{"id":27785,"date":"2025-04-21T04:17:00","date_gmt":"2025-04-20T20:17:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=27785"},"modified":"2025-04-21T05:38:12","modified_gmt":"2025-04-20T21:38:12","slug":"chest%e5%8f%91%e5%b8%83%e6%8c%87%e5%8d%97%ef%bc%9a%e6%88%90%e5%b9%b4%e9%87%8d%e7%97%87%e6%82%a3%e8%80%85%e8%be%93%e6%b3%a8%e7%ba%a2%e7%bb%86%e8%83%9e%ef%bc%9a%e7%be%8e%e5%9b%bd%e8%83%b8%e7%a7%91","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=27785","title":{"rendered":"[Chest\u53d1\u5e03\u6307\u5357]\uff1a\u6210\u5e74\u91cd\u75c7\u60a3\u8005\u8f93\u6ce8\u7ea2\u7ec6\u80de\uff1a\u7f8e\u56fd\u80f8\u79d1\u533b\u5e08\u5b66\u9662\u4e34\u5e8a\u5b9e\u8df5\u6307\u5357"},"content":{"rendered":"\n

Critical Care: Guideline and Consensus Statement<\/p>\n\n\n\n

Red Blood Cell Transfusion in Critically Ill Adults: An American College of Chest Physicians Clinical Practice Guideline<\/h1>\n\n\n\n

Angel O.\u00a0Coz Yataco,\u00a0Israa\u00a0Soghier,\u00a0Paul C.\u00a0H\u00e9bert, et al<\/h3>\n\n\n\n

Chest Available online 26 September 2024 https:\/\/doi.org\/10.1016\/j.chest.2024.09.016<\/h3>\n\n\n\n

Background<\/h3>\n\n\n\n

Blood products frequently are administered to critically ill patients. Considering recent trials and practice variability, a comprehensive review of current evidence was deemed essential to offer pertinent guidance to critical care practitioners. This American College of Chest Physicians (CHEST) guidelines panel examined the literature on RBC transfusions among critically ill patients overall and specific subgroups, including patients with gastrointestinal bleeding, acute coronary syndrome (ACS), cardiac surgery, isolated troponin elevation, and septic shock, to provide evidence-based recommendations.<\/p>\n\n\n\n

Study Design and Methods<\/h3>\n\n\n\n

A panel of experts developed six Population, Intervention, Comparator, and Outcome questions addressing RBC transfusions in critically ill patients and performed a comprehensive evidence review. The panel applied the Grading of Recommendations, Assessment, Development, and Evaluations approach to assess the certainty of evidence and to formulate and grade recommendations. A modified Delphi technique was used to reach consensus on the recommendations.<\/p>\n\n\n\n

Results<\/h3>\n\n\n\n

The initial search identified a total of 3,082 studies, and after the initial screening, 38 articles were reviewed. Among them, 23 studies met inclusion criteria, comprising 22 randomized controlled trials and one cohort study. Based on the analysis of these studies, the panel formulated two strong and four conditional recommendations. The overall quality of evidence for recommendations ranged from very low to moderate.<\/p>\n\n\n\n

Question 1: Should critically ill patients be treated with a restrictive or permissive RBC transfusion strategy?<\/strong><\/p>\n\n\n\n

1. In critically ill patients, we recommend a restrictive RBC transfusion strategy over a permissive RBC transfusion strategy<\/strong>\u00a0(Strong Recommendation, Moderate Certainty of Evidence).<\/p>\n\n\n\n

Question 2: Should critically ill patients who have acute gastrointestinal bleeding be treated with a restrictive or permissive RBC transfusion strategy?<\/strong><\/p>\n\n\n\n

2. In critically ill patients with acute gastrointestinal bleeding, we recommend a restrictive RBC transfusion strategy over a permissive RBC transfusion strategy<\/strong>(Strong Recommendation, Moderate Certainty of Evidence).<\/p>\n\n\n\n

Question 3: Should critically ill patients with acute coronary syndrome be treated with a restrictive or permissive RBC transfusion strategy?<\/strong><\/p>\n\n\n\n

3. In critically ill patients with acute coronary syndrome, we suggest against a restrictive RBC transfusion strategy<\/strong>\u00a0(Conditional Recommendation, Low Certainty of Evidence).<\/p>\n\n\n\n

Question 4: Should critically ill patients undergoing cardiac surgery be treated with a restrictive or permissive RBC transfusion strategy?<\/strong><\/p>\n\n\n\n

4. In critically ill patients undergoing cardiac surgery, we suggest a restrictive RBC transfusion strategy over a permissive transfusion strategy<\/strong>\u00a0during<\/strong>\u00a0the perioperative period<\/strong>\u00a0(Conditional Recommendation, Moderate Certainty of Evidence).<\/p>\n\n\n\n

Question 5: Should critically ill patients with an isolated elevation of serum troponin levels without other evidence of cardiac ischemia be treated with a restrictive or a permissive RBC transfusion strategy?<\/strong><\/p>\n\n\n\n

5. In critically ill patients with isolated elevation of serum troponin without other evidence of cardiac ischemia, we suggest a restrictive RBC transfusion strategy over a permissive RBC transfusion strategy<\/strong>\u00a0(Conditional Recommendation, Very Low Certainty of Evidence).<\/p>\n\n\n\n

Question 6: Should critically ill patients with septic shock with end-organ hypoperfusion be treated with RBC transfusion in addition to usual care or usual care alone?<\/strong><\/p>\n\n\n\n

6. In patients with septic shock and end-organ hypoperfusion, we suggest against adding permissive RBC transfusion thresholds to usual care<\/strong> (Conditional Recommendation, Low Certainty of Evidence).<\/p>\n\n\n\n

Remarks:<\/em>\u00a0Studies evaluating protocol-driven approaches to goal-directed therapy in septic shock were not considered in the evidence review.<\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n

Conclusions<\/h3>\n\n\n\n

In most critically ill patients, a restrictive strategy was preferable to a permissive approach because it does not increase the risk of death or complications, but does decrease RBC use significantly. Data from critically ill subpopulations also supported a restrictive approach, except in patients with ACS, for whom favoring a restrictive approach could increase adverse outcomes<\/p>\n","protected":false},"excerpt":{"rendered":"

Critical Care: Guideline and Consensus Statement Red Bl […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[25,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/27785"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=27785"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/27785\/revisions"}],"predecessor-version":[{"id":27786,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/27785\/revisions\/27786"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=27785"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=27785"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=27785"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}