Abstract | OBJECTIVE: To compare a restrictive versus a liberal transfusion strategy in patients with moderate to severe closed head injury following multiple trauma in 13 Canadian intensive care units (ICUs). METHODS: This is a subgroup analysis of a multicenter randomized controlled clinical trial involving sixty-seven critically ill patients from the Transfusion Requirements in the Critical Care trial who sustained a closed head injury. Patients had a hemoglobin concentration less than 9.0 g/dL within 72 hours of admission to the ICU. Patients were randomized to a restrictive allogeneic red blood cell transfusion strategy ( hemoglobin 7.0 g/dL and maintained between 7.0 and 9.0 g/dL) or a liberal strategy ( hemoglobin 10.0 g/dL and maintained between 10.0 and 12.0 g/dL). RESULTS: Baseline characteristics in the restrictive ( n = 29) and the liberal ( n = 38) transfusion groups were comparable. Average hemoglobin concentrations and red blood cell units transfused per patient were significantly lower in the restrictive compared to the liberal group. The 30-day all-cause mortality rates in the restrictive group were 17% as compared to 13% in the liberal group (risk difference 4.1 with 95% confidence interval [CI], 13.4 to 21.5, p = 0.64). Presence of multiple organ dysfunction (12.1 +/- 6.4 versus 10.6 +/- 6.3, p = 0.35) and changes in multiple organ dysfunction from baseline scores adjusted for death (4.5 +/- 6.2 versus 3.4 +/- 6.2, p = 0.49) were similar between the restrictive and liberal transfusion groups, respectively. Median length of stay in ICU (10 days, interquartile range 5 to 21 days versus 8 days, interquartile range 5 to 11 days, p = 0.26) and hospital (27 days, interquartile range 14 to 39 days versus 30.5 days, interquartile range 17 to 47 days, p = 0.72) were similar between the restrictive and liberal transfusion groups. CONCLUSIONS: We were unable to detect significant improvements in mortality with a liberal as compared to restrictive transfusion strategy in critically ill trauma victims with moderate to severe head injury.
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Authors | Lauralyn A McIntyre, Dean A Fergusson, James S Hutchison, Giuseppe Pagliarello, John C Marshall, Elizabeth Yetisir, Gregory M T Hare, Paul C Hébert |
Journal | Neurocritical care
(Neurocrit Care)
Vol. 5
Issue 1
Pg. 4-9
( 2006)
ISSN: 1541-6933 [Print] United States |
PMID | 16960287
(Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial)
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Chemical References |
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Topics |
- Adult
- Brain Injuries
(mortality, pathology, therapy)
- Critical Illness
- Erythrocyte Transfusion
(methods)
- Female
- Glasgow Coma Scale
- Head Injuries, Closed
(mortality, pathology, therapy)
- Hemoglobins
(metabolism)
- Hospitalization
- Humans
- Injury Severity Score
- Length of Stay
(statistics & numerical data)
- Male
- Prevalence
- Survival Rate
- Time Factors
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