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Effect of a liberal versus restrictive transfusion strategy on mortality in patients with moderate to severe head injury.

AbstractOBJECTIVE:
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.
AuthorsLauralyn A McIntyre, Dean A Fergusson, James S Hutchison, Giuseppe Pagliarello, John C Marshall, Elizabeth Yetisir, Gregory M T Hare, Paul C Hébert
JournalNeurocritical care (Neurocrit Care) Vol. 5 Issue 1 Pg. 4-9 ( 2006) ISSN: 1541-6933 [Print] United States
PMID16960287 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial)
Chemical References
  • Hemoglobins
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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