CHEST Guidelines-Red-Blood-Cell-Transfusion-in-Critically-Ill-Adult

Red-Blood-Cell-Transfusion-in-Critically-Ill-Adult

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The American College of Chest Physicians developed guidelines addressing red blood cell (RBC) transfusion strategies in critically ill adults. The guidelines, based on a comprehensive review of current evidence, recommend considering a restrictive RBC transfusion strategy over a permissive one in most critically ill patients. They assessed various clinical subgroups, including those with gastrointestinal bleeding, acute coronary syndrome (ACS), cardiac surgery, isolated troponin elevation, and septic shock.

Key findings include:

1. <strong>General Critically Ill Patients</strong>: A restrictive RBC transfusion strategy is recommended for most critically ill patients, as it significantly reduces RBC use without increasing mortality or adverse outcomes. However, ACS patients should not follow a restrictive strategy due to potential risks of adverse outcomes.

2. <strong>Subgroups</strong>:
   - <strong>Gastrointestinal Bleeding</strong>: A restrictive approach is recommended due to reduced adverse reactions and mortality.
   - <strong>Cardiac Surgery</strong>: Suggests a restrictive strategy, with evidence indicating similar mortality rates and fewer transfusion-related complications.
   - <strong>Septic Shock</strong>: Advises against adding permissive transfusion thresholds to usual care, as it does not demonstrate clear benefits.

The guidelines stress the importance of individualized patient care and the judicious use of blood resources. They also highlight the need for ongoing research, particularly in subpopulations such as patients with ACS and septic shock, where evidence is less robust.

The evaluation followed the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology, and recommendations were formulated through a modified Delphi consensus technique. The key focus is optimizing resource use, minimizing unnecessary transfusions, and ensuring improved patient outcomes while considering economic and implementation factors.

Keywords

RBC transfusion

critically ill patients

restrictive strategy

American College of Chest Physicians

gastrointestinal bleeding

acute coronary syndrome

cardiac surgery

septic shock

patient care

GRADE methodology