A CANADIAN SURVEY OF TRANSFUSION PRACTICES IN CRITICALLY ILL PATIENTS

Objectives: To characterize the contemporary red cell transfusion prac tice in the critically ill and to define clinical factors that influen ce these practices, Design: Scenario based national survey. Study Popu lation: Canadian critical care practitioners, Measurements and Main Re sults: We evaluated transfusion thresholds before transfusion and the number of red cell units ordered, under the given conditions, Of 254 C anadian critical care physicians, 193 (76%) responded to the survey, T he primary specialty of most respondents was internal medicine (56%), Internal medicine respondents were in practice for an average of 8.4 /- 5.7 (SD) yrs, and worked most often in combined medical/surgical in tensive care units. Baseline hemo globin transfusion thresholds averag ed from 8.3 +/- 1.0 g/dL in a scenario involving a young stable trauma victim to 9.5 +/- 1.0 g/dL for an older patient after gastrointestina l bleeding, Transfusion thresholds differed significantly (p < .0001) between all four separate scenarios, With the exception of congestive heart failure (p > .05), all clinical factors (including age, Acute Ph ysiology and Chronic Health Evaluation II score, preoperative status, hypoxemia shock, lactic acidosis, coronary ischemia, and chronic anemi a significantly (p < .0001) modified the transfusion thresholds, A sta tistically significant (p < .01) difference in baseline transfusion th resholds was noted across four major regions (with a maximum of five a cademic centers per region) of the country, Low physician numbers in t wo of the regions did not allow for further investigation of regional variations, Conclusions: There is significant variation in critical ca re trans fusion practice, with many intensivists adhering to a 10.0-g/ dL threshold, while other physicians described a much more restrictive approach to red cell transfusion, Also, many physicians opted to admi nister multiple units, despite published guidelines to the contrary, A dditionally, the administration of red cells was strongly influenced b y a number of clinical factors, many unique to intensive care unit pat ients, There is a need for prospective studies to define optimal pract ice in the critically ill.