Sanne de Bruin

214 Chapter 9 Plasma transfusion has been studied more extensively in the ICU in non-bleeding patients, compared to platelet transfusion. Several studies have compared different plasma strategies in critically ill patients. Although these studies were prematurely stopped due to low inclusion rates, none of these studies were able to find any benefit of plasma transfusion 10,11 . Despite the lack of evidence for a positive effect of plasma transfusion in these studies, but in line with the limited attention on the efficacy of plasma transfusion we found a large degree of heterogeneity in plasma transfusion practice. This is in line with sev- eral observational studies that aimed to study the incidence of inappropriate plasma transfusion. Even these studies did not have an agreement on the definition of plasma transfusion. For example, the use of plasma prior to an upcoming procedure in pa- tients suffering from coagulopathy was a particular point on which the authors did not agree 12,13 . Based on our survey, an ICU specific transfusion guideline is published that advises against plasma in non-bleeding critically ill patients 3 . Possibly, this will influence current practice on plasma transfusion and reduce the number of plasma transfusions. Future directives As mentioned above, the INPUT study (NTR9049), a large international point preva- lence study, is currently enrolling patients. In chapter 4 the protocol for this study was tested. In this international study we will assess if the findings in our surveys are similar in actual clinical practice. The aim of this project includes identifying commonly used clinical transfusion triggers besides or in addition to Hb levels, platelet levels and INR/PT. These triggers could be the next step in designing algorithms that allow tailor made transfusion practice. An important remark is that surveys and observational studies cannot identify themost optimal transfusion practice. The goal of this sort of studies is to investigate the current opinion on transfusion practices. Furthermore, it shows the gaps in current knowledge andmay find correlations between transfusion practice and outcome. To prove causality, additional RCTs are necessary. After determining when transfusion is inappropriate, the next step will be to implement these new insights in daily practice. Organisational interventions such as educational interventions and audits have shown to reduce rates of inappropriate transfusion 14 .