Sanne de Bruin

26 Chapter 2 Abstract Background: Over the last decade multiple large randomized controlled trials have studied alternative transfusion strategies in critically ill patients, demonstrating the safety of restrictive transfusion strategies. Due to the lack of international guidelines specific for the intensive care unit (ICU), we hypothesized that a large heterogeneity in transfusion practice in this patient population exists. The aim of this study was to describe current transfusion practices and identify knowledge gaps. Methods: An online, anonymous, worldwide survey among ICU physicians was per- formed evaluating red blood cell, platelet and plasma transfusion practices. Further- more, the presence of a hospital or ICU specific transfusion guideline was asked. Only completed surveys were analysed. Results : 947 respondents filled in the survey of which 725 could be analysed. Hospital transfusion protocol available in their ICU was reported by 53% of the respondents. Only 29% of respondents used an ICU specific transfusion guideline. The reported hae- moglobin (Hb) threshold for the general ICU population was 7 g/dL (7-7). The highest reported variation in transfusion thresholdwas in patients on extracorporeal membrane oxygenation or with brain injury (8 g/dL (7.0-9.0)). Platelets were transfused at amedian count of 20x10 9 cells/L IQR (10-25) in asymptomatic patients, but at a higher count prior to invasive procedures (p<0.001). In patients with an international normalized ratio (INR) >3, 43% and 57% of the respondents would consider plasma transfusion without any upcoming procedures or prior to a planned invasive procedure, respectively. Finally, doctors with base specialty anaesthesiology transfused critically ill patients more lib- erally compared to internal medicine physicians. Conclusion : Red blood cell transfusion practice for the general ICU population is re- strictive, while for different subpopulations higher Hb thresholds are applied. Further- more, practice in plasma and platelet transfusion is heterogeneous and local transfusion guidelines are lacking in the majority of the ICUs.