Effect of a liberal versus restrictive transfusion strategy on mortality in patients with moderate to severe head injury
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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).
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).
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.
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.
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- Effect of a liberal versus restrictive transfusion strategy on mortality in patients with moderate to severe head injury
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- Critical care
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- Author Affiliations
- 1. Centre for Transfusion Research and Clinical Epidemiology Program, Ottawa Health Research Institute, General Campus, 501 Smyth Road, Box 201, K1H 8L6, Ottawa, Ontario
- 2. Departments of Critical Care and Pediatrics, Hospital for Sick Children, University of Toronto, Ottawa, Canada
- 3. Critical Care Program, The Ottawa Hospital, Ottawa, Canada
- 4. Department of Surgery, Critical Care Program, University of Toronto, Ottawa, Canada
- 5. University of Ottawa Heart Insitute, Ottawa, Canada
- 6. Department of Anesthesia and Physiology, University of Toronto, St. Michael's Hospital, Toronto, Canada