tailieunhanh - Báo cáo y học: " Red cell transfusion triggers in critically ill patients: time for some new TRICCs"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Red cell transfusion triggers in critically ill patients: time for some new TRICCs? | Walsh Critical Care 2010 14 170 http content 14 3 170 CRITICAL CARE COMMENTARY L__ Red cell transfusion triggers in critically ill patients time for some new TRICCs Timothy S Walsh See related research by Sakr etal. http content 14 3 R92 Abstract Current evidence suggests that critically ill patients tolerate anaemia well and that blood transfusions may increase the risk of adverse outcomes. Dr Sakr and colleagues present a contradictory analysis of a surgical ICU cohort finding an association between blood transfusions and lower hospital mortality after adjustment for a range of potential confounders. Analyses of this kind are interesting and provocative but are limited by residual confounding and bias by indication. The data emphasise the need for additional high quality trials of transfusion practice in critical care. Dr Sakr and colleagues 1 report a single centre cohort study evaluating the relationship between anaemia blood transfusions and mortality in patients admitted to a surgical ICU. The authors report some findings that are not new or surprising namely that anaemia is associated with adverse patient outcomes. However when they performed multivariate analyses with adjustment for potential confounders to the blood transfusion patient outcomes relationship they found that transfusions were associated with lower patient mortality especially among older sicker patients. At face value this contradicts the majority of previous cohort studies 2 and the only large randomised trial of different transfusion triggers in critically ill patients the Canadian Critical Care Trials Group s Transfusion requirements in critical care TRICC trial 3 . The authors findings raise a number of questions including does this association indicate cause and effect Are the findings of the TRICC trial generalisable to intensive care patients today And perhaps most importantly should we use blood more liberally in critically ill patients than the TRICC