Red Blood Cell Transfusion in the Intensive Care Unit

doi:10.1001/jama.2023.20737

. 2023 Nov 21;330(19):1852-1861.

doi: 10.1001/jama.2023.20737.

Red Blood Cell Transfusion in the Intensive Care Unit

Senta Jorinde Raasveld¹, Sanne de Bruin¹, Merijn C Reuland¹, Claudia van den Oord¹, Jimmy Schenk^{1

2}, Cécile Aubron³, Jan Bakker^{4

5

6}, Maurizio Cecconi⁷, Aarne Feldheiser⁸, Jens Meier⁹, Marcella C A Müller¹, Thomas W L Scheeren¹⁰, Zoe McQuilten¹¹, Andrew Flint^{11

12}, Tarikul Hamid¹³, Michaël Piagnerelli¹⁴, Tina Tomic Mahecic¹⁵, Jan Benes¹⁶, Lene Russell^{17

18

19}, Hernan Aguirre-Bermeo²⁰, Konstantina Triantafyllopoulou²¹, Vasiliki Chantziara²², Mohan Gurjar²³, Sheila Nainan Myatra²⁴, Vincenzo Pota²⁵, Muhammed Elhadi²⁶, Ryszard Gawda²⁷, Mafalda Mourisco²⁸, Marcus Lance²⁹, Vojislava Neskovic³⁰, Matej Podbregar³¹, Juan V Llau³², Manual Quintana-Diaz³³, Maria Cronhjort³⁴, Carmen A Pfortmueller³⁵, Nihan Yapici³⁶, Nathan D Nielsen³⁷, Akshay Shah³⁸, Harm-Jan de Grooth¹, Alexander P J Vlaar¹; InPUT Study Group

Collaborators, Affiliations

Collaborators

InPUT Study Group:
Alisa Higgins, Ary Serpa Neto, Karina Brady, Erica Wood, Alexis Poole, Tony Trapani, Meredith Young, Jamie Cooper, Paul Secombe, Graham Reece, Prashanti Marella, David Brewster, Alan Rashid, Ruwan Suwandarathne, Raman Azad, Jonathan Barrett, Elisha Turner, Amber-Louise Poulter, Lixian Chen, Vishwanath Biradar, Christina Whitehead, Sandra Peake, Alexis Tabah, Stephanie O'Connor, Michael Reade, Guido Janssen, Richard McAllister, Katherine Triplett, David Bowen, Hergen Buscher, John Santamaria, Dinesh Parmar, Paul Power, Craig French, Matthew Mac Partlin, Md Motiul Islam, Injamam Ull Haque, Alain Roman, Lionel Haentjens, Višnja Ikic, Slavica Kvolik, Robert Bojčić, Kazimir Juričić, Martin Duksa, Lukáš Bílek, Igor Satinsky, Jan Zatloukal, Lene Russell, Morten H Bestle, Christian S Meyhoff, Ana Maria Diaz-Medina, Verónica Llumiquinga, Hernán Aguirre-Bermeo, Heinert Enmanuel Gonzabay-Campos, Mohamed Elbahnasawy, Xavier Chapalain, Charlène Le Moal, Pierre-Yves Egreteau, Yoann Launey, Florian Reizine, Florence Boissier, Reignier Jean, Stephan Ehrmann, Eddy Lebas, Gaelle Corno, Pauline Cailliez, Pierre Garçon, Guillaume Carteaux, Antoine Kimmoun, Danai Theodoulou, Stavros Aloizos, Eleftherios Papadakis, Konstantinos Tsakalis, Giorgos Marinakis, Ioannis Georgakas, Paraskevi Tripolitsioti, Sofia Nikolakopoulou, Georgios Papathanakos, Chrysanthi Sklavou, Evangelia Tsika, Ourania Mousafiri, Athanasios Prekates, Georgia Micha, Athina Lavrentieva, Theodoros Aslanidis, Athina Palaiologou, Clementine Bostantzoglou, Evangelia Dikoudi, Silia Karaouli, Sophia Pouriki, Swapna Vijayakumaran, Darshana Rathod, Venkat Raman Kola, Deepak Jeswani, Kadarapura Nanjundaiah Gopalakrishna, Amol Hartalkar, Ata Mahmoodpoor, Marwah Abdulkhaleq, Mariachiara Ippolito, Antonella Cotoia, Marco Covotta, Filippo Sanfilippo, Ehab Ishteiwy, Hebtallah Benzarti, Ahmed Elmabri Mohammed Bouhuwaish, Alya Abdalhadi, Ahmad Buimsaedah, Eman Ali Abdulwahed, Khalil Tamoos, Eman Younes, Asma Abubakr Saleh Alkamkhe, Marwa Biala, Hajer Abdalla Mohammed Hwili, Najat Shaban Ben Hasan, Bushray Alhadi Almiqlash, Mawadda Altair, Rema Otman, Mohamed Fathi Al Gharyani, Omlez Mohammed Alkeelani, Hibah Bakeer, Azah Mukhtar Omar Affat, Husayn Aween, Aihab Benamwor, Mohamed Alsori, Najwa Abdelrahim, Ghannam Abdelilah, Rachael Parke, Yan Chen, Jan Mehrtens, Pawel Twardowski, Ross Freebairn, Rima Song, Charles Gibson, Jonathan Chen, Richard Moore, Mary Rose Sol Cruz, Anna Wludarczyk, Łukasz Krzych, Marta Szczukocka, Marcin Kubiak, Maciej Molsa, Magdalena Wujtewicz, Agnieszka Wieczorek, Agnieszka Misiewska-Kaczur, Marek Maslicki, Dariusz Onichimowski, Jakub Mazur, Pawel Zatorski, Ana Marta Mota, Joana Fernandes, Diana Castro, Elisabete Coelho, Alexandra Paula, Teresa Guimarães, Diana Adrião, Igor Mark, Elizabeta Mušič, Tomislav Mirković, Andrej Markota, Natalija Krope, Marko Kmet, Petra Forjan, Tomaž Savli, Gerardo Aguilar, Rebeca González-Celdrán, Estefanía Martínez-González, Agustín Díaz, María José Colomina, Francisco Hidalgo, Carlos Ferrando, Raquel Ferrandis, Carolina Ferrer, Virginia Cegarra, Aurelio Gómez-Luque, Stina Henman, Disa Blomstrand, Emelie Risberg, Natalie Johansen, Henrik Rajala, Natalie Layous, Eline A Vlot, Michiel Erkamp, Nicole Juffermans, Stefan van Wonderen, Lidija Kuznecova-Keppel Hesselink, Victor van Bochove, Murat Acarel, Evren Senturk, Mahmut Alp Karahan, Aynur Camkiran Firat, Yahya Yildiz, Osman Ekinci, Asu Ozgultekin, Huseyin Arikan, Gamze Kucukosman, Bengu Gulhan Aydin, Mehmet Yavuz, Alev Oztas, Nilgun Kavrut Ozturk, Umut Sabri Kasapoglu, Hakan Miniksar, Eylem Tuncay, Cenk Indelen, Halide Ogus, Basar Erdivanli, Ayca Sultan Sahin, Mehmet Yilmaz, Erken Sayan, Canan Yilmaz, Senay Goksu, Betul Basaran, Emine Kutahya, Ayfer Kaya Gok, Ayse Ozcan, Iskender Kara, Seyfi Kartal, Kemal Tolga Saracoglu, Yeliz Bilir, Selin Eyupoglu, Nigar Ertugrul Oruc, Kubilay Issever, Jamie Patel, Jayson Clarke, Louise Ma, Tom Lawton, Brendan Sloan, Santhana Kannan, Richard Innes, Mark Carpenter, Luke Newey, Hazem Alwagih, Chris Acott, Anil Hormis, James Herdman, Osama Akrama, Rachel Baumber, Olena Khomenko, Akram Khan, Zubair Hasan, Jay S Raval, Lauren Sutherland

Affiliations

¹ Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
² Department of Epidemiology and Data Science, Amsterdam University Medical Centre, Amsterdam Public Health, University of Amsterdam, Amsterdam, the Netherlands.
³ Médecine Intensive Réanimation, CHU de Brest, Université de Bretagne Occidentale, Brest, France.
⁴ Department of Pulmonary and Critical Care, New York University and Columbia University New York.
⁵ Department of Intensive Care Adults, Erasmus MC University Medical Centers, Rotterdam, the Netherlands.
⁶ Department of Intensive Care, Pontificia Universidad Católica de Chile, Santiago, Chile.
⁷ Department of Anesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, Milan, Italy.
⁸ Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, EvangKliniken Essen-Mitte, Huyssens-Stiftung/Knappschaft, Essen, Germany.
⁹ Department of Anesthesiology and Intensive Care, Kepler University Clinic, Kepler University, Linz, Austria.
¹⁰ Department of Anesthesiology, University Medical Center Groningen, Groningen, the Netherlands.
¹¹ School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
¹² The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
¹³ Department of Critical Care, Asgar Ali Hospital, Dhaka, Bangladesh.
¹⁴ Department of Intensive Care, CHU Charleroi Marie Curie, Université Libre de Brussels, Charleroi, Belgium.
¹⁵ Department of Anesthesiology and Intensive Care, University Clinical Hospital Center Zagreb, Croatia.
¹⁶ Department of Anesthesiology and Intensive Care Medicine, University Hospital and Faculty of Medicine in Plzen-Charles University, Plzen, Czech Republic.
¹⁷ Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet Copenhagen, Copenhagen, Denmark.
¹⁸ Department of Anesthesia and Intensive Care Medicine, Copenhagen University Hospital-Gentofte, Hellerup, Denmark.
¹⁹ Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
²⁰ Unidad de Cuidados Intensivos, Hospital Vicente Corral Moscoso, Cuenca, Ecuador.
²¹ Department of Cardiothoracic Surgery, European Interbalkan Medical Center, Thessaloniki, Greece.
²² Intensive Care Unit, First Department of Respiratory Medicine, National and Kapodistrian University of Athens, Sotiria Chest Hospital, Athens, Greece.
²³ Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
²⁴ Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
²⁵ Department of Child, General and Specialistic Surgery, University of Campania, Luigi Vanvitelli, Naples, Italy.
²⁶ Faculty of Medicine, University of Tripoli, Tripoli, Libya.
²⁷ Department of Anesthesiology and Intensive Care, Institute of Medical Sciences, University of Opole, Opole, Poland.
²⁸ Department of Intensive Care, Centro Hospitalar de Entro o Douro e Vouga, Santa Maria da Feira, Portugal.
²⁹ Department of Anesthesiology, Aga Khan University Hospital, Nairobi, Kenya.
³⁰ Department of Anesthesia and Intensive Care, Military Medical Academy Belgrade, Belgrade, Serbia.
³¹ Department for Internal Intensive Care, General Hospital Celje, Medical Faculty, University of Ljubljana, Slovenia.
³² Department of Anesthesiology and Post-surgical Critical Care, University Hospital Doctor Peset, Valencia, Spain.
³³ Intensive Care Service, Hospital Universitario La Paz, Madrid, Spain.
³⁴ Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
³⁵ Department of Intensive Care, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
³⁶ Department of Anesthesiology and Reanimation, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Center, University of Health Sciences, Istanbul, Turkey.
³⁷ Division of Pulmonary, Critical Care and Sleep Medicine, and Section of Transfusion Medicine and Therapeutic Pathology, University of New Mexico School of Medicine, Albuquerque.
³⁸ Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.

PMID: 37824112
PMCID: PMC10570913
DOI: 10.1001/jama.2023.20737

Red Blood Cell Transfusion in the Intensive Care Unit

Senta Jorinde Raasveld et al. JAMA. 2023.

. 2023 Nov 21;330(19):1852-1861.

doi: 10.1001/jama.2023.20737.

Authors

Collaborators

InPUT Study Group:
Alisa Higgins, Ary Serpa Neto, Karina Brady, Erica Wood, Alexis Poole, Tony Trapani, Meredith Young, Jamie Cooper, Paul Secombe, Graham Reece, Prashanti Marella, David Brewster, Alan Rashid, Ruwan Suwandarathne, Raman Azad, Jonathan Barrett, Elisha Turner, Amber-Louise Poulter, Lixian Chen, Vishwanath Biradar, Christina Whitehead, Sandra Peake, Alexis Tabah, Stephanie O'Connor, Michael Reade, Guido Janssen, Richard McAllister, Katherine Triplett, David Bowen, Hergen Buscher, John Santamaria, Dinesh Parmar, Paul Power, Craig French, Matthew Mac Partlin, Md Motiul Islam, Injamam Ull Haque, Alain Roman, Lionel Haentjens, Višnja Ikic, Slavica Kvolik, Robert Bojčić, Kazimir Juričić, Martin Duksa, Lukáš Bílek, Igor Satinsky, Jan Zatloukal, Lene Russell, Morten H Bestle, Christian S Meyhoff, Ana Maria Diaz-Medina, Verónica Llumiquinga, Hernán Aguirre-Bermeo, Heinert Enmanuel Gonzabay-Campos, Mohamed Elbahnasawy, Xavier Chapalain, Charlène Le Moal, Pierre-Yves Egreteau, Yoann Launey, Florian Reizine, Florence Boissier, Reignier Jean, Stephan Ehrmann, Eddy Lebas, Gaelle Corno, Pauline Cailliez, Pierre Garçon, Guillaume Carteaux, Antoine Kimmoun, Danai Theodoulou, Stavros Aloizos, Eleftherios Papadakis, Konstantinos Tsakalis, Giorgos Marinakis, Ioannis Georgakas, Paraskevi Tripolitsioti, Sofia Nikolakopoulou, Georgios Papathanakos, Chrysanthi Sklavou, Evangelia Tsika, Ourania Mousafiri, Athanasios Prekates, Georgia Micha, Athina Lavrentieva, Theodoros Aslanidis, Athina Palaiologou, Clementine Bostantzoglou, Evangelia Dikoudi, Silia Karaouli, Sophia Pouriki, Swapna Vijayakumaran, Darshana Rathod, Venkat Raman Kola, Deepak Jeswani, Kadarapura Nanjundaiah Gopalakrishna, Amol Hartalkar, Ata Mahmoodpoor, Marwah Abdulkhaleq, Mariachiara Ippolito, Antonella Cotoia, Marco Covotta, Filippo Sanfilippo, Ehab Ishteiwy, Hebtallah Benzarti, Ahmed Elmabri Mohammed Bouhuwaish, Alya Abdalhadi, Ahmad Buimsaedah, Eman Ali Abdulwahed, Khalil Tamoos, Eman Younes, Asma Abubakr Saleh Alkamkhe, Marwa Biala, Hajer Abdalla Mohammed Hwili, Najat Shaban Ben Hasan, Bushray Alhadi Almiqlash, Mawadda Altair, Rema Otman, Mohamed Fathi Al Gharyani, Omlez Mohammed Alkeelani, Hibah Bakeer, Azah Mukhtar Omar Affat, Husayn Aween, Aihab Benamwor, Mohamed Alsori, Najwa Abdelrahim, Ghannam Abdelilah, Rachael Parke, Yan Chen, Jan Mehrtens, Pawel Twardowski, Ross Freebairn, Rima Song, Charles Gibson, Jonathan Chen, Richard Moore, Mary Rose Sol Cruz, Anna Wludarczyk, Łukasz Krzych, Marta Szczukocka, Marcin Kubiak, Maciej Molsa, Magdalena Wujtewicz, Agnieszka Wieczorek, Agnieszka Misiewska-Kaczur, Marek Maslicki, Dariusz Onichimowski, Jakub Mazur, Pawel Zatorski, Ana Marta Mota, Joana Fernandes, Diana Castro, Elisabete Coelho, Alexandra Paula, Teresa Guimarães, Diana Adrião, Igor Mark, Elizabeta Mušič, Tomislav Mirković, Andrej Markota, Natalija Krope, Marko Kmet, Petra Forjan, Tomaž Savli, Gerardo Aguilar, Rebeca González-Celdrán, Estefanía Martínez-González, Agustín Díaz, María José Colomina, Francisco Hidalgo, Carlos Ferrando, Raquel Ferrandis, Carolina Ferrer, Virginia Cegarra, Aurelio Gómez-Luque, Stina Henman, Disa Blomstrand, Emelie Risberg, Natalie Johansen, Henrik Rajala, Natalie Layous, Eline A Vlot, Michiel Erkamp, Nicole Juffermans, Stefan van Wonderen, Lidija Kuznecova-Keppel Hesselink, Victor van Bochove, Murat Acarel, Evren Senturk, Mahmut Alp Karahan, Aynur Camkiran Firat, Yahya Yildiz, Osman Ekinci, Asu Ozgultekin, Huseyin Arikan, Gamze Kucukosman, Bengu Gulhan Aydin, Mehmet Yavuz, Alev Oztas, Nilgun Kavrut Ozturk, Umut Sabri Kasapoglu, Hakan Miniksar, Eylem Tuncay, Cenk Indelen, Halide Ogus, Basar Erdivanli, Ayca Sultan Sahin, Mehmet Yilmaz, Erken Sayan, Canan Yilmaz, Senay Goksu, Betul Basaran, Emine Kutahya, Ayfer Kaya Gok, Ayse Ozcan, Iskender Kara, Seyfi Kartal, Kemal Tolga Saracoglu, Yeliz Bilir, Selin Eyupoglu, Nigar Ertugrul Oruc, Kubilay Issever, Jamie Patel, Jayson Clarke, Louise Ma, Tom Lawton, Brendan Sloan, Santhana Kannan, Richard Innes, Mark Carpenter, Luke Newey, Hazem Alwagih, Chris Acott, Anil Hormis, James Herdman, Osama Akrama, Rachel Baumber, Olena Khomenko, Akram Khan, Zubair Hasan, Jay S Raval, Lauren Sutherland

Affiliations

¹ Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
² Department of Epidemiology and Data Science, Amsterdam University Medical Centre, Amsterdam Public Health, University of Amsterdam, Amsterdam, the Netherlands.
³ Médecine Intensive Réanimation, CHU de Brest, Université de Bretagne Occidentale, Brest, France.
⁴ Department of Pulmonary and Critical Care, New York University and Columbia University New York.
⁵ Department of Intensive Care Adults, Erasmus MC University Medical Centers, Rotterdam, the Netherlands.
⁶ Department of Intensive Care, Pontificia Universidad Católica de Chile, Santiago, Chile.
⁷ Department of Anesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, Milan, Italy.
⁸ Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, EvangKliniken Essen-Mitte, Huyssens-Stiftung/Knappschaft, Essen, Germany.
⁹ Department of Anesthesiology and Intensive Care, Kepler University Clinic, Kepler University, Linz, Austria.
¹⁰ Department of Anesthesiology, University Medical Center Groningen, Groningen, the Netherlands.
¹¹ School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
¹² The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
¹³ Department of Critical Care, Asgar Ali Hospital, Dhaka, Bangladesh.
¹⁴ Department of Intensive Care, CHU Charleroi Marie Curie, Université Libre de Brussels, Charleroi, Belgium.
¹⁵ Department of Anesthesiology and Intensive Care, University Clinical Hospital Center Zagreb, Croatia.
¹⁶ Department of Anesthesiology and Intensive Care Medicine, University Hospital and Faculty of Medicine in Plzen-Charles University, Plzen, Czech Republic.
¹⁷ Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet Copenhagen, Copenhagen, Denmark.
¹⁸ Department of Anesthesia and Intensive Care Medicine, Copenhagen University Hospital-Gentofte, Hellerup, Denmark.
¹⁹ Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
²⁰ Unidad de Cuidados Intensivos, Hospital Vicente Corral Moscoso, Cuenca, Ecuador.
²¹ Department of Cardiothoracic Surgery, European Interbalkan Medical Center, Thessaloniki, Greece.
²² Intensive Care Unit, First Department of Respiratory Medicine, National and Kapodistrian University of Athens, Sotiria Chest Hospital, Athens, Greece.
²³ Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
²⁴ Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
²⁵ Department of Child, General and Specialistic Surgery, University of Campania, Luigi Vanvitelli, Naples, Italy.
²⁶ Faculty of Medicine, University of Tripoli, Tripoli, Libya.
²⁷ Department of Anesthesiology and Intensive Care, Institute of Medical Sciences, University of Opole, Opole, Poland.
²⁸ Department of Intensive Care, Centro Hospitalar de Entro o Douro e Vouga, Santa Maria da Feira, Portugal.
²⁹ Department of Anesthesiology, Aga Khan University Hospital, Nairobi, Kenya.
³⁰ Department of Anesthesia and Intensive Care, Military Medical Academy Belgrade, Belgrade, Serbia.
³¹ Department for Internal Intensive Care, General Hospital Celje, Medical Faculty, University of Ljubljana, Slovenia.
³² Department of Anesthesiology and Post-surgical Critical Care, University Hospital Doctor Peset, Valencia, Spain.
³³ Intensive Care Service, Hospital Universitario La Paz, Madrid, Spain.
³⁴ Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
³⁵ Department of Intensive Care, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
³⁶ Department of Anesthesiology and Reanimation, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Center, University of Health Sciences, Istanbul, Turkey.
³⁷ Division of Pulmonary, Critical Care and Sleep Medicine, and Section of Transfusion Medicine and Therapeutic Pathology, University of New Mexico School of Medicine, Albuquerque.
³⁸ Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.

PMID: 37824112
PMCID: PMC10570913
DOI: 10.1001/jama.2023.20737

Erratum in

Nonauthor Collaborator Name Shown Incorrectly.
[No authors listed] [No authors listed] JAMA. 2024 Aug 6;332(5):428. doi: 10.1001/jama.2024.12247. JAMA. 2024. PMID: 38976278 Free PMC article. No abstract available.

Abstract

Importance: Red blood cell (RBC) transfusion is common among patients admitted to the intensive care unit (ICU). Despite multiple randomized clinical trials of hemoglobin (Hb) thresholds for transfusion, little is known about how these thresholds are incorporated into current practice.

Objective: To evaluate and describe ICU RBC transfusion practices worldwide.

Design, setting, and participants: International, prospective, cohort study that involved 3643 adult patients from 233 ICUs in 30 countries on 6 continents from March 2019 to October 2022 with data collection in prespecified weeks.

Exposure: ICU stay.

Main outcomes and measures: The primary outcome was the occurrence of RBC transfusion during ICU stay. Additional outcomes included the indication(s) for RBC transfusion (consisting of clinical reasons and physiological triggers), the stated Hb threshold and actual measured Hb values before and after an RBC transfusion, and the number of units transfused.

Results: Among 3908 potentially eligible patients, 3643 were included across 233 ICUs (median of 11 patients per ICU [IQR, 5-20]) in 30 countries on 6 continents. Among the participants, the mean (SD) age was 61 (16) years, 62% were male (2267/3643), and the median Sequential Organ Failure Assessment score was 3.2 (IQR, 1.5-6.0). A total of 894 patients (25%) received 1 or more RBC transfusions during their ICU stay, with a median total of 2 units per patient (IQR, 1-4). The proportion of patients who received a transfusion ranged from 0% to 100% across centers, from 0% to 80% across countries, and from 19% to 45% across continents. Among the patients who received a transfusion, a total of 1727 RBC transfusions were administered, wherein the most common clinical indications were low Hb value (n = 1412 [81.8%]; mean [SD] lowest Hb before transfusion, 7.4 [1.2] g/dL), active bleeding (n = 479; 27.7%), and hemodynamic instability (n = 406 [23.5%]). Among the events with a stated physiological trigger, the most frequently stated triggers were hypotension (n = 728 [42.2%]), tachycardia (n = 474 [27.4%]), and increased lactate levels (n = 308 [17.8%]). The median lowest Hb level on days with an RBC transfusion ranged from 5.2 g/dL to 13.1 g/dL across centers, from 5.3 g/dL to 9.1 g/dL across countries, and from 7.2 g/dL to 8.7 g/dL across continents. Approximately 84% of ICUs administered transfusions to patients at a median Hb level greater than 7 g/dL.

Conclusions and relevance: RBC transfusion was common in patients admitted to ICUs worldwide between 2019 and 2022, with high variability across centers in transfusion practices.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Cecconi reported receiving personal fees from Edwards Lifesciences, GE Healthcare, and Directed Systems outside the submitted work. Dr Feldheiser reported receiving personal fees from Baxter and Medtronic outside the submitted work. Dr Scheeren reported serving as senior medical director for Edwards Lifesciences (Garching, Germany). Dr McQuilten reported receiving grants from Australian National Blood Authority and National Health and Medical Research Council during the conduct of the study. Dr Flint reported receiving grants from the Australian National Blood Authority and Blood Synergy (Monash University) during the conduct of the study. Dr Piagnerelli reported receiving grants from Centre Federal d'Expertise Belge–KCE grant for COVID-19 study outside the submitted work. Dr Gurjar reported receiving royalties for edited books (Manual of ICU Procedures and Textbook of Ventilation, Fluids, Electrolytes and Blood Gases) from the publisher Jaypee Brothers Medical Publishers (Pvt) Ltd, New Delhi. Dr Pfortmueller reported receiving grants from Orion Pharma, Abbott Nutrition International, B Braun Medical AG, CSEM AG, Edwards Lifesciences Services GmbH, Kenta Biotech Ltd, Maquet Critical Care AB, Omnicare Clinical Research AG, Nestle, Pierre Fabre Pharma AG, Pfizer, Bard Medica SA, Abbott AG, Anandic Medical Systems, Pan Gas AG Healthcare, Bracco, Hamilton Medical AG, Fresenius Kabi, Getinge Group Maquet AG, Dräger AG, Teleflex Medical GmbH, GlaxoSmithKline, Merck Sharp and Dohme AG, Eli Lilly and Co, Baxter, Boehringer Ingelheim, Aseptuva, Astellas, AstraZeneca, CSL Behring, Novartis, Covidien, and Nycomed outside the submitted work; the funds were paid into departmental funds and no personal financial gain applied. Dr Nielsen reported receiving personal fees from Adrenomed outside the submitted work. Dr Vlaar reported receiving personal fees from a Vidi grant (ZonMW: 09150172010047). No other disclosures were reported.

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1. Ducrocq G, Gonzalez-Juanatey JR, Puymirat E, et al. ; REALITY Investigators . Effect of a restrictive vs liberal blood transfusion strategy on major cardiovascular events among patients with acute myocardial infarction and anemia: the REALITY randomized clinical trial. JAMA. 2021;325(6):552-560. doi:10.1001/jama.2021.0135 - DOI - PMC - PubMed

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[1] Free RJ, Sapiano MRP, Chavez Ortiz JL, Stewart P, Berger J, Basavaraju SV. Continued stabilization of blood collections and transfusions in the United States: findings from the 2021 National Blood Collection and Utilization Survey. Transfusion. 2023;(January):1-11. doi:10.1111/trf.17360 - DOI - PMC - PubMed

[2] Free RJ, Sapiano MRP, Chavez Ortiz JL, Stewart P, Berger J, Basavaraju SV. Continued stabilization of blood collections and transfusions in the United States: findings from the 2021 National Blood Collection and Utilization Survey. Transfusion. 2023;(January):1-11. doi:10.1111/trf.17360 - DOI - PMC - PubMed

[3] Bosboom JJ, Klanderman RB, Zijp M, et al. . Incidence, risk factors, and outcome of transfusion-associated circulatory overload in a mixed intensive care unit population: a nested case-control study. Transfusion. 2018;58(2):498-506. doi:10.1111/trf.14432 - DOI - PubMed

[4] Bosboom JJ, Klanderman RB, Zijp M, et al. . Incidence, risk factors, and outcome of transfusion-associated circulatory overload in a mixed intensive care unit population: a nested case-control study. Transfusion. 2018;58(2):498-506. doi:10.1111/trf.14432 - DOI - PubMed

[5] Mazer CD, Whitlock RP, Fergusson DA, et al. ; TRICS Investigators and Perioperative Anesthesia Clinical Trials Group . Restrictive or liberal red-cell transfusion for cardiac surgery. N Engl J Med. 2017;377(22):2133-2144. doi:10.1056/NEJMoa1711818 - DOI - PubMed

[6] Mazer CD, Whitlock RP, Fergusson DA, et al. ; TRICS Investigators and Perioperative Anesthesia Clinical Trials Group . Restrictive or liberal red-cell transfusion for cardiac surgery. N Engl J Med. 2017;377(22):2133-2144. doi:10.1056/NEJMoa1711818 - DOI - PubMed

[7] Murphy GJ, Pike K, Rogers CA, et al. ; TITRe2 Investigators . Liberal or restrictive transfusion after cardiac surgery. N Engl J Med. 2015;372(11):997-1008. doi:10.1056/NEJMoa1403612 - DOI - PubMed

[8] Murphy GJ, Pike K, Rogers CA, et al. ; TITRe2 Investigators . Liberal or restrictive transfusion after cardiac surgery. N Engl J Med. 2015;372(11):997-1008. doi:10.1056/NEJMoa1403612 - DOI - PubMed

[9] Ducrocq G, Gonzalez-Juanatey JR, Puymirat E, et al. ; REALITY Investigators . Effect of a restrictive vs liberal blood transfusion strategy on major cardiovascular events among patients with acute myocardial infarction and anemia: the REALITY randomized clinical trial. JAMA. 2021;325(6):552-560. doi:10.1001/jama.2021.0135 - DOI - PMC - PubMed

[10] Ducrocq G, Gonzalez-Juanatey JR, Puymirat E, et al. ; REALITY Investigators . Effect of a restrictive vs liberal blood transfusion strategy on major cardiovascular events among patients with acute myocardial infarction and anemia: the REALITY randomized clinical trial. JAMA. 2021;325(6):552-560. doi:10.1001/jama.2021.0135 - DOI - PMC - PubMed

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Red Blood Cell Transfusion in the Intensive Care Unit

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