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Cited by 5,187Blood transfusion and managementTrauma, Hemostasis, Coagulopathy, ResuscitationHemodynamic Monitoring and Therapy

The DOI matches its Crossref record; 29 of the 29 references it cites were found in a registry or an index.

A Multicenter, Randomized, Controlled Clinical Trial of Transfusion Requirements in Critical Care

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Hébert, Paul C., Wells, George, Blajchman, Morris A., Marshall, John, Martin, Claudio, Pagliarello, Giuseppe, Tweeddale, Martin, Schweitzer, Irwin, Yetisir, Elizabeth·1999·New England Journal of Medicine
DOI 10.1056/nejm199902113400601
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Abstract

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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Research works printed but not linked: 4

  1. Langenfeld JE, 1991, Surgery, 110, 398
  2. Baker CH, 1986, Circ Shock, 20, 127
  3. Friedman LM, Furberg CD, DeMets DL. Fundamentals of clinical trials. 3rd ed. St. Louis: Mosby-Year Book, 1996.
  4. Hebert PC, 1997, Can Med Assoc J, 156, S9

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Metadata

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)
ORCID
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
DOI
10.1056/nejm199902113400601
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
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Hamilton Health Sciences
  • University of Waterloo
  • Jewish General Hospital
Topics
  • Health Sciences › Medicine › Hematology › 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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