NEW evidence-based guidelines for red blood cell (RBC) transfusions in critically ill patients have been released, offering critical care practitioners a roadmap to optimize patient outcomes. The American College of Chest Physicians panel reviewed 3,082 studies, narrowing their analysis to 23 robust articles, including 22 randomized controlled trials and one cohort study.
The findings emphasize a restrictive transfusion strategy—administering fewer transfusions unless absolutely necessary—for most critically ill patients. This approach was linked to a significant reduction in RBC use without increasing mortality or complications. However, there are exceptions: for patients with acute coronary syndrome (ACS), a more permissive strategy may prevent adverse outcomes.
To ensure the recommendations are well-supported, the panel formulated six key questions on transfusion practices, assessed evidence using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework, and reached consensus through a modified Delphi process. The resulting guidance includes two strong and four conditional recommendations, with evidence quality ranging from very low to moderate.
Critical care physicians can now make more informed decisions about RBC transfusions, balancing risks and benefits for diverse patient subgroups, such as those with gastrointestinal bleeding, ACS, cardiac surgery, or septic shock.
These guidelines aim to standardize practices amid the variability in transfusion protocols, enhancing patient safety and resource management in intensive care settings.
Reference: Coz Yataco AO et al. Red Blood Cell Transfusion in Critically Ill Adults. Chest. 2024. doi: 10.1016/j.chest.2024.09.016.
Anaya Malik | AMJ
