Individualised or liberal red blood cell transfusion after cardiac surgery: a randomised controlled trial.
cardiac surgery
central venous oxygen saturation
haemoglobin
outcomes
red blood cell transfusion
Journal
British journal of anaesthesia
ISSN: 1471-6771
Titre abrégé: Br J Anaesth
Pays: England
ID NLM: 0372541
Informations de publication
Date de publication:
Jan 2022
Jan 2022
Historique:
received:
04
05
2021
revised:
30
08
2021
accepted:
21
09
2021
pubmed:
5
12
2021
medline:
17
2
2022
entrez:
4
12
2021
Statut:
ppublish
Résumé
Current practice guidelines for red blood cell (RBC) transfusion in ICUs are based on haemoglobin threshold, without consideration of oxygen delivery or consumption. We aimed to evaluate an individual physiological threshold-guided by central venous oxygen saturation ScvO In a randomised study in two French academic hospitals, 164 patients who were admitted to ICU after cardiac surgery with postoperative haemoglobin <9 g dl The primary outcome was observed for 80 of 80 subjects (100%) in the haemoglobin group and in 61 of 77 patients (79%) in the individualised group (absolute risk -21% [-32.0; -14.0]; P<0.001). There was no significant difference in the secondary outcome between the two groups. Follow-up showed a non-significant difference in mortality at 1 and 6 months. An individualised strategy based on an central venous oxygen saturation threshold of 70% allows for a more restrictive red blood cell transfusion strategy with no incidence on postoperative morbidity or 6-month mortality. NCT02963883.
Sections du résumé
BACKGROUND
BACKGROUND
Current practice guidelines for red blood cell (RBC) transfusion in ICUs are based on haemoglobin threshold, without consideration of oxygen delivery or consumption. We aimed to evaluate an individual physiological threshold-guided by central venous oxygen saturation ScvO
METHODS
METHODS
In a randomised study in two French academic hospitals, 164 patients who were admitted to ICU after cardiac surgery with postoperative haemoglobin <9 g dl
RESULTS
RESULTS
The primary outcome was observed for 80 of 80 subjects (100%) in the haemoglobin group and in 61 of 77 patients (79%) in the individualised group (absolute risk -21% [-32.0; -14.0]; P<0.001). There was no significant difference in the secondary outcome between the two groups. Follow-up showed a non-significant difference in mortality at 1 and 6 months.
CONCLUSIONS
CONCLUSIONS
An individualised strategy based on an central venous oxygen saturation threshold of 70% allows for a more restrictive red blood cell transfusion strategy with no incidence on postoperative morbidity or 6-month mortality.
CLINICAL TRIAL REGISTRATION
BACKGROUND
NCT02963883.
Identifiants
pubmed: 34862002
pii: S0007-0912(21)00650-4
doi: 10.1016/j.bja.2021.09.037
pii:
doi:
Substances chimiques
Hemoglobins
0
Oxygen
S88TT14065
Banques de données
ClinicalTrials.gov
['NCT02963883']
Types de publication
Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
37-44Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2021 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.