CLINICAL NEWS
The New Normal
Lower Transfusion Thresholds for Septic Shock Patients
A restrictive approach to blood transfusion
reduced blood use by half but, more importantly, caused no harm to 998 critically
ill patients with septic shock, according to
results from a recent study published in the
New England Journal of Medicine. A lower
threshold also meant more patients were
able to avoid transfusion.
“Blood transfusions are frequently
given to patients with septic shock,” the
authors, led by Lars B. Holst, MD, from
University of Copenhagen in Denmark,
wrote. “However, the benefits and harms of
different hemoglobin thresholds for transfusion have not been established.”
Guidelines have generally advised
transfusion to a hematocrit of 30 percent or
hemoglobin of 10 g/dL during the first six
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hours of septic shock – if hypoperfusion is
present despite fluids and vasopressors. The
evidence supporting these recommendations, though, has been weak. The reports
from the current analysis of the TRISS trial
may put an end to those practices.
In this multicenter, parallel-group trial,
Dr. Holst and investigators enrolled 998
patients with septic shock from 32 intensive
care units (ICU) throughout Denmark.
Patients were randomized to transfusion
throughout their ICU stay to maintain a hemoglobin concentration of ≥7 g/dL (lower
threshold) or ≥9 g/dL (higher threshold).
The primary endpoint was mortality at 90
days after randomization.
Ninety-nine percent of patients in the
higher-threshold group were transfused,
receiving a median of four units of blood
while in the ICU; two-thirds of the lowerthreshold patients were transfused, but
received only a median of one unit.
At 90 days after randomization,
mortality was statistically similar in both
groups: 216 of 502 pa ѥ