Effect of Tissue Perfusion Oriented Red Blood Cell Transfusion Strategy on Outcomes of Critically Ill Patients
10.3969/j.issn.1674-9081.2015.05.010
- VernacularTitle:组织灌注导向红细胞输注策略对重症患者预后的影响
- Author:
Xiang ZHOU
1
;
Da-Wei LIU
;
Yun LONG
;
Long-Xiang SU
;
Wei CHENG
;
Qing ZHANG
Author Information
1. 中国医学科学院 北京协和医学院 北京协和医院重症医学科
- Keywords:
tissue perfusion;
lactate acid;
red blood cell;
acute kidney injury;
acute myocardial injury;
acute lung injury
- From:
Medical Journal of Peking Union Medical College Hospital
2015;(5):361-368
- CountryChina
- Language:Chinese
-
Abstract:
Objective To compare the effects of Eastern Association for Surgery of Trauma/American College of Critical Care Medicine/Society of Critical Care Medicine ( EAST/ACCM/SCCM) red blood cell trans-fusion in adult trauma and critical care guidelines (2009) guided red blood cell (RBC) transfusion strategy and tissue perfusion oriented RBC transfusion strategy in critically ill patients. Methods In 2013, RBC transfusion in Department of Critical Care Medicine of Peking Union Medical College Hospital followed the EAST/ACCM/SC-CM guidelines recommendation in critically ill patients, and in 2014 tissue perfusion oriented RBC transfusion strategy was adopted. The in-hospital mortality, length of Intensive Care Unit ( ICU) stay, incidence of new or-gan injury, mean pre-transfusion hemoglobin ( Hb) level, blood lactate acid level upon admission ( Lac admit-ted), pre-transfusion blood lactate acid level (Lac pre-transfusion), mean RBC transfusion volume, and inci-dence of transfusion-related complications in all ICU patients and patients with Acute Physiology and Chronic Health Evaluation Ⅱ ( APACHE Ⅱ) ≥15 were compared between the year 2013 and the year 2014 . Results In 2013 and 2014, 2110 and 2638 patients were admitted to ICU, respectively. The mean APACHEⅡscore up-on admission and the proportion of patients with APACHEⅡ≥15 were both higher in 2014 than in 2013 ( P<0. 05 ) . The proportion of patients treated with RBC transfusion was significantly lower in 2014 than in 2013 (P<0. 05). The mean pre-transfusion Hb level, Lac admitted, and the proportion of patients with Lac admitted<4 mmol/L showed no significant difference between the two years (P>0. 05). Lac pre-transfusion in 2014 was significantlyhigherthanthatin2013[(4.16±1.18) mmol/Lvs. (2.78±1.03) mmol/L,P=0.031]. Inthe patients treated with RBC transfusion, the proportion of patients with Lac admitted<4 mmol/L was significantly lower in 2014 than in 2013 (20. 5% vs. 33. 4%, P=0. 018). The mean RBC transfusion volume was significant lower in 2014 than in 2013 [(1. 02 ± 0. 51) U vs. (1. 55 ± 0. 70) U, P=0. 037]. The in-hospital mortality was not significantly different between the two years in all ICU patients (2. 77% vs. 2. 39%, P=0. 749), but the mean length of ICU stay was significantly shorter in 2014 than in 2013 [(5. 31 ± 1. 98) d vs. (6. 84 ± 2. 36) d, P=0. 025] . The incidences of new onset acute kidney injury, acute liver injury, acute myocardial injury, and acute lung injury showed no significant difference between the two years ( P>0. 05 ) . In patients with APACHEⅡ≥15, the in-hospital mortality was significant lower (7. 00% vs. 12. 01%, P=0. 018) and the length of ICU stay significantly shorter in 2014 than in 2013 [(7. 16 ± 3. 53) d vs. (12. 44 ± 5. 27) d, P<0. 001];the inci-dences of new onset acute kidney injury, acute myocardial injury, and acute lung injury were significantly lower in 2014 (P<0. 05). No transfusion-related infection or hemolysis occurred in the two years. The incidences of non-hemolytic febrile transfusion reaction and transfusion-related lung injury in all the ICU patients and patients with APACHE Ⅱ ≥15 were not significantly different between the two years ( P>0. 05 ) . Conclusions Com-pared with EAST/ACCM/SCCM guideline based RBC transfusion strategy, tissue perfusion oriented RBC transfu-sion strategy in critically ill patients can reduce RBC transfusion volume and shorten length of ICU stay. Especial-ly for ICU patient with APACHE Ⅱ ≥15 , it can also reduce in-hospital mortality and incidences of new onset acute kidney injury, acute myocardial injury, and acute lung injury, without increasing the incidence of transfu-sion-related complications.
