Revisiting transfusion practices in critically ill patients

Crit Care Med. 2005 Jan;33(1):7-12; discussion 232-2. doi: 10.1097/01.ccm.0000151047.33912.a3.


Objective: The objective of this study was to characterize contemporary red cell transfusion practice in the critically ill and to examine changes in practice over time.

Study design: The authors conducted a scenario-based national survey.

Study population: This study consisted of Canadian critical care practitioners.

Outcome measure: The authors evaluated transfusion thresholds in four hypothetical scenarios.

Results: Of 343 eligible Canadian critical care physicians, 235 (68.5%) responded to the survey. Most respondents were general internists (57%) who had been in practice for an average of 11.1 (+/-7.1) yrs and worked most often in combined medical/surgical intensive care units. Transfusion thresholds differed significantly among the four scenarios (p < .0001). The proportion of respondents adopting a threshold of 70 g/L was 63% and 70% in the hypothetical scenarios of trauma and septic shock compared with 16% and 3% who adopted the same threshold for scenarios involving patients with stable gastrointestinal hemorrhage and postoperative myocardial infarction, respectively. Fifteen percent of respondents identified transfusion thresholds exceeding 100 g/L for the postoperative myocardial infarction scenario, and 7% identified this threshold for the gastrointestinal hemorrhage scenario. Only 0.4% of respondents adopted a 100-g/L threshold for the two remaining scenarios. There was a significant decrease in transfusion thresholds in all four scenarios (p < .001) since the administration of a previous survey in 1993. The reported use of single-unit transfusions was 56% in 2002 vs. 10% in 1993. Eighty-five percent of physicians stated that they had modified their approach to transfusion, primarily in response to the publication of a major Canadian clinical trial and institutional guidelines.

Conclusions: Canadian physicians appear to have adopted lower transfusion triggers and an increase in the use of single-unit red cell transfusion.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Blood Volume / physiology
  • Canada
  • Critical Care / statistics & numerical data*
  • Drug Utilization Review / statistics & numerical data
  • Erythrocyte Transfusion / statistics & numerical data*
  • Female
  • Gastrointestinal Hemorrhage / blood
  • Gastrointestinal Hemorrhage / therapy*
  • Hemoglobinometry
  • Humans
  • Male
  • Middle Aged
  • Multiple Trauma / blood
  • Multiple Trauma / therapy*
  • Myocardial Infarction / blood
  • Myocardial Infarction / therapy*
  • Resuscitation
  • Shock, Septic / blood
  • Shock, Septic / therapy*