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Titolo:
Is a low transfusion threshold safe in critically ill patients with cardiovascular diseases?
Autore:
Hebert, PC; Yetisir, E; Martin, C; Blajchman, MA; Wells, G; Marshall, J; Tweeddale, M; Pagliarello, G; Schweitzer, I;
Indirizzi:
Univ Ottawa, Crit Care Programs, Ottawa, ON, Canada Univ Ottawa Ottawa ONCanada awa, Crit Care Programs, Ottawa, ON, Canada Univ Toronto, Toronto, ON, Canada Univ Toronto Toronto ON CanadaUniv Toronto, Toronto, ON, Canada Univ Western Ontario, London, ON, Canada Univ Western Ontario London ON Canada estern Ontario, London, ON, Canada Univ British Columbia, Vancouver, BC, Canada Univ British Columbia Vancouver BC Canada olumbia, Vancouver, BC, Canada Univ Ottawa, Clin Epidemiol Unit, Ottawa, ON, Canada Univ Ottawa Ottawa ON Canada wa, Clin Epidemiol Unit, Ottawa, ON, Canada McMaster Univ, Dept Pathol, Hamilton, ON, Canada McMaster Univ Hamilton ON Canada Univ, Dept Pathol, Hamilton, ON, Canada McMaster Univ, Dept Med, Hamilton, ON, Canada McMaster Univ Hamilton ON Canada er Univ, Dept Med, Hamilton, ON, Canada Ottawa Gen Hosp, TRICC Trial Execut & Writing Comm, Ottawa, ON, Canada Ottawa Gen Hosp Ottawa ON Canada ecut & Writing Comm, Ottawa, ON, Canada Ottawa Civic Hosp, Ottawa, ON, Canada Ottawa Civic Hosp Ottawa ON CanadaOttawa Civic Hosp, Ottawa, ON, Canada McMaster Univ, Med Ctr, Hamilton, ON, Canada McMaster Univ Hamilton ON Canada ter Univ, Med Ctr, Hamilton, ON, Canada Toronto Hosp, Gen Div, Toronto, ON, Canada Toronto Hosp Toronto ON Canada oronto Hosp, Gen Div, Toronto, ON, Canada Vancouver Gen Hosp, Vancouver, BC, Canada Vancouver Gen Hosp Vancouver BCCanada r Gen Hosp, Vancouver, BC, Canada Queen Elizabeth II Hlth Sci Ctr, Halifax, NS, Canada Queen Elizabeth II Hlth Sci Ctr Halifax NS Canada r, Halifax, NS, Canada Royal Victoria Hosp, Montreal, PQ, Canada Royal Victoria Hosp Montreal PQCanada ctoria Hosp, Montreal, PQ, Canada St Michaels Hosp, Toronto, ON, Canada St Michaels Hosp Toronto ON CanadaSt Michaels Hosp, Toronto, ON, Canada Wellesley Hosp, Toronto, ON, Canada Wellesley Hosp Toronto ON CanadaWellesley Hosp, Toronto, ON, Canada Hamilton Gen Hosp, Hamilton, ON, Canada Hamilton Gen Hosp Hamilton ON Canada lton Gen Hosp, Hamilton, ON, Canada Foothills Hosp, Calgary, AB, Canada Foothills Hosp Calgary AB CanadaFoothills Hosp, Calgary, AB, Canada St Pauls Hosp, Vancouver, BC, Canada St Pauls Hosp Vancouver BC CanadaSt Pauls Hosp, Vancouver, BC, Canada Victoria Hosp, London, ON, Canada Victoria Hosp London ON CanadaVictoria Hosp, London, ON, Canada Hlth Sci Ctr, St Johns, NF, Canada Hlth Sci Ctr St Johns NF CanadaHlth Sci Ctr, St Johns, NF, Canada Montreal Gen Hosp, Montreal, PQ, Canada Montreal Gen Hosp Montreal PQ Canada real Gen Hosp, Montreal, PQ, Canada Jewish Gen Hosp, Montreal, PQ, Canada Jewish Gen Hosp Montreal PQ CanadaJewish Gen Hosp, Montreal, PQ, Canada Toronto Hosp, Western Div, Toronto, ON, Canada Toronto Hosp Toronto ON Canada to Hosp, Western Div, Toronto, ON, Canada St Josephs Hosp, London, ON, Canada St Josephs Hosp London ON CanadaSt Josephs Hosp, London, ON, Canada Univ Hosp Saskatoon, Saskatoon, SK, Canada Univ Hosp Saskatoon Saskatoon SK Canada Saskatoon, Saskatoon, SK, Canada Univ Hosp Edmonton, Edmonton, AB, Canada Univ Hosp Edmonton Edmonton AB Canada osp Edmonton, Edmonton, AB, Canada Kingston Gen Hosp, Kingston, ON, Canada Kingston Gen Hosp Kingston ON Canada ston Gen Hosp, Kingston, ON, Canada Hop Maison Neuve Rosemont, Montreal, PQ, Canada Hop Maison Neuve RosemontMontreal PQ Canada emont, Montreal, PQ, Canada Hotel Dieu Grace Hosp, Windsor, ON, Canada Hotel Dieu Grace Hosp Windsor ON Canada Grace Hosp, Windsor, ON, Canada Calgary Gen Hosp, Peter Lougheed Ctr, Calgary, AB, Canada Calgary Gen Hosp Calgary AB Canada ter Lougheed Ctr, Calgary, AB, Canada Hamilton Hlth Sci Ctr, Hamilton, ON, Canada Hamilton Hlth Sci Ctr Hamilton ON Canada h Sci Ctr, Hamilton, ON, Canada Ottawa Hosp, Clin Epidemiol Unit, Ottawa, ON, Canada Ottawa Hosp Ottawa ON Canada sp, Clin Epidemiol Unit, Ottawa, ON, Canada St Pauls Hosp, Vancouver, BC, Canada St Pauls Hosp Vancouver BC CanadaSt Pauls Hosp, Vancouver, BC, Canada Dr Everett Chalmers Hosp, Fredericton, NB, Canada Dr Everett Chalmers Hosp Fredericton NB Canada , Fredericton, NB, Canada Univ Waterloo, Waterloo, ON, Canada Univ Waterloo Waterloo ON CanadaUniv Waterloo, Waterloo, ON, Canada
Titolo Testata:
CRITICAL CARE MEDICINE
fascicolo: 2, volume: 29, anno: 2001,
pagine: 227 - 234
SICI:
0090-3493(200102)29:2<227:IALTTS>2.0.ZU;2-Y
Fonte:
ISI
Lingua:
ENG
Soggetto:
CORONARY STENOSIS; BLOOD-TRANSFUSION; OXYGEN DELIVERY; CLINICAL-TRIAL; HEMODILUTION; ANEMIA; STRATEGIES; REDUCTION; MORTALITY; SURGERY;
Keywords:
critical care; cardiovascular disease; red blood cell transfusion practice; oxygen delivery; transfusion trigger; anemia; ischemic heart disease; hemoglobin; cardiac surgery; vascular surgery;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
30
Recensione:
Indirizzi per estratti:
Indirizzo: Hebert, PC Univ Ottawa, Crit Care Programs, Ottawa, ON, Canada Univ Ottawa Ottawa ON Canada are Programs, Ottawa, ON, Canada
Citazione:
P.C. Hebert et al., "Is a low transfusion threshold safe in critically ill patients with cardiovascular diseases?", CRIT CARE M, 29(2), 2001, pp. 227-234

Abstract

Objective: To compare a restrictive red blood cell transfusion strategy with a more liberal strategy in volume-resuscitated critically ill patients with cardiovascular disease. Setting: Twenty-two academic and three community critical care units across Canada. Study Design: Randomized controlled clinical trial. Study Population: Three hundred fifty-seven critically ill patients with cardiovascular diseases from the Transfusion Requirements in Critical Care trial who had a hemoglobin concentration of <90 g/L within 72 hrs of admission to the intensive care unit. Interventions: Patients were randomized to a restrictive strategy to receive allogeneic red blood cell transfusions at a hemoglobin concentration of 70 g/L (and maintained between 70 and 90 g/L) or a liberal strategy to receive red blood cells at 100 g/L land maintained between 100 and 120 gill. Results: Baseline characteristics in the restrictive (n = 160) and the liberal group (n = 197) were comparable, except for the use of cardiac and anesthetic drugs (p < .02), Average hemoglobin concentrations (85 +/- 6.2 vs. 103 +/- 6.7 g/L; p < .01) and red blood cell units transfused (2.4 +/- 4.1 vs. 5.2 +/- 5.0 red blood cell units; p < .01) were significantly lower in the restrictive compared with the liberal group. Overall, all mortality rates were similar in both study groups, including 30-day (23% vs. 23%; p 1.00), 60-day, hospital, and intensive care unit rates. Changes in multiple organ dysfunction from baseline scores were significantly less in the restrictive transfusion group overall (0.2 +/- 4.2 vs. 1.3 +/- 4.4; p = .02). In the 257 patients with severe ischemic heart disease, there were no statistically significant differences in all survival measures, but this is the only subgroup where the restrictive group had lower but nonsignificant absolute survival rates compared with the patients in the liberal group. Conclusion: A restrictive red blood cell transfusion strategy generally appears to be safe in most critically ill patients with cardiovascular disease, with the possible exception of patients with acute myocardial infarcts and unstable angina.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 09/04/20 alle ore 00:29:46