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Blood management in intensive care medicine: CRIT and ABC – what can we learn?

机译：重症监护医学中的血液管理：CRIT和ABC –我们可以学到什么？

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In 284 US intensive care units the CRIT study (Anemia and blood transfusion in the critically ill – Current clinical practice in the United States) assessed allogeneic red blood cell (RBC) transfusion and outcome in 4892 patients. As in the former European ABC study (Anemia and blood transfusion in the critically ill), the mean pretransfusion hemoglobin was approximately 8.5 g/dl and RBC transfusions were independently associated with an increased mortality. These studies were purely observational and, therefore, despite the finest statistical models indicating that RBC transfusions were independently associated with a higher mortality, it remains possible that this adverse outcome is not due to a harmful effect of RBC transfusion in itself, but merely reflects the fact that transfused patients were sicker to start with. The definitive call is still out, but one mechanism by which RBC transfusion might be harmful now appears less likely; namely, storage lesion. In the CRIT study, mortality was not increased in patients receiving 'old' RBCs (>14 days stored) versus 'fresh' RBCs. The effect of leukoreduction could not be assessed since mainly nonleukoreduced RBCs were transfused. The evidence is mounting, however, that RBC transfusions are efficacious only when oxygen delivery is compromised. What can be done to diminish the use of RBC transfusions, its costs and side effects in intensive care medicine? There are two important options available today: decreasing blood loss for diagnostic purposes using pediatric sampling tubes, and establishing restrictive multidisciplinary transfusion guidelines and implementing them in daily clinical practice.Keywords: blood transfusion, morbidity, mortality
机译：在284个美国重症监护病房中，CRIT研究（重症患者的贫血和输血–美国当前的临床实践）评估了4892例患者的异体红细胞（RBC）输血和预后。与以前的欧洲ABC研究（重病中的贫血和输血）一样，平均输血前血红蛋白约为8.5 g / dl，RBC输血与死亡率增加独立相关。这些研究纯粹是观察性的，因此，尽管有最好的统计模型表明，RBC输血与较高的死亡率独立相关，但这种不良后果仍然可能不是由于RBC输血本身的有害作用，而仅仅是反映了输血患者一开始就病了的事实。明确的呼吁仍未解决，但现在似乎不太可能出现一种可能使RBC输血有害的机制。即存储病变。在CRIT研究中，与“新鲜” RBC相比，接受“旧” RBC（储存> 14天）的患者死亡率没有增加。由于主要输注非白细胞减少的红细胞，因此无法评估白细胞减少的效果。然而，越来越多的证据表明，只有在氧气输送受到损害时，RBC输血才有效。如何减少RBC输血在重症监护医学中的使用，其成本和副作用？今天有两种重要的选择：使用儿科采样管减少失血以进行诊断，建立限制性的多学科输血指南并在日常临床实践中加以实施。关键词：输血，发病率，死亡率

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