Written by Mary Marschner
Spoon Feed
In ICU patients with septic shock, there was no difference in mortality or life support used at 90 days for a transfusion threshold hemoglobin of 7 g/dL versus 9 g/dL.
Don’t be confused! No need to transfuse!
ICU patients with septic shock have an estimated mortality rate of 40-60% at 90 days, despite what we do in the ICU. This study looked for a difference in outcomes for a transfusion threshold of 7 g/dL versus 9 g/dL – and it didn’t find it. For these patients without underlying coronary artery disease, giving blood products did not change the trajectory of their illness at all. This randomized controlled trial investigated whether a lower hemoglobin threshold (7 g/dL) for red blood cell transfusion in septic shock improved outcomes compared to a higher threshold (9 g/dL). Among 998 patients, 90-day mortality was similar between groups (lower threshold 43.0% vs. higher threshold 45.0%; RR 0.94, 95%CI: 0.78–1.09, p=0.44). There were no statistically significant differences in the secondary analyses comparing days alive without vasopressor or inotropic therapy, days alive without mechanical ventilation, days alive without RRT, days alive and out of hospital, or ischemic events. Findings from the TRISS trial cemented a restrictive transfusion strategy in septic shock, reducing blood use without increasing mortality or adverse events. This study was beautifully designed and executed. The only flaw is the low numbers when looking at the secondary outcomes.
How does this change my practice?
This study really cemented a transfusion hemoglobin threshold of 7 unless you have underlying coronary artery disease, and this has remained my current practice.
Source
Lower versus higher hemoglobin threshold for transfusion in septic shock. N Engl J Med. 2014 Oct 9;371(15):1381-91. doi: 10.1056/NEJMoa1406617. Epub 2014 Oct 1. PMID: 25270275
