Hebert PC, Wells G, Martin C, Tweeddale M, Marshall J, Blajchman M, Pagliarello G, Sandham D, Schweitzer I, Boisvert D, Calder L: Variation in red cell transfusion practice in the intensive care unit: a multicentre cohort study. Hebert PC, Wells G, Martin C, Tweeddale M, Marshall J, Blajchman M, Pagliarello G, Schweitzer I, Calder L: A Canadian survey of transfusion practices in critically ill patients. 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. Goodnough LT, Brecher ME, Kanter MH, AuBuchon JP: Transfusion medicine. Weiskopf RB, Viele MK, Feiner J, Kelley S, Lieberman J, Noorani M, Leung JM, Fisher DM, Murray WR, Toy P, Moore MA: Human cardiovascular and metabolic response to acute, severe isovolemic anemia. Heyland DK, Cook DJ, King D, Kernerman P, Brun-Buisson C: Maximizing oxygen delivery in critically ill patients: a methodologic appraisal of the evidence. Shoemaker WC, Appel PL, Kram HB, Waxman K, Lee TS: Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients. Subsequent review of patients with a cardiac diagnosis showed that, even in this high-risk population, a restrictive transfusion policy resulted in improved clinical outcomes, although the differences were not statistically significant. A review of the adverse events in both groups revealed that the major morbidity in the liberal group was the sequelae of transfusion – acute respiratory distress syndrome, congestive heart failure, and volume overload. The significant differences in mortality rates during hospitalization, rates of cardiac complications, and rates of organ dysfunction all favored the restrictive strategy. There was a trend toward decreased 30-day mortality among patients who were treated according to the restrictive transfusion strategy. The development of new organ dysfunction in the ICU was significantly less in patients randomly assigned to the restrictive arm (Table 1). Surprisingly, when outcome data were analyzed, patients in the restrictive arm exhibited a strong trend toward improved 30-day survival and a significant improvement in hospital survival. Patients in the restrictive arm received half the volume of transfused blood that patients in the liberal arm did. Patients enrolled in the two study groups had comparable baseline demographic features, and compliance to the protocol was excellent. Eligible patients were those who had a hemoglobin of 90 g/l or less within 72 hours of ICU admission. A total of 838 patients from 25 centers were randomly assigned to a liberal transfusion strategy (maintenance of the hemoglobin >100 g/l) or a restrictive transfusion strategy (maintenance of hemoglobin >70 g/l). The Transfusion Requirements in Critical Care (TRICC) Trial, a multicenter, randomized, controlled trial, was conducted between 19.
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