CHEST Guidelines-Red Blood Cell Transfusion in the ICU

Red Blood Cell Transfusion in the ICU

Pdf Summary

The American College of Chest Physicians guidelines on red blood cell (RBC) transfusion in critically ill adults provides evidence-based recommendations for clinical practice. The guidelines emphasize a restrictive RBC transfusion strategy over a permissive one, except in cases of acute coronary syndrome (ACS), where a restrictive approach might increase adverse outcomes. The guidelines panel reviewed 3,082 studies and refined their focus to 23 studies, primarily consisting of randomized controlled trials. The key recommendations are:

1. <strong>General Critically Ill Patients:</strong> A restrictive RBC transfusion strategy is recommended due to similar mortality rates and lower RBC use compared to a permissive strategy. 
2. <strong>Acute Gastrointestinal Bleeding:</strong> A restrictive approach is also recommended due to reduced mortality and fewer adverse events.
3. <strong>Acute Coronary Syndrome (ACS):</strong> A permissive RBC transfusion strategy is suggested due to trends indicating higher mortality with restrictive strategies.
4. <strong>Cardiac Surgery:</strong> A restrictive transfusion strategy is preferred during perioperative cardiac surgery, demonstrating no significant differences in outcomes.
5. <strong>Isolated Troponin Elevation without Ischemia:</strong> With very low certainty of evidence, a restrictive strategy is suggested.
6. <strong>Septic Shock with End-organ Hypoperfusion:</strong> Avoiding permissive transfusion thresholds in addition to usual care is suggested, maintaining a restrictive approach.

These guidelines aim to optimize resource use and minimize adverse effects from unnecessary transfusions. They also propose research priorities to further explore individualized RBC transfusion strategies, particularly in underrepresented patient subsets such as those with chronic cardiovascular conditions or liver disease. The guidelines support developments in transfusion practices, supporting medical professionals in implementing restrictive strategies in line with current evidence.

Keywords

RBC transfusion

critically ill adults

restrictive strategy

permissive strategy

acute coronary syndrome

gastrointestinal bleeding

cardiac surgery

septic shock

transfusion guidelines

evidence-based recommendations