A Multicenter, Randomized, Controlled Clinical Trial of Transfusion Requirements in Critical Care
Open accessAbstract
BACKGROUND: To determine whether a restrictive strategy of red-cell transfusion and a liberal strategy produced equivalent results in critically ill patients, we compared the rates of death from all causes at 30 days and the severity of organ dysfunction. METHODS: We enrolled 838 critically ill patients with euvolemia after initial treatment who had hemoglobin concentrations of less than 9.0 g per deciliter within 72 hours after admission to the intensive care unit and randomly assigned 418 patients to a restrictive strategy of transfusion, in which red cells were transfused if the hemoglobin concentration dropped below 7.0 g per deciliter and hemoglobin concentrations were maintained at 7.0 to 9.0 g per deciliter, and 420 patients to a liberal strategy, in which transfusions were given when the hemoglobin concentration fell below 10.0 g per deciliter and hemoglobin concentrations were maintained at 10.0 to 12.0 g per deciliter. RESULTS: Overall, 30-day mortality was similar in the two groups (18.7 percent vs. 23.3 percent, P= 0.11). However, the rates were significantly lower with the restrictive transfusion strategy among patients who were less acutely ill -- those with an Acute Physiology and Chronic Health Evaluation II score of < or =20 (8.7 percent in the restrictive-strategy group and 16.1 percent in the liberal-strategy group; P=0.03) -- and among patients who were less than 55 years of age (5.7 percent and 13.0 percent, respectively; P=0.02), but not among patients with clinically significant cardiac disease (20.5 percent and 22.9 percent, respectively; P=0.69). The mortality rate during hospitalization was significantly lower in the restrictive-strategy group (22.3 percent vs. 28.1 percent, P=0.05). CONCLUSIONS: A restrictive strategy of red-cell transfusion is at least as effective as and possibly superior to a liberal transfusion strategy in critically ill patients, with the possible exception of patients with acute myocardial infarction and unstable angina.
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In the TRICC trial, a restrictive transfusion threshold of 70 g/L versus 100 g/L in 838 euvolemic ICU patients showed no difference in 30-day mortality.
“The Transfusion requirements in in Critical Care trial (TRICC), which compared a restrictive transfusion threshold of 70 g/L versus 100 g/L in 838 euvolemic ICU patients, demonstrated no difference in the primary outcome (30-day mortality).”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [484]
In the TRISS trial, a transfusion threshold of 70 g/L versus 90 g/L in 1000 septic shock patients after ICU admission resulted in similar 90-day mortality, ischaemic events, and use of life support, with fewer transfusions in the lower-threshold group.
“The results showed similar 90-day mortality, ischaemic events, and use of life support in the two treatment groups with fewer transfusions in the lower-threshold group.”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [484]
In the subgroup of 218 patients with sepsis or septic shock in the TRICC trial, 30-day mortality was similar between restrictive and liberal groups (22.8% vs 29.7%, p = 0.36).
“In the subgroup of 218 patients with sepsis or septic shock 30-day mortality was similar in the two groups (22.8% in the restrictive group vs. 29.7% in the liberal group, p = 0.36).”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [484]
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Self-citation
- Authors
- Hébert, P. C., Wells, G., Blajchman, M. A., Marshall, J., Martin, C., Pagliarello, G., Tweeddale, M., Schweitzer, I., & Yetisir, E.
- Affiliations
- University of Ottawa (CA)
- McMaster University (CA)
- University of Toronto (CA)
- Western University (CA)
- University of British Columbia (CA)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 1999-02-11
- Volume
- 340
- Issue
- 6
- Pages
- 409-417
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W127034668
- Cited by
- 5,187
- References
- 24
- Citations by year
- 2026: 88 · 2025: 121 · 2024: 123 · 2023: 116 · 2022: 124 · 2021: 137 · 2020: 188 · 2019: 173 · 2018: 168 · 2017: 231 · 2016: 256 · 2015: 246 · 2014: 287 · 2013: 269 · 2012: 254
- FWCI
- 79.72
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Hamilton Health Sciences
- University of Waterloo
- Jewish General Hospital
- Topics
- Health Sciences › Medicine › Biochemistry › Blood transfusion and management
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Trauma, Hemostasis, Coagulopathy, Resuscitation
- Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
- Keywords
- red blood cell transfusion, restrictive transfusion, liberal transfusion, critically ill patients, hemoglobin threshold, 30-day mortality, organ dysfunction, APACHE II score, age, heart disease, acute myocardial infarction, unstable angina
- MeSH terms
- Adult, Aged, Critical Care, Female, Hemoglobins, Humans, Intensive Care Units, Male, Middle Aged, Multiple Organ Failure, Logistic Models, Survival Analysis, Critical Illness, Hospital Mortality, Erythrocyte Transfusion, APACHE
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