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

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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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Self-citation
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Background
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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: Hébert, Paul C.
Wells, George
Martin, Claudio
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: 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 › 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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A Multicenter, Randomized, Controlled Clinical Trial of Transfusion Requirements in Critical Care

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