Interpretation of European Society of Intensive Care Medicine of clinical practice guideline on transfusion strategies fornon-bleeding critically ill adults in 2020_Chinese Journal of Evidence-Based Medicine

Authors：

WU Ying ^1,2 , HONG Jianchao ^1,2 , ZHANG Jin ^1,2 , XIAO Wenyan ^1,2 ,  YANG Min ^1,2

1. The Second Department of Intensive Care Unit, the Second Affiliated Hospital of Anhui Medical University, Hefei 230601, P.R.China;
2. The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei 230601, P.R.China;

Corresponding author：

YANG Min, Email: 512130761@qq.com

Keywords：

Non-bleeding critically ill adults; Transfusion; Clinical practice guideline; Guideline interpretation

DOI：

10.7507/1672-2531.202004140

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Anemia and coagulopathy are frequently presented in critically ill patients on the intensive care unit. Scientific use of blood products assist the treatment of critically ill patients. However, life-threatening adverse effects are also a risk. In 2020, the European Society of Critical Care Medicine (ESICM) published a clinical practice guideline on transfusion strategies for non-bleeding critically ill adults in an attempt to resolve the transfusion strategy problems of relevant critically ill patients. This paper interprets the key contents in order to assist Chinese clinicians for better understanding and using of the guideline.

Citation： WU Ying, HONG Jianchao, ZHANG Jin, XIAO Wenyan, YANG Min. Interpretation of European Society of Intensive Care Medicine of clinical practice guideline on transfusion strategies fornon-bleeding critically ill adults in 2020. Chinese Journal of Evidence-Based Medicine, 2020, 20(10): 1136-1141. doi: 10.7507/1672-2531.202004140 Copy

1.	Vlaar AP, Oczkowski S, de Bruin S, et al. Transfusion strategies in non-bleeding critically ill adults: a clinical practice guideline from the European Society of Intensive Care Medicine. Intensive Care Med, 2020, 46(4): 673-696.
2.	Long B, Koyfman A. Red blood cell transfusion in the emergency department. J Emerg Med, 2016, 51(2): 120-130.
3.	李保才. ICU贫血患者限制性输血与开放性输血的临床效果. 齐齐哈尔医学院学报, 2016, 37(31): 3881-3882.
4.	Hébert PC, Wells G, Blajchman MA, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. N Engl J Med, 1999, 340(6): 409-417.
5.	Guyatt GH, Oxman AD, Kunz R, et al. GRADE guidelines 6. Rating the quality of evidence--imprecision. J Clin Epidemiol, 2011, 64(12): 1283-1293.
6.	No ne. Lower versus higher haemoglobin threshold for transfusion in septic shock. J Intensive Care Soc, 2015, 16(4): 345-347.
7.	Walsh TS, Boyd JA, Watson D, et al. Restrictive versus liberal transfusion strategies for older mechanically ventilated critically ill patients: a randomized pilot trial. Crit Care Med, 2013, 41(10): 2354-2363.
8.	Hébert PC, Blajchman MA, Cook DJ, et al. Do blood transfusions improve outcomes related to mechanical ventilation? Chest, 2001, 119(6): 1850-1857.
9.	贺慧为, 陈志, 卢院华, 等. 限制性输血和开放性输血策略在贫血的机械通气患者中的比较. 江西医药, 2014, (12): 1383-1385.
10.	Murphy GJ, Pike K, Rogers CA, et al. Liberal or restrictive transfusion after cardiac surgery. N Engl J Med, 2015, 372(11): 997-1008.
11.	Mazer CD, Whitlock RP, Fergusson DA, et al. Restrictive or liberal red-cell transfusion for cardiac surgery. N Engl J Med, 2017, 377(22): 2133-2144.
12.	李志强. 危重病患者个体化输血策略与管理. 临床输血与检验, 2016, 18(2): 97-100.
13.	van Iperen CE, Gaillard CA, Kraaijenhagen RJ, et al. Response of erythropoiesis and iron metabolism to recombinant human erythropoietin in intensive care unit patients. Crit Care Med, 2000, 28(8): 2773-2778.
14.	Madi-Jebara SN, Sleilaty GS, Achouh PE, et al. Postoperative intravenous iron used alone or in combination with low-dose erythropoietin is not effective for correction of anemia after cardiac surgery. J Cardiothorac Vasc Anesth, 2004, 18(1): 59-63.
15.	Yoo YC, Shim JK, Kim JC, et al. Effect of single recombinant human erythropoietin injection on transfusion requirements in preoperatively anemic patients undergoing valvular heart surgery. Anesthesiology, 2011, 115(5): 929-937.
16.	Smoller BR, Kruskall MS, Horowitz GL. Reducing adult phlebotomy blood loss with the use of pediatric-sized blood collection tubes. Am J Clin Pathol, 1989, 91(6): 701-703.
17.	Sanchez-Giron F, Alvarez-Mora F. Reduction of blood loss from laboratory testing in hospitalized adult patients using small-volume (pediatric) tubes. Arch Pathol Lab Med, 2008, 132(12): 1916-1919.
18.	Dolman HS, Evans K, Zimmerman LH, et al. Impact of minimizing diagnostic blood loss in the critically ill. Surgery, 2015, 158(4): 1083-1087.
19.	Peruzzi WT, Parker MA, Lichtenthal PR, et al. A clinical evaluation of a blood conservation device in medical intensive care unit patients. Crit Care Med, 1993, 21(4): 501-506.
20.	Moron NG, Moreno IF, Jordan EC. Dispositivo VAMP. La hipotesis de trabajo plantea que el uso del dispositivo VAMP disminuye el riesgo de transfusion. Revista Rol De Enfermería, 2003, 26(9): 591-594.
21.	MacIsaac CM, Presneill JJ, Boyce CA, et al. The influence of a blood conserving device on anaemia in intensive care patients. Anaesth Intensive Care, 2003, 31(6): 653-657.
22.	Harber CR, Sosnowski KJ, Hegde RM. Highly conservative phlebotomy in adult intensive care--a prospective randomized controlled trial. Anaesth Intensive Care, 2006, 34(4): 434-437.
23.	Mahdy S, Khan EI, Attia M, et al. Evaluation of a blood conservation strategy in the intensive care unit: a prospective, randomised study. Middle East J Anaesthesiol, 2009, 20(2): 219-223.
24.	Woda RP, Dzwonczyk R, Buyama C, et al. On the dynamic performance of the Abbott Safeset blood-conserving arterial line system. J Clin Monit Comput, 1999, 15(3-4): 215-221.
25.	Rezende E, Ferez MA, Silva Junior JM, et al. Closed system for blood sampling and transfusion in critically ill patients. Rev Bras Ter Intensiva, 2010, 22(1): 5-10.
26.	Liu F, Liao T, Wang Q, et al. Evaluation of a novel flushing protocol for a peripherally inserted central catheter (PICC) in the neurological intensive care unit: A prospective randomized study. Natl Med J India, Jan-Feb, 2018, 31(1): 5-7.
27.	Page C, Retter A, Wyncoll D. Blood conservation devices in critical care: a narrative review. Ann Intensive Care, 2013, 3(1): 14.
28.	卫生部. 临床输血技术规范. 中国医院, 2000, (6): 16-17.
29.	王前, 彭玉龙, 黄连涛, 等. 特发性血小板减少性紫癜患者预防性血小板输注阈值的探讨. 岭南急诊医学杂志, 2008, (1): 20-21.
30.	van Hout FM, Hogervorst EK, Rosseel PM, et al. Does a platelet transfusion independently affect bleeding and adverse outcomes in cardiac surgery? Anesthesiology, 2017, 126(3): 441-449.
31.	Zeidler K, Arn K, Senn O, et al. Optimal preprocedural platelet transfusion threshold for central venous catheter insertions in patients with thrombocytopenia. Transfusion, 2011, 51(11): 2269-2276.
32.	Warner MA, Woodrum D, Hanson A, et al. Preprocedural platelet transfusion for patients with thrombocytopenia undergoing interventional radiology procedures is not associated with reduced bleeding complications. Transfusion, 2017, 57(4): 890-898.
33.	Müller MC, Straat M, Meijers JC, et al. Fresh frozen plasma transfusion fails to influence the hemostatic balance in critically ill patients with a coagulopathy. J Thromb Haemost, 2015, 13(6): 989-997.
34.	Yang L, Stanworth S, Hopewell S, et al. Is fresh-frozen plasma clinically effective? An update of a systematic review of randomized controlled trials. Transfusion, 2012, 52(8): 1673-1686.

1. Vlaar AP, Oczkowski S, de Bruin S, et al. Transfusion strategies in non-bleeding critically ill adults: a clinical practice guideline from the European Society of Intensive Care Medicine. Intensive Care Med, 2020, 46(4): 673-696.
2. Long B, Koyfman A. Red blood cell transfusion in the emergency department. J Emerg Med, 2016, 51(2): 120-130.
3. 李保才. ICU贫血患者限制性输血与开放性输血的临床效果. 齐齐哈尔医学院学报, 2016, 37(31): 3881-3882.
4. Hébert PC, Wells G, Blajchman MA, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. N Engl J Med, 1999, 340(6): 409-417.
5. Guyatt GH, Oxman AD, Kunz R, et al. GRADE guidelines 6. Rating the quality of evidence--imprecision. J Clin Epidemiol, 2011, 64(12): 1283-1293.
6. No ne. Lower versus higher haemoglobin threshold for transfusion in septic shock. J Intensive Care Soc, 2015, 16(4): 345-347.
7. Walsh TS, Boyd JA, Watson D, et al. Restrictive versus liberal transfusion strategies for older mechanically ventilated critically ill patients: a randomized pilot trial. Crit Care Med, 2013, 41(10): 2354-2363.
8. Hébert PC, Blajchman MA, Cook DJ, et al. Do blood transfusions improve outcomes related to mechanical ventilation? Chest, 2001, 119(6): 1850-1857.
9. 贺慧为, 陈志, 卢院华, 等. 限制性输血和开放性输血策略在贫血的机械通气患者中的比较. 江西医药, 2014, (12): 1383-1385.
10. Murphy GJ, Pike K, Rogers CA, et al. Liberal or restrictive transfusion after cardiac surgery. N Engl J Med, 2015, 372(11): 997-1008.
11. Mazer CD, Whitlock RP, Fergusson DA, et al. Restrictive or liberal red-cell transfusion for cardiac surgery. N Engl J Med, 2017, 377(22): 2133-2144.
12. 李志强. 危重病患者个体化输血策略与管理. 临床输血与检验, 2016, 18(2): 97-100.
13. van Iperen CE, Gaillard CA, Kraaijenhagen RJ, et al. Response of erythropoiesis and iron metabolism to recombinant human erythropoietin in intensive care unit patients. Crit Care Med, 2000, 28(8): 2773-2778.
14. Madi-Jebara SN, Sleilaty GS, Achouh PE, et al. Postoperative intravenous iron used alone or in combination with low-dose erythropoietin is not effective for correction of anemia after cardiac surgery. J Cardiothorac Vasc Anesth, 2004, 18(1): 59-63.
15. Yoo YC, Shim JK, Kim JC, et al. Effect of single recombinant human erythropoietin injection on transfusion requirements in preoperatively anemic patients undergoing valvular heart surgery. Anesthesiology, 2011, 115(5): 929-937.
16. Smoller BR, Kruskall MS, Horowitz GL. Reducing adult phlebotomy blood loss with the use of pediatric-sized blood collection tubes. Am J Clin Pathol, 1989, 91(6): 701-703.
17. Sanchez-Giron F, Alvarez-Mora F. Reduction of blood loss from laboratory testing in hospitalized adult patients using small-volume (pediatric) tubes. Arch Pathol Lab Med, 2008, 132(12): 1916-1919.
18. Dolman HS, Evans K, Zimmerman LH, et al. Impact of minimizing diagnostic blood loss in the critically ill. Surgery, 2015, 158(4): 1083-1087.
19. Peruzzi WT, Parker MA, Lichtenthal PR, et al. A clinical evaluation of a blood conservation device in medical intensive care unit patients. Crit Care Med, 1993, 21(4): 501-506.
20. Moron NG, Moreno IF, Jordan EC. Dispositivo VAMP. La hipotesis de trabajo plantea que el uso del dispositivo VAMP disminuye el riesgo de transfusion. Revista Rol De Enfermería, 2003, 26(9): 591-594.
21. MacIsaac CM, Presneill JJ, Boyce CA, et al. The influence of a blood conserving device on anaemia in intensive care patients. Anaesth Intensive Care, 2003, 31(6): 653-657.
22. Harber CR, Sosnowski KJ, Hegde RM. Highly conservative phlebotomy in adult intensive care--a prospective randomized controlled trial. Anaesth Intensive Care, 2006, 34(4): 434-437.
23. Mahdy S, Khan EI, Attia M, et al. Evaluation of a blood conservation strategy in the intensive care unit: a prospective, randomised study. Middle East J Anaesthesiol, 2009, 20(2): 219-223.
24. Woda RP, Dzwonczyk R, Buyama C, et al. On the dynamic performance of the Abbott Safeset blood-conserving arterial line system. J Clin Monit Comput, 1999, 15(3-4): 215-221.
25. Rezende E, Ferez MA, Silva Junior JM, et al. Closed system for blood sampling and transfusion in critically ill patients. Rev Bras Ter Intensiva, 2010, 22(1): 5-10.
26. Liu F, Liao T, Wang Q, et al. Evaluation of a novel flushing protocol for a peripherally inserted central catheter (PICC) in the neurological intensive care unit: A prospective randomized study. Natl Med J India, Jan-Feb, 2018, 31(1): 5-7.
27. Page C, Retter A, Wyncoll D. Blood conservation devices in critical care: a narrative review. Ann Intensive Care, 2013, 3(1): 14.
28. 卫生部. 临床输血技术规范. 中国医院, 2000, (6): 16-17.
29. 王前, 彭玉龙, 黄连涛, 等. 特发性血小板减少性紫癜患者预防性血小板输注阈值的探讨. 岭南急诊医学杂志, 2008, (1): 20-21.
30. van Hout FM, Hogervorst EK, Rosseel PM, et al. Does a platelet transfusion independently affect bleeding and adverse outcomes in cardiac surgery? Anesthesiology, 2017, 126(3): 441-449.
31. Zeidler K, Arn K, Senn O, et al. Optimal preprocedural platelet transfusion threshold for central venous catheter insertions in patients with thrombocytopenia. Transfusion, 2011, 51(11): 2269-2276.
32. Warner MA, Woodrum D, Hanson A, et al. Preprocedural platelet transfusion for patients with thrombocytopenia undergoing interventional radiology procedures is not associated with reduced bleeding complications. Transfusion, 2017, 57(4): 890-898.
33. Müller MC, Straat M, Meijers JC, et al. Fresh frozen plasma transfusion fails to influence the hemostatic balance in critically ill patients with a coagulopathy. J Thromb Haemost, 2015, 13(6): 989-997.
34. Yang L, Stanworth S, Hopewell S, et al. Is fresh-frozen plasma clinically effective? An update of a systematic review of randomized controlled trials. Transfusion, 2012, 52(8): 1673-1686.

Chinese Journal of Evidence-Based Medicine

Interpretation of European Society of Intensive Care Medicine of clinical practice guideline on transfusion strategies fornon-bleeding critically ill adults in 2020

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