Effect of Tissue Perfusion Oriented Red Blood Cell Transfusion Strategy on Outcomes of Critically Ill Patients

  Objective  To compare the effects of Eastern Association for Surgery of Trauma/AmericanCollege of Critical Care Medicine/Society of Critical Care Medicine (EAST/ACCM/SCCM) red blood cell transfusion in adult trauma and critical care guidelines (2009) guided red blood cell (RBC) transfusion strategy and tissue perfusion oriented RBC transfusion strategy in critically ill patients.

  Methods  In 2013, RBC transfusion in Department of Critical Care Medicine of Peking Union Medical College Hospital followed the EAST/ACCM/SCCM guidelines recommendation in critically ill patients, and in 2014 tissue perfusion oriented RBC transfusion strategy was adopted. The in-hospital mortality, length of Intensive Care Unit (ICU) stay, incidence of new organ injury, mean pre-transfusion hemoglobin (Hb) level, blood lactate acid level upon admission (Lac admitted), pre-transfusion blood lactate acid level (Lac pre-transfusion), mean RBC transfusion volume, and incidence of transfusion-related complications in all ICU patients and patients with Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ) ≥ 15 were compared between the year 2013 and the year 2014.

  Results  In 2013 and 2014, 2110 and 2638 patients were admitted to ICU, respectively. The mean APACHE Ⅱ score upon admission and the proportion of patients with APACHE Ⅱ ≥ 15 were both higher in 2014 than in 2013(P < 0.05). The proportion of patients treated with RBC transfusion was significantly lower in 2014 than in 2013(P < 0.05). The mean pre-transfusion Hb level, Lac admitted, and the proportion of patients with Lac admitted < 4 mmol/L showed no significant difference between the two years (P>0.05). Lac pre-transfusion in 2014 was significantly higher than that in 2013(4.16±1.18)mmol/L vs. (2.78±1.03)mmol/L, P=0.031. In the patients treated with RBC transfusion, the proportion of patients with Lac admitted < 4 mmol/L was significantly lower in 2014 than in 2013 (20.5% vs. 33.4%, P=0.018). The mean RBC transfusion volume was significant lower in 2014 than in 2013(1.02±0.51)U vs. (1.55±0.70)U, P=0.037. The in-hospital mortality was not significantly different between the two years in all ICU patients (2.77% vs. 2.39%, P=0.749), but the mean length of ICU stay was significantly shorter in 2014 than in 2013(5.31±1.98)d vs. (6.84±2.36)d, P=0.025. The incidences of new onset acute kidney injury, acute liver injury, acute myocardial injury, and acute lung injury showed no significant difference between the two years (P>0.05). In patients with APACHE Ⅱ ≥ 15, the in-hospital mortality was significant lower (7.00% vs. 12.01%, P=0.018) and the length of ICU stay significantly shorter in 2014 than in 2013(7.16±3.53)d vs. (12.44±5.27)d, P < 0.001; the incidences of new onset acute kidney injury, acute myocardial injury, and acute lung injury were significantly lower in 2014 (P < 0.05). No transfusion-related infection or hemolysis occurred in the two years. The incidences of non-hemolytic febrile transfusion reaction and transfusion-related lung injury in all the ICU patients and patients with APACHE Ⅱ ≥ 15 were not significantly different between the two years (P>0.05).

  Conclusions  Compared with EAST/ACCM/SCCM guideline based RBC transfusion strategy, tissue perfusion oriented RBC transfusion strategy in critically ill patients can reduce RBC transfusion volume and shorten length of ICU stay. Especially for ICU patient with APACHE Ⅱ ≥ 15, it can also reduce in-hospital mortality and incidences of new onset acute kidney injury, acute myocardial injury, and acute lung injury, without increasing the incidence of transfusion-related complications.