Table 1.

Summary of recommendations

1. Liberal vs. restrictive red blood cell transfusion in non-bleeding, critically ill adults

We recommend a restrictive transfusion threshold (7 g/dL) vs. a liberal transfusion threshold (9 g/dL) in a general ICU population, with or without ARDS (Strong recommendation, moderate certainty). This recommendation does not apply to patient populations addressed in subsequent recommendations below

We suggest a liberal transfusion threshold (9-10 g/dL) vs. a restrictive transfusion threshold (7 g/dL) in critically ill adults with acute coronary syndromes (conditional recommendation, low certainty)

We suggest a restrictive transfusion threshold (7 g/dL) vs. a liberal transfusion threshold (9 g/dL) in critically ill adults with sepsis and septic shock (conditional recommendation, moderate certainty)

We suggest a restrictive transfusion threshold (7 g/dL) vs. a liberal transfusion threshold (9 g/dL) in critically ill adults with prolonged weaning from mechanical ventilation (conditional recommendation, low certainty)

We recommend a restrictive transfusion threshold (7.5 g/dL) vs. a liberal transfusion threshold (8.5-9.0 g/dL) in critically ill adults undergoing cardiac surgery (strong recommendation, moderate certainty)

We do not make a recommendation for a restrictive (7 g/dL) vs. a liberal (9-11.5 g/dL) transfusion threshold in critically ill adults with acute neurologic injury (traumatic brain injury, subarachnoid haemorrhage, or stroke). Transfusion at either threshold remains appropriate pending further research (no recommendation, low certainty)

We do not make a recommendation for a restrictive (7 g/dL) vs. a liberal transfusion (9 g/dL) threshold in critically ill adults undergoing veno-venous or veno-arterial ECMO. Transfusion at either threshold would be appropriate pending further research (no recommendation, very low certainty)

We do not make a recommendation for a restrictive transfusion threshold (7 g/dL) vs. a liberal transfusion threshold (9 g/dL) in critically ill adults with malignancy (haematologic or solid tumour). Transfusion at either threshold would be appropriate pending further research (no recommendation, low certainty)

We do not make a recommendation for a restrictive transfusion threshold (7 g/dL) vs. a liberal transfusion threshold (9 g/dL) in critically ill elderly patients. Transfusion at either threshold would be appropriate until further research is available (no recommendation, low certainty)

2. Alternative transfusion triggers in non-bleeding, critically ill adults

We suggest using haemoglobin or hematocrit transfusion triggers rather than alternative transfusion triggers (conditional recommendation, very low certainty)

3. RBC transfusion prevention in non-bleeding, critically ill adults

We suggest not using iron therapy (oral or intravenous) to prevent RBC transfusion (conditional recommendation, low certainty)

We suggest not using erythropoietin to prevent RBC transfusion (conditional recommendation, low certainty)

We suggest not using a combination of erythropoietin and iron to prevent RBC transfusion (conditional recommendation, very low certainty)

We suggest using small-volume blood collection tubes to prevent RBC transfusion (conditional recommendation, very low certainty)

We suggest using blood conservation devices versus conventional blood sampling systems to prevent RBC transfusion (conditional recommendation, low certainty)

4. Platelet transfusion in non-bleeding, critically ill adults

We suggest not using platelet transfusion to treat thrombocytopenia unless the platelet count falls below 10 × 109/L (conditional recommendation, very low certainty)

We recommend not giving prophylactic platelet transfusion prior to invasive procedures for platelet counts above 100 × 109/L (strong recommendation, low certainty)

We suggest not giving prophylactic platelet transfusion prior to percutaneous tracheostomy or central line insertion for platelet counts between 50 and 100 × 109/L (conditional recommendation, very low certainty)

We make no recommendation regarding prophylactic platelet transfusion prior to invasive procedures for platelet counts between 10 and 50 × 109/L

5. Plasma transfusion in non-bleeding critically ill adults

We suggest not giving prophylactic plasma transfusion in patients with coagulopathy (conditional recommendation, very low certainty)

We suggest not giving prophylactic plasma transfusion prior to invasive bedside procedures in patients with coagulopathy (conditional recommendation, very low certainty)