Red cell transfusion triggers in critically ill patients time for some new TRICCs 英文参考文献.docVIP

Walsh Critical Care 2010,14:170 /content/14/3/170 CO MMENTA RY Red cell transfusion triggers in critically ill patients: time for some new TRICCs? Timothy S Walsh* See related research by Sakr et al., /content/14/3/R92 Does this association indicate ‘cause and e?ect’? Abstract Although it is possible to perform complex statistical Current evidence suggests that critically ill patients tolerate anaemia well and that blood transfusions may increase the risk of adverse outcomes. Dr Sakr and colleagues present a contradictory analysis of a surgical ICU cohort, ?nding an association between blood transfusions and lower hospital mortality after adjustment for a range of potential confounders. Analyses of this kind are interesting and provocative, adjustments for potential confounders in cohort studies to try to clarify the true relationship between a variable or intervention of interest and an outcome, this is notoriously problematic, especially in relation to blood transfusions [4]. Adjustments can be made for measured factors, but there is always the possibility of residual confounding from ‘unknowns’, which is more likely in complex heterogeneous populations. ICU populations but are limited by residual confounding and bias by indication. The data emphasise the need for additional high quality trials of transfusion practice in critical care. are highly heterogeneous at multiple levels, including pre-illness co-morbidity, diagnosis requiring admission, early illness severity, and subsequent complications, to name a few. Dr Sakr and colleagues included adjustment for some factors but, as they acknowledge, it is very likely Dr Sakr and colleagues [1] report a single centre cohort there were many ‘unknowns’ that were potentially rele- study evaluating the relationship between anaemia, blood vant. Bias by indication is very likely in this sort of transfusions