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BACKGROUND: Despite evidence supporting the use of restrictive hemoglobin (Hb) transfusion triggers in critically ill patients, translation of this evidence into practice remains inconsistent. It was hypothesized that clinicians believe that longer-term ventilated patients require a higher Hb, particularly when ischemic heart disease coexists. STUDY DESIGN AND METHODS: A scenario was developed describing an anemic patient recovering from multiple organ failure, but failing weaning trials after 6 days of mechanical ventilation. Clinicians were asked to state their Hb transfusion trigger and target Hb range assuming no history of ischemic heart disease (Scenario 1), known stable chronic ischemic heart disease (Scenario 2), or evidence of myocardial ischemia during weaning trials (Scenario 3). A prospective cross-sectional postal survey of clinicians practicing intensive care in the United Kingdom was undertaken. RESULTS: A total of 184 responses were obtained (52% response rate), which varied widely. Median (first, third quartile) transfusion trigger Hb levels were 8 (7, 8), 9 (8, 9.5), and 9.5 (9, 9.5) g/dL for Scenarios 1 to 3, respectively (p < 0.001 across and between each group). The target Hb was more than 9 g/dL for 47, 80, and 94% of respondents for Scenarios 1 to 3, respectively, and more than 10 g/dL for 14, 44, and 65% of respondents for Scenarios 1 to 3, respectively (p < 0.001 across the groups). CONCLUSIONS: In response to scenarios, clinicians in the United Kingdom believe that a more liberal transfusion practice is required for patients failing weaning trials after 6 days of mechanical ventilation than the current evidence base supports. [ABSTRACT FROM AUTHOR]

Anemia commonly complicates critical illness. Restrictive transfusion triggers are appropriate in this setting, but no large studies have measured red cell (RBC) requirements for intensive care patients when evidence-based transfusion guidelines are followed consistently.Data were recorded daily for 1023 of 1042 sequential admissions to 10 intensive care units (ICUs) over 100 days. The sample comprised 44 percent of all ICU admissions in Scotland during this period. RBC transfusions and the occurrence of clinically significant hemorrhage were recorded for every ICU day. Transfusion episodes were classified as either associated with or not associated with hemorrhage. Measures of RBC use were derived for the cohort and for Scotland with national audit data.A total of 39.5 percent (95% confidence interval[CI], 36.5%-42.5%) of admissions received transfusions. Eighteen percent of admissions received at least one transfusion associated with hemorrhage and 26 percent received at least one transfusion not associated with hemorrhage. The median (interquartile range) transfusion trigger in the absence of hemorrhage was 78 (73-78) g/L. The overall mean RBC use was 1.87 (95% CI, 1.79-1.96) units per admission or 0.34 (95% CI, 0.33-0.36) units per ICU-day. Forty-seven percent of RBCs administered were not associated with clinically significant hemorrhage. Mean RBC requirements for intensive care in Scotland were estimated to be 3950 (95% CI, 3780-4140) per million-adult-population per year. This represented 7 to 8 percent of the Scottish blood supply.Despite evidence-based transfusion practice, 40 percent of ICU patients receive transfusions, which account for 7 to 8 percent of the national blood supply. [ABSTRACT FROM AUTHOR]