Feb 16, 2016
The management of the septic patient in ICU is a recurrent topic
for debate amongst intensivists. The decision of if and/or when to
give blood transfusions is one of the key sources of contention. Dr
Anders Perner is one of the most qualified people to weigh in on
this debate. In this talk from SMACC Chicago, he delivers his
stance on when to pull the transfusion trigger.
Dr Anders Perner is an Intensive Care Specialist at Rigshospitalet
and a professor in intensive care at Copenhagen University. He is
the chairman of the Scandinavian Critical Care Trials Group and the
strategic research program “New resuscitation strategies in
patients with severe sepsis’. The contents of this talk are based
on the findings of the TRISS trial - Transfusion Requirements in
Septic Shock. This trial, Lower versus Higher Hemoglobin Threshold
for Transfusion in Septic Shock was published in the NEJM in
October 2014. The aim was to evaluate the recommendations from the
Surviving Sepsis Campaign regarding transfusion in septic shock.
The recommendation is that after the first 6 hours, transfusion
threshold should be a Hb <7g/dL aiming for a Hb between 7-9g/dL
in patients who do not have MI, severe hypoxia, acute haemorrhage
or ischaemic coronary artery disease. Unfortunately, these
recommendations were made with limited supporting data, hence the
TRISS trial was born.
The TRISS trial was conducted as a multicentre, parallel-group
trial run across 32 ICUs in Denmark, Norway, Sweden and Finland.
Patients with septic shock who had a Hb </9g/dL were randomly
assigned to either a higher transfusion threshold group (Hb </
9g/dL) or a lower transfusion threshold group (Hb</ 7g/dL). They
each received 1 unit of leukoreduced PRBC when they reached their
respective transfusion threshold. The primary outcome was death
within 90 days of randomisation. In this SMACC talk, some of the
key findings and limitations of the trial are discussed. So check
out this talk and then read the full article available here to see
if you agree with 7g/dL – the new normal.
What’s your transfusion trigger? Is it time to rethink it?