease in these levels correlated with mortality.
Transfusion for Patients With Sepsis in 2018
- Medicine, BiologyClinical Pulmonary Medicine
- 2018
The conclusions of these studies no longer argue for a 10 g/dL (30% hematocrit) transfusion threshold during the early phase of septic shock and a more liberal transfusion strategy should be adopted if patients are not stabilized or for patients at risk of bleeding, with myocardial ischemia, or oncohematologic patients with potential hemostasis disorders.
Hemoglobin threshold for transfusion in septic shock.
- Medicine, PsychologyThe New England journal of medicine
- 2015
To rule out whether patients with septic shock who have a lower hemoglobin concentration are at risk for ischemic events such as silent cerebral ischemia and cognitive impairment, both brain imaging and cognitive-function tests after hospital discharge should be considered.
Hemoglobin levels and blood transfusion in patients with sepsis in Internal Medicine Departments
- MedicineBMC Infectious Diseases
- 2016
While hemoglobin concentration on admission had strong correlation with in-hospital mortality, blood transfusion was not found to be an independent predicting factor for mortality.
Liberal or restrictive transfusion after cardiac surgery.
- MedicineThe New England journal of medicine
- 2015
A restrictive transfusion threshold after cardiac surgery was not superior to a liberal threshold with respect to morbidity or health care costs.
Liberal or Restrictive Transfusion after Cardiac Surgery.
- Medicine, BiologyThe New England journal of medicine
- 2015
To the Editor: In their article on red-cell transfusion, Murphy et al. (March 12 issue)1 report substantial nonadherence to treatment in both study groups — one of which had a restrictive threshold…
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