Chest
Clinical Investigations in Critical CareDo Blood Transfusions Improve Outcomes Related to Mechanical Ventilation?
Section snippets
Description of the TRICC Trial
The TRICC trial9 was a randomized, controlled trial that enrolled 838 critically ill patients with hemoglobin concentrations ≤ 9.0 g/dL within 72 h of ICU admission, and were considered volume resuscitated by the attending ICU staff. Patients with chronic anemia and acute severe blood loss, defined as a decrease in hemoglobin concentration > 30 g/L or a requirement for three RBC units in 12 h, were excluded from the TRICC trial, as well as this analysis. Physicians caring for patients allocated
Study Population
The TRICC trial randomized 838 patients (418 in the restrictive allogeneic transfusion group and 420 in the liberal-strategy group). In total, 713 patients (85%) required mechanical ventilation, 357 in the restrictive-strategy group and 356 in the liberal-strategy group. All patients in this analysis completed the trial and were followed up for 30 days. Two patients were unavailable for follow-up at 60 days.
All baseline characteristics were equally balanced between the treatment groups among
Discussion
In summary, we found no significant differences in the duration of mechanical ventilation, in the number of ventilator-free days, or in the time necessary to successfully wean and extubate patients from mechanical ventilation among those receiving a restrictive transfusion strategy vs a liberal transfusion strategy. This was true for all patients receiving mechanical ventilation and in the subgroup who required mechanical ventilation for > 7 days. Therefore, hemoglobin concentrations and RBC
TRICC Trial Executive and Writing Committee
Paul C. Hébert, MD, Irwin Schweitzer, MSc, Ottawa Hospital, General Campus; George Wells, PhD, MSc, Guiseppe Pagliarello, MD, Ottawa Hospital, Civic Campus; Morris Blajchman, MD, McMaster University, Hamilton; John Marshall, MD, Toronto Hospital, General Division; Claudio Martin, MD, MSc, Victoria Hospital, London; Martin Tweeddale, MD, PhD, Vancouver General Hospital.
TRICC Investigators
Paul C. Hébert, MD, Ottawa Hospital, General Campus; Guiseppe Pagliarello, MD, Ottawa Hospital, Civic Campus; John Marshall, MD,
ACKNOWLEDGMENT
We thank Drs. Graeme Rocker, Darren Heyland, Jacques Lacroix, Thomas Todd, and the members of the Canadian Critical Care Trials group; the nurses and critical care teams who provided medical care; and Christine Piché for secretarial support. We also thank Dr. Mark Pickett, Director of Research and Development at Bayer Inc., and Dr. Bert T. Aye, former Director of the Canadian Red Cross Society Blood Services.
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Cited by (125)
Challenges Facing Transfusion Practices
2018, Clinical Principles of Transfusion MedicineAnemia and Red Blood Cell Transfusion: Advances in Critical Care
2017, Critical Care ClinicsThe effects of postoperative hematocrit on shunt occlusion for neonates undergoing single ventricle palliation
2017, Journal of Thoracic and Cardiovascular SurgeryUpdate in Critical Care for the Nephrologist: Transfusion in Nonhemorrhaging Critically Ill Patients
2013, Advances in Chronic Kidney DiseaseCitation Excerpt :In a post hoc analysis, in patients with APACHE II scores less than 20 and with ages younger than 55 years of age, significant reductions in 30-day mortality were found. A liberal transfusion strategy did not speed extubation in mechanically ventilated patients.32 In pediatric patients, a similar trial compared a restrictive (Hgb < 7 g/dL) vs liberal (Hgb < 9.5 g/dL) transfusion strategy.33
Drs. Hébert and Cook are Career Scientists of the Ontario Ministry of Health.
This study was supported by the Medical Research Council of Canada and an unrestricted grant from Bayer Inc.
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A list of other study investigators is given in the Appendix