Sanne de Bruin

56 Chapter 3 Abstract Background: Transfusion is very common in the intensive care unit (ICU), but practice is highly variable, as has recently been shown in non-bleeding critically ill patients prac- tices survey. Bleeding patients in ICU require different blood products across a range of specific patient categories. We hypothesize that a large variety in transfusion practice exists in bleeding patients. Study design andmethods: An international online survey was performed among phy- sicians working in the ICU. Transfusion practice inmassively and non-massively bleeding patients was examined, including transfusion ratios, thresholds and the presence of transfusion guidelines. Results: 611 respondents filled in the survey of which 401 could be analyzed, repre- senting 64 countries. Among the respondents, 52%had a massive transfusion protocol (MTP) available at their ICU. In massively bleeding patients, 46% of the respondents used fixed transfusion component ratios. Of those who used fixed blood ratios, the 1:1:1 ratio (red blood cell (RBC) concentrates: plasma: platelet concentrates) was most commonly used (33%). The presence of an MTP was associated with a more frequent use of fixed ratio’s (p<0.001). For RBC transfusion in the general non-massively bleeding ICU population, a hemo- globin (Hb) threshold of 7.0[7.0-7.3] g/dL was reported. In the general ICU population, a platelet count threshold of 50[26-50] x10 9 /L was applied. Discussion: Half of the centers had no massive transfusion protocol available. Transfu- sion practice in massively bleeding critically ill patients is highly variable and driven by the presence of anMTP. In the general non-massively bleeding ICU population restrictive transfusion triggers were chosen. Keywords: Transfusion, critically ill, bleeding, massive transfusion, anemia, coagulation