A Multicenter, Randomized, Controlled Clinical Trial of Transfusion Requirements in Critical Care

Hébert, Paul C.; Wells, George A.; Blajchman, Morris A.; Marshall, John C.; Martin, Claudio M.; Pagliarello, Giuseppe; Tweeddale, Martin; Schweitzer, Irwin; Yetisir, Elizabeth

doi:10.1056/nejm199902113400601

Cited by 4,480 publications

(1,265 citation statements)

References 19 publications

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“…Overall 30-day mortality, length of stay, and morbidity were not different for either group [84]. Hill and co-workers [85], who undertook a meta-analysis comparing liberal and restrictive transfusion strategies, confirmed the conclusions reached by these researchers.…”

Section: Transfusion Threshold and Coagulopathy Correctionmentioning

confidence: 61%

Critical Care Issues in the Early Management of Severe Trauma

García

2006

Surgical Clinics of North America

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Violent trauma and road traffic injuries kill more than 2.5 million people in the world every year. It has been calculated by the World Health Organization that in 2002 there occurred 1.6 million violent deaths [1] and 1.2 million deaths from traffic injury [2], for a combined mortality of 48 deaths per 100,000 population per year.Most trauma deaths occur at the scene or in the first hour after trauma, with a proportion from 34% to 50% occurring in hospitals [3]. These deaths could be prevented by optimization of trauma care. Preventability of trauma deaths has been reported as high as 76% [4] and as low as 1% in mature trauma systems [5,6].Prehospitalization procedures, elapsed time to hospital arrival are, of course, vital to the whole trauma scenario, but errors made in the in-hospital phase of care are responsible for one third to two thirds of the reported by different authors [7,8]. Of these, intensive care unit (ICU) errors are among the most frequent and significant. Errors in the ICU management of trauma patients were studied by Duke and colleagues [9]. They reported 165 ICU trauma deaths. Two hundred fifty-eight errors occurred in 81 patients (52%), and 134 of them contributed to death in 52 patients (34%). ICU errors were classified as management errors (82%), diagnostic (9%), technique (5%), and system inadequacies (4%). Davis and colleagues [10] identified critical care errors in 30% of 125 trauma deaths with errors. These errors contributed to 48% of all preventable deaths.The most common critical care errors are related to airway and respiratory management, fluid resuscitation, neurotrauma diagnosis and support, and delayed diagnosis of critical lesions [9,10].It is imperative for the general surgeon who takes care of trauma patients to know how to deal with these critical aspects, to reduce preventable morbidity and mortality. In the next segment, the situations in which the participation of the surgeon is crucial, during the initial phases of reanimation and stabilization of the critically traumatized patient will be discussed. Airway and ventilation managementAirway and respiratory management errors are the most common of those identified by several authors [9][10][11] The cardinal manifestation is a sudden or a rapidly progressing desaturation, frequently accompanied by tachycardia and arrhytmias, and occasionally by agitation. Hypertension announces the cardiovascular collapse, and bradicardia appears immediately after the total collapse [12]. The symptoms should not be attributed to agitation when it is present, and other possible causes must be ruled out before. Diagnosing the complication involves a directed physical examination, the analysis of the airway pressures and ventilator volumes, chest radiographs, and sometimes the measurement of arterial blood gases (ABG), and the urinary bladder pressure ( Table 1).The emergency conditions in which the access to the airways must be gained, the displacement to diagnosis areas or operating room and the agitation, often present, make the critical...

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Section: Transfusion Threshold and Coagulopathy Correctionmentioning

confidence: 61%

Critical Care Issues in the Early Management of Severe Trauma

García

2006

Surgical Clinics of North America

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“…Thus, the patients treated with a conservative strategy in the FACTT study [19] had better neurological status -perhaps because the patients were desedated earlier because of better respiratory status, perhaps because they had less severe cerebral edema. Moreover, the patients with conservative treatment received fewer transfusions whose potentially deleterious role is well known in intensive care [32]. A simplified version of the algorithm used in the FACTT study was published by the ARDS Network and discussed in a recent review on the subject [33].…”

Section: Fluid Restriction and Diuretics: Clinical Studies And Practimentioning

confidence: 99%

Fluid Management in Acute Lung Injury and ARDS

Roch

Guervilly

Papazian

2010

Yearbook of Intensive Care and Emergency Medicine

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“…1 The effect of transfusion strategy on mortality is dependent on the presence or absence prerandomization of ischaemic heart disease. In the TRICC transfusion trigger trial [1], the effects of transfusion thresholds on 30-day mortality were significantly different and opposite depending on the presence or absence prerandomization of ischaemic heart disease (Breslow-Day test; p = 0.03). In patients with ischaemic heart disease (n = 257), the use of a restrictive transfusion strategy increased mortality compared with the use of a liberal strategy.…”

Section: Resultsmentioning

confidence: 97%

“…The TRICC and TRISS trials are the highest quality evidence in the critically ill, and both used a restrictive Hb trigger of 70 g/L [1,2]. Both reported underpowered cardiovascular and/or ischaemic heart disease subgroup analyses; these showed (non-significant) point estimates that favoured liberal practice (TRICC ARR 4.0 %, 95 % CI -6.9 to 14.9; TRISS RR 1.08, 95 % CI 0.75-1.40).…”

Section: Physiological Arguments Against a Blanket Restrictive Hb Trimentioning

confidence: 99%