The Latest in Critical Care, 1/8/23 (Issue #24)
The transfusion issue: Reducing wasted blood, red cell transfusion in MI, updated transfusion guidelines
Smaller blood-collection tubes to reduce red blood cell transfusion (STRATUS trial)
Cumulatively, daily labs on hospitalized patients deplete substantial volumes of blood, almost all of which is wasted. The 4 to 6 mL of blood drawn per standard tube is a legacy of older equipment: modern testing machines only need <0.5 mL per sample, and the rest is discarded. More blood is drawn and discarded the next day, and the next, and the next—wasting about a unit of whole blood per week from each patient in the ICU.
Restricting blood transfusion in patients with myocardial infarction and anemia (MINT trial)
In randomized trials totaling over 21,000 patients, restricting red blood cell transfusion until hemoglobin fell below 7 or 8 g/dL in acutely ill, hemodynamically stable patients (as compared to transfusing below 9 or 10 g/dL) resulted in a 50% reduction in blood transfused, without apparent harm.
New guidelines on red cell transfusion from the AABB
The Association for the Advancement of Blood and Biotherapies (formerly called the American Association of Blood Banks) issued newly updated guidelines on red cell transfusion in hospitalized patients. More than 45 randomized trials were considered, including more than a dozen since their last guideline update several years ago.
Jon-Emile Kenny’s latest article in Critical Care Explorations
Jon and colleagues ask:
“What is fluid tolerance? What is fluid responsiveness? With Doppler ultrasound measures (e.g., VExUS, VTI) there is growing interest in characterizing these phenomena. But what are they and more specifically, how do they relate to each other? In this brief commentary in Critical Care Explorations, we propose that the Frank-Starling relationship and the venerable Diamond-Forrester classification are useful roadmaps.”