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Liberal Versus Restrictive Transfusion Strategy in Critically Ill Oncologic Patients: The Transfusion Requirements in Critically Ill Oncologic Patients Randomized Controlled Trial.
- Source :
-
Critical Care Medicine . May2017, Vol. 45 Issue 5, p766-773. 8p. - Publication Year :
- 2017
-
Abstract
- <bold>Objective: </bold>To assess whether a restrictive strategy of RBC transfusion reduces 28-day mortality when compared with a liberal strategy in cancer patients with septic shock.<bold>Design: </bold>Single center, randomized, double-blind controlled trial.<bold>Setting: </bold>Teaching hospital.<bold>Patients: </bold>Adult cancer patients with septic shock in the first 6 hours of ICU admission.<bold>Interventions: </bold>Patients were randomized to the liberal (hemoglobin threshold, < 9 g/dL) or to the restrictive strategy (hemoglobin threshold, < 7 g/dL) of RBC transfusion during ICU stay.<bold>Measurements and Main Results: </bold>Patients were randomized to the liberal (n = 149) or to the restrictive transfusion strategy (n = 151) group. Patients in the liberal group received more RBC units than patients in the restrictive group (1 [0-3] vs 0 [0-2] unit; p < 0.001). At 28 days after randomization, mortality rate in the liberal group (primary endpoint of the study) was 45% (67 patients) versus 56% (84 patients) in the restrictive group (hazard ratio, 0.74; 95% CI, 0.53-1.04; p = 0.08) with no differences in ICU and hospital length of stay. At 90 days after randomization, mortality rate in the liberal group was lower (59% vs 70%) than in the restrictive group (hazard ratio, 0.72; 95% CI, 0.53-0.97; p = 0.03).<bold>Conclusions: </bold>We observed a survival trend favoring a liberal transfusion strategy in patients with septic shock when compared with the restrictive strategy. These results went in the opposite direction of the a priori hypothesis and of other trials in the field and need to be confirmed. [ABSTRACT FROM AUTHOR]
- Subjects :
- *SEPTIC shock treatment
*ACADEMIC medical centers
*CATASTROPHIC illness
*COMPARATIVE studies
*CRITICAL care medicine
*RED blood cell transfusion
*LENGTH of stay in hospitals
*INTENSIVE care units
*RESEARCH methodology
*MEDICAL cooperation
*RESEARCH
*SEPTIC shock
*TIME
*TUMORS
*EVALUATION research
*RANDOMIZED controlled trials
*PROPORTIONAL hazards models
*BLIND experiment
*SEVERITY of illness index
Subjects
Details
- Language :
- English
- ISSN :
- 00903493
- Volume :
- 45
- Issue :
- 5
- Database :
- Academic Search Index
- Journal :
- Critical Care Medicine
- Publication Type :
- Academic Journal
- Accession number :
- 123181451
- Full Text :
- https://doi.org/10.1097/CCM.0000000000002283