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Adherence to a rest...
Adherence to a restrictive red blood cell transfusion strategy in critically ill patients : An observational study
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- Bjurström, Martin F. (author)
- Uppsala University,Lund University,Lunds universitet,Uppsala universitet,Anestesiologi och intensivvård,Skåne Univ Hosp, Lund Univ, Dept Intens & Perioperat Care, Lund, Sweden; Lund Univ, Lund, Sweden,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Anesthesiology and Intensive Care,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Skåne University Hospital
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- Linder, Ylva C. (author)
- Lund Univ, Dept Clin Immunol & Transfus Med, Off Med Serv, Lab Med, Lund, Sweden.,Lund University,Medical Services, Region Skåne
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- Kjeldsen-Kragh, Jens (author)
- Lund Univ, Dept Clin Immunol & Transfus Med, Off Med Serv, Lab Med, Lund, Sweden.,Medical Services, Region Skåne,Lund University
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- Bengtsson, Jesper (author)
- Lund Univ, Dept Clin Immunol & Transfus Med, Off Med Serv, Lab Med, Lund, Sweden.,Medical Services, Region Skåne
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- Kander, Thomas (author)
- Lund University,Lunds universitet,Anestesiologi och intensivvård,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Klinisk forskning inom anestesi och intensivvårdsmedicin,Forskargrupper vid Lunds universitet,Anesthesiology and Intensive Care,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Clinical Research in Anaesthesia and Intensive Care Medicine,Lund University Research Groups,Skåne University Hospital,Skane Univ Hosp, Lund Univ, Dept Intens & Perioperat Care, Lund, Sweden.;Lund Univ, Lund, Sweden.
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(creator_code:org_t)
- 2024
- 2024
- English.
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In: Acta Anaesthesiologica Scandinavica. - : John Wiley & Sons. - 0001-5172 .- 1399-6576.
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Abstract
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- BackgroundRandomized controlled trials relatively consistently show that restrictive red blood cell (RBC) transfusion strategies are safe and associated with similar outcomes compared to liberal transfusion strategies in critically ill patients. Based on these data, the general threshold for RBC transfusion was changed to 70 g/L at a 9-bed tertiary level intensive care unit in September 2020. Implementation measures included lectures, webinars and feedback during clinical practice. The aim of this study was to investigate how implementation of a restrictive transfusion strategy influenced RBC usage, haemoglobin trigger levels and adherence to prescribed trigger levels.MethodsIn this registry-based, observational study, critically ill adult patients without massive bleeding were included and divided into a pre-cohort, with admissions prior to the change of transfusion strategy, and a post-cohort, with admissions following the change of transfusion strategy. These cohorts were compared regarding key RBC transfusion-related variables.ResultsIn total 5626 admissions were included in the analyses (pre-cohort n = 4373, post-cohort n = 1253). The median volume (interquartile range, IQR) of RBC transfusions per 100 admission days, in the pre-cohort was 6120 (4110–8110) mL versus 3010 (2890–4970) mL in the post-cohort (p < .001). This corresponds to an estimated median saving of 1128 € per 100 admission days after a restrictive RBC transfusion strategy was implemented. In total, 26% of the admissions in the pre-cohort and 19% in the post-cohort (p < .001) received RBC transfusion(s) during days 0–10. Both median (IQR) prescribed trigger levels (determined by intensivist) and actual haemoglobin trigger levels (i.e., levels prior to actual administration of transfusion) were higher in the pre- versus post-cohort (90 [80–100] vs. 80 [72–90] g/L, p < .001 and 89 [82–96] g/L vs. 83 [79–94], p < .001, respectively). Percentage of days without compliance with the prescribed transfusion trigger was higher in the pre-cohort than in the post-cohort (23% vs. 14%, p < .001). Sensitivity analyses, excluding patients with traumatic brain injury, ischemic heart disease and COVID-19 demonstrated similar results.ConclusionsImplementation of a restrictive transfusion trigger in a critical care setting resulted in lasting decreased RBC transfusion use and costs, decreased prescribed and actual haemoglobin trigger levels and improved adherence to prescribed haemoglobin trigger levels.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Anestesi och intensivvård (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Anesthesiology and Intensive Care (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Hematologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Hematology (hsv//eng)
Keyword
- adherence
- critically ill
- erythrocyte transfusions
- guideline
- healthcare economic
- intensive care medicine
- red blood cell transfusion
- transfusion costs
- transfusion strategy
Publication and Content Type
- ref (subject category)
- art (subject category)
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