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2010

The impact of packed red blood cell transfusion on clinical The impact of packed red blood cell transfusion on clinical

outcomes in patients with septic shock treated with early goal outcomes in patients with septic shock treated with early goal

directed therapy directed therapy

Brian M. Fuller Washington University School of Medicine in St. Louis

Mithil Gajera Cooper University Hospital

Christa Schorr Cooper University Hospital

David Gerber Cooper University Hospital

R. Phillip Dellinge Cooper University Hospital

See next page for additional authors

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Recommended Citation Recommended Citation Fuller, Brian M.; Gajera, Mithil; Schorr, Christa; Gerber, David; Dellinge, R. Phillip; Parrillo, Joseph; and Zanotti, Sergio, ,"The impact of packed red blood cell transfusion on clinical outcomes in patients with septic shock treated with early goal directed therapy." Indian Journal of Critical Care Medicine. 14,4. . (2010). https://digitalcommons.wustl.edu/open_access_pubs/5259

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Authors Authors Brian M. Fuller, Mithil Gajera, Christa Schorr, David Gerber, R. Phillip Dellinge, Joseph Parrillo, and Sergio Zanotti

This open access publication is available at Digital Commons@Becker: https://digitalcommons.wustl.edu/open_access_pubs/5259

Figure 1: The early goal directed therapy protocol utilized at Cooper University Hospital

Table 1: Baseline character ist icsVariable PRBC (n = 34) No PRBC (n = 59) P value

Age (years) 63.5 59.3 0.199

Gender Male Female

22 (64.7)12 (35.3)

33 (55.9)26 (44.1)

0.512

Race Black Hispanic White Other

15 (44.1)3 (8.8)

16 (47.1)0 (0)

22 (37.3)9 (15.3)27 (45.8)1 (1.7)

0.676

APACHE II 21.1 20.3 0.682

Lactate (mmol/l) 6.0 5.4 0.463

PBRC: Packed red blood cell, Values in paranthesis indicates percentage

Table 2: ResuscitaƟ on variablesVar iable PRBC (n = 34) No PRBC (n = 59) P value

Intravenous fluids (l) 0–6 hours 6–72 hours Total

5.717.623.3

3.913.016.9

< 0.05< 0.05< 0.05

First vasoactive med. Norepinephrine Dopamine Dobutamine

26 (81.3)5 (15.6)1 (3.1)

31 (83.8)4 (10.8)2 (5.4)

0.770

CVP 8ET (minutes) 732.0 465.3 0.135

ScvO2 70% after 24 hours 70% within 24 hours Not obtained

5 (15.6)23 (71.9)4 (12.5)

4 (7.1)37 (66.1)14 (25.0)

0.301

Average PRBCs (units) 4.56 0 < 0.05

PBRC: Packed red blood cell, Values in paranthesis indicates percentage

Table 3: Clinical outcomesVariable PRBC (n = 34) No PRBC (n = 59) P value

MV Days

25 (73.5)11.2

23 (39.0)5.0

< 0.05

ILOS (days) 11.4 3.8 < 0.05

HLOS (days) 25.9 12.5 < 0.05

Hospital mortality no.

14 (41.2) 20 (33.9) 0.510

PBRC: Packed red blood cell, Values in paranthesis indicates percentage

�

1. Consensus Conference (National Institutes of Health). Perioperative red blood cell transfusion. J AMA 1988;260:2700-3.

Source of Suppor t: Nil, Confl ict of Interest: None declared.

2. Gerber D. Transfusion of packed red blood cells in patients with ischemic heart disease. Crit Care Med 2008;36:1068-74.

3. Gould S, Cimino MJ , Gerber D. Packed Red Blood Cell Transfusion in the Intensive Care Unit: Limitations and Consequences. Am J Crit Care 2007;16:39-48.

4. Rivers E, Nguyen B, Havstad S, Ressler J , Muzzin A, Knoblich B, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001;345:1368-77.

5. Otero RM, Nguyen HB, Huang DT, Gaieski DF, Goyal M, Gunnerson KJ , et al. Early Goal-Directed Therapy in Severe Sepsis and Septic Shock Revisited: Concepts, Controversies, and Contemporary Findings. Chest 2006;130:1579-95.

6. Hebert PC, Wells G, Blajchman MA, Marshall J , Martin C, Pagliarello G, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. N Engl J Med 1999;340:409–17.

7. Hebert PC, Tinmouth A, Corwin H. Controversies in RBC Transfusion in the Critically Ill. Chest 2007;131:1583-90.

8. Carson J L, Noveck H, Berlin J A, Gould SA. Mortality and morbidity in patients with very low postoperative hemoglobin levels who decline blood transfusion. Transfusion 2002;42:812-8.

9. Taylor RW, Manganaro L, O’Brien J , Trottier SJ , Parkar N, Veremakis C. Impact of allogenic packed red blood cell transfusion on nosocomial infection rates in the critically ill patient. Crit Care Med 2002;30:2249-54.

10. Vamvakas E C, Carven J H . Allogeneic blood t ransfusion and postoperative duration of mechanical ventilation: effects of red cell

supernatant, platelet supernatant, plasma components and total transfused fluid. Vox Sang 2002;82:141-9.

11. Gong MN, Thompson BT, Williams P, Pothier L, Boyce PD, Christiani DC. Clinical predictors of and mortality in acute respiratory distress syndrome: potent ial role of red cell transfusion. Crit Care Med 2005;33:1191-8.

12. Croce MA, Tolley EA, Coleridge J A, Fabian TC. Transfusions result in pulmonary morbidity and death after a moderate degree of injury. J Trauma 2005;59:19-23.

13. Yang X, Alexander KP, Chen AY, Roe MT, Brindis RG, Rao SV, et al. The implications of blood transfusions for patients with non-ST-segment elevation acute coronary syndromes: Results from the CRUSADE National Quality Improvement Initiative. J Am Coll Cardiol 2005;46:1490-5.

14. Malone DL, Dunne J , Tracy J K, Putnam AT, Scalea TM, Napolitano LM. Blood transfusion, independent of shock severity, is associated with worse outcome in trauma. J Trauma 2003;54:898-905.

15. Palmieri TL, Caruso DM MD, Foster KN, Cairns BA, Peck MD, Gamelli RL, et al. Effect of blood transfusion on outcome after major burn injury: a multicenter study. Crit Care Med 2006;34:1602-7.

16. Fernandes CJ , Akamine N, De Marco F, De Souza J , Lagudis S, Knobel E. Red blood cell transfusion does not increase oxygen consumption in critically ill septic patients. Crit Care Med 2001;5:362-7.

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