Transfusional practices: what have we learnt with Transfusion Requirements In Critical Care (TRICC)

Introduction

After the publication of the TRICC trial [1] almost 3 years ago, we expected transfusional practices to change, becoming more restrictive. However, since then no survey has been made in order to observe these practices in our intensive care units (ICUs).

Materials and methods

We carried out a prospective and observational study on four general ICUs in João Pessoa-PB during 4 months (9 January 2002 to 1 January 2003) in order to collect data concerning transfusional practices in critically ill patients. The data collected were: age, Acute Physiology and Chronic Health Evaluation (APACHE) II, vasoactive drug use, transfusion indication (hemoglobin [Hb] < 7 g/dl, acute bleeding with hemodynamic compromise [ABHC] or no specific motive), and number of transfused red blood units (RBU) per indication.

Results

During this period, 614 patients were admitted to the ICUs. There were 121 transfusion indications (238 RBU) in 91 patients. The average age was 58.2 ± 21.8 years, and the mean APACHE II score was 20.3 ± 7.3. Sixty percent were in vasoactive drug use, the mean Hb was 6.9 ± 1.9 g/dl, and 2.03 ± 1.01 RBU were transfused on average (total of 238 RBU). There was a specific motive in 91.7% of indications (57% because Hb < 7 g/dl, and 34.7% had ABHC). Ten (8.3%) of the indications did not have any specific motive and 14 RBU were used according to these indications. Patients who were less sick (APACHE II < 10) were transfused mostly with a specific motive (94.8%) (P < 0.03). In seriously ill patients (APACHE II > 20), low Hb (< 7 g/dl) was the most predominant indication (71.7%) (P = 0.038). More than three RBU were transfused mainly when there was ABHC (60%) (P = 0.005). When there was no specific motive, only 1 RBU was likely to be indicated (70%) (P = 0.001).

Conclusion

The majority of transfusion indications were in agreement with the guidelines proposed by the TRICC trial. Transfusion indications without specific motives were most likely to be made in sicker patients (APACHE II > 20). These patients received only 1 RBU, in most cases.