The impact of packed red blood cell transfusion on clinical outcomes in patients with septic shock treated with early goal directed therapy
Brian Fuller, Mithil Gajera, Christa Schorr, David Gerber, R. Dellinger, Joseph Parrillo, Sergio Zanotti
Early goal directed therapy, packed red blood cell, septic shock, severe sepsis, transfusion
Citation Information :
Fuller B, Gajera M, Schorr C, Gerber D, Dellinger R, Parrillo J, Zanotti S. The impact of packed red blood cell transfusion on clinical outcomes in patients with septic shock treated with early goal directed therapy. Indian J Crit Care Med 2010; 14 (4):165-169.
Background: The optimal hemoglobin level and transfusion threshold in patients with septic shock treated with an early, goal oriented approach to resuscitation remains unknown.
Aims: To assess the impact of packed red blood cell (PRBC) transfusion on clinically relevant outcomes in patients with septic shock treated with early goal directed therapy (EGDT).
Settings and Design: Retrospective cohort study of 93 patients who presented with septic shock, to a single center academic intensive care unit and received EGDT.
Materials and Methods: Data were collected on patients identified via the Surviving Sepsis Campaign Chart Review database and linked to Project IMPACT database. The PRBC group and no PRBC group were compared by the Pearson chi-square and Fisher′s exact test to analyze statistical significance.
Results: The PRBC group had a mortality of 41.2% vs. 33.9% in the no PRBC transfusion group (P = NS). The PRBC group also had more mechanical ventilation days (11.2 days vs. 5.0 days, P ≤ 0.05), longer hospital length of stay (25.9 days vs. 12.5 days, P ≤ 0.05), and longer intensive care unit length of stay (11.4 days vs. 3.8 days, P ≤ 0.05).
Conclusions: In this retrospective cohort study, transfusion of PRBCs was associated with worsened clinical outcomes in patients with septic shock treated with EGDT. Further studies are needed to determine the impact of transfusion of PRBC within the context of early resuscitation of patients with septic shock, as the beneficial effects gained by an early and goal oriented approach to resuscitation may be lost by the negative effects associated with PRBC transfusion.
Consensus Conference (National Institutes of Health). Perioperative red blood cell transfusion. JAMA 1988;260:2700-3.
Gerber D. Transfusion of packed red blood cells in patients with ischemic heart disease. Crit Care Med 2008;36:1068-74.
Gould S, Cimino MJ, Gerber D. Packed Red Blood Cell Transfusion in the Intensive Care Unit: Limitations and Consequences. Am J Crit Care 2007;16:39-48.
Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001;345:1368-77.
Otero RM, Nguyen HB, Huang DT, Gaieski DF, Goyal M, Gunnerson KJ, et al. Early Goal-Directed Therapy in Severe Sepsis and Septic Shock Revisited: Concepts, Controversies, and Contemporary Findings. Chest 2006;130:1579-95.
Hebert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. N Engl J Med 1999;340:409-17.
Hebert PC, Tinmouth A, Corwin H. Controversies in RBC Transfusion in the Critically Ill. Chest 2007;131:1583-90.
Carson JL, Noveck H, Berlin JA, Gould SA. Mortality and morbidity in patients with very low postoperative hemoglobin levels who decline blood transfusion. Transfusion 2002;42:812-8.
Taylor RW, Manganaro L, O′Brien J, Trottier SJ, Parkar N, Veremakis C. Impact of allogenic packed red blood cell transfusion on nosocomial infection rates in the critically ill patient. Crit Care Med 2002;30:2249-54.
Vamvakas EC, Carven JH. Allogeneic blood transfusion and postoperative duration of mechanical ventilation: effects of red cell supernatant, platelet supernatant, plasma components and total transfused fluid. Vox Sang 2002;82:141-9.
Gong MN, Thompson BT, Williams P, Pothier L, Boyce PD, Christiani DC. Clinical predictors of and mortality in acute respiratory distress syndrome: potential role of red cell transfusion. Crit Care Med 2005;33:1191-8.
Croce MA, Tolley EA, Coleridge JA, Fabian TC. Transfusions result in pulmonary morbidity and death after a moderate degree of injury. J Trauma 2005;59:19-23.
Yang X, Alexander KP, Chen AY, Roe MT, Brindis RG, Rao SV, et al. The implications of blood transfusions for patients with non-ST-segment elevation acute coronary syndromes: Results from the CRUSADE National Quality Improvement Initiative. J Am Coll Cardiol 2005;46:1490-5.
Malone DL, Dunne J, Tracy JK, Putnam AT, Scalea TM, Napolitano LM. Blood transfusion, independent of shock severity, is associated with worse outcome in trauma. J Trauma 2003;54:898-905.
Palmieri TL, Caruso DM MD, Foster KN, Cairns BA, Peck MD, Gamelli RL, et al. Effect of blood transfusion on outcome after major burn injury: a multicenter study. Crit Care Med 2006;34:1602-7.
Fernandes CJ, Akamine N, De Marco F, De Souza J, Lagudis S, Knobel E. Red blood cell transfusion does not increase oxygen consumption in critically ill septic patients. Crit Care Med 2001;5:362-7.