Sanne de Bruin

107 InPUT- pilot study in the Netherlands Introduction Critically ill patients often receive a blood products to correct coagulopathy and/or improve oxygen delivery to peripheral tissues 1,2,3,4 . Administration of blood products can be lifesaving, but may also come with severe adverse events, varying from allergic reactions, acute haemolytic transfusion reactions, transfusion transmitted infections to transfusion related acute lung injury 5 . Since multiple large randomized controlled trials (RCTs) in the intensive care unit (ICU) proved the safety of a restrictive red blood cell (RBC) transfusion strategy 6–8 , an overall reduction in the proportion of patients who received a RBC transfusion was observed 2,9 . However, the superiority of a liberal RBC transfusion strategy is still debatable for different subpopulations; particularly patients with acute coronary syndrome and elderly patients might benefit from a liberal transfu- sion strategy compared to a restrictive strategy 10,11 . For plasma and platelet transfusions, well powered randomized controlled trials are lacking 12 , also the definitions for liberal and restrictive transfusion strategies are not yet well defined. This lack of definition and research gap may explain the heterogeneous transfusion practices described in multiple studies 3,4,13 . Current platelet transfusion practice is mainly based on studies conducted in haemato-oncological patients or in low quality studies in critically ill pa- tients. Furthermore, the effectiveness of a large number of plasma transfusions is not proven, and might even be harmful 14,15 . For plasma transfusion multiple alternatives exist, including administration of vitamin K and prothrombin complex, depending on the cause of the coagulopathy. However, these alternatives cannot completely replace plasma transfusion in critically ill patients. Multiple observational studies have investigated transfusion practice in critically ill pa- tients using questionnaires or examining patient cohorts. Limitations of these studies in- clude focussing on only one blood product 2–4 or being single country 4,13,16 or single centre studies 17 . Since the administration of different blood products might be correlated 18 , there is a need for a large international multicentre observational study that examines the administration of different blood products and coagulations factors. Considering the challenging character of these kind of studies, a pilot study is necessary to opti- mize the study protocol before enrolling it worldwide. In this pilot study, we assessed current transfusion practice in a university centre in the Netherlands and also assessed the feasibility of this study protocol and the case record forms (CRF) in preparation for a worldwide study. 4