Time course of hemoglobin concentrations in nonbleeding intensive care unit patients

Ba, Vinh Nguyen; Bota, Daliana Peres; Mélot, Christian; Vincent, Jean‐Louis

doi:10.1097/01.ccm.0000048623.00778.3f

Cited by 139 publications

(34 citation statements)

References 25 publications

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“…The CRIT Study showed similar results in the United States [2]. A number of factors contribute to this anemia, including the acute inflammatory reaction typical of these patients [3,4]. Anemia of inflammation has been clearly described in patients with cancer, with chronic inflammatory disease and with chronic infection [5-10].…”

Section: Introductionmentioning

confidence: 88%

Untitled

et al. 2004

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356 APACHE = Acute Physiology and Chronic Health Evaluation; FID = functional iron deficiency; ICU = intensive care unit; IL = interleukin; IV = intravenous; rHuEPO = recombinant human erythropoietin. Critical Care October 2004 Vol 8 No 5 Darveau et al. IntroductionRecent observational studies have shown that most patients in the intensive care unit (ICU) become anemic within a few days [1][2][3]. In Europe, approximately 37% of patients receive transfusions and just over 70% of those remaining in the ICU for longer than 7 days are transfused [1]. The CRIT Study showed similar results in the United States [2]. A number of factors contribute to this anemia, including the acute inflammatory reaction typical of these patients [3,4]. Anemia of inflammation has been clearly described in patients with cancer, with chronic inflammatory disease and with chronic infection [5][6][7][8][9][10]. This type of anemia is related to the release of mediators that cause a blunted erythropoietic response and an activation of red blood cell catabolism by macrophages. The inflammatory state also results in decreased mobilization of iron stores from the reticuloendothelial system, leading to the development and persistence of anemia [5][6][7][8][9][10].Special attention has been paid in recent years to limiting the number of transfusions received by ICU patients. Limiting blood collection [1] and restrictive transfusion thresholds [11] are among the strategies that have been adopted for blood conservation. Although the optimal dose of recombinant human erythropoietin (rHuEPO) in the intensive care setting has yet to be determined, its use constitutes another blood conservation strategy [12,13]. Erythropoietin's ability to stimulate erythrocyte production is highly dependent on the availability of iron. Understanding iron metabolism in this patient population is important in order to act on the mechanisms of and the causes of anemia in critically ill patients. The decrease in iron availability seen in inflammatory diseases may contribute to inadequate erythropoiesis in ICU patients.Is the iron metabolism imbalance seen in chronic inflammatory states similar to that found in ICU patients? To Review Bench-to-bedside review: Iron metabolism in critically ill patients AbstractCritically ill patients frequently develop anemia due to several factors. Iron-withholding mechanisms caused by inflammation contribute to this anemia. The iron metabolism imbalances described or reported in all intensive care studies are similar to the values observed in anemia of inflammation. The administration of iron could be useful in the optimization of recombinant human erythropoietin activity, but this could be at the expense of bacterial proliferation. Since there is a lack of evidence to support either oral or intravenous iron administration in intensive care patients, further studies are necessary to determine the efficacy and safety of iron supplementation in conjunction with recombinant human erythropoietin in critically ill patients. We review the mec...

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Section: Introductionmentioning

confidence: 88%

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et al. 2004

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“…Anemia in critical illness is a complex phenomenon with a number of causes [2]. Acute blood loss is commonly a feature of the presenting disease process, for example, gastrointestinal bleeding, multiple trauma, or major elective surgery.…”

Section: Transfusion Of Critically Ill Patientsmentioning

confidence: 99%

Transfusion in the Intensive Care Unit

Marshall

2005

Surgical Infections

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“…Anemia is a common, life-threatening condition among critically ill patients, and almost 40% of intensive care unit (ICU) patients receive a red blood cell (RBC) transfusion during their stay[1–3]. However, high rates of transfusions are associated with increased cost, infection rate, multi-organ failure, and mortality[1, 4, 5].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of RBC Transfusion Practice in Adult ICUs and the Effect of Restrictive Transfusion Protocols on Routine Care

Seitz

Sevransky

Martin

et al. 2017

Critical Care Medicine

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Objective Research supports the efficacy and safety of Restrictive Transfusion Protocols (RTP) to reduce avoidable red blood cell (RBC) transfusions, but evidence of their effectiveness in practice is limited. This study assessed whether admission to an intensive care unit (ICU) with an RTP reduces the likelihood of transfusion for adult patients. Design Observational study using data from the multi-center, cohort Critical Illness Outcomes Study. Patient-level analyses were conducted with RBC transfusion on day of enrollment as the outcome and admission to an ICU with an RTP as the exposure of interest. Covariates included demographics, hospital course (e.g. lowest hematocrit, blood loss), severity of illness (e.g. SOFA score), interventions (e.g. sedation/analgesia), and ICU characteristics (e.g. size). Multivariable logistic regression modeling assessed the independent effects of RTPs on transfusions. Setting 59 US ICUs. Patients 6,027 adult ICU patients. Interventions None. Measurements and Main Results Of the 59 study ICUs, 24 had an RTP; 2,510 (41.6%) patients were in an ICU with an RTP. The incidence of RBC transfusion among patients with severe (Hct<21%), moderate (Hct: 21–30%), and mild (Hct>30%) anemia in RTP ICUs were 67%, 19%, and 4%, respectively, compared to 60%, 14%, and 2% for those in ICUs without an RTP. Only 27% of transfusions were associated with a hematocrit less than 21%. Adjusting for confounding factors, RTPs independently reduced the odds of transfusion in moderate anemia with an odds ratio of 0.59 (95%CI: 0.36–0.96) while demonstrating no effect in mild (p=0.93) or severe (p=0.52) anemia. Conclusions In this sample of ICU patients, transfusions often occurred outside evidence-based guidelines, but admission to an ICU with an RTP did reduce the risk of transfusion in moderately anemic patients controlling for patient and ICU factors. This study supports the effectiveness of RTPs for influencing transfusions in clinical practice.

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Time course of hemoglobin concentrations in nonbleeding intensive care unit patients

Cited by 139 publications

References 25 publications

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Transfusion in the Intensive Care Unit

Evaluation of RBC Transfusion Practice in Adult ICUs and the Effect of Restrictive Transfusion Protocols on Routine Care

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