how low is too low cardiac risks with anemia心脏风险太低贫血多低.pdfVIP

Available online /content/8/S2/S11 Review How low is too low? Cardiac risks with anemia Samir M Fakhry1 and Paola Fata2 1Chief, Trauma and Critical Care Services, Associate Chair for Research and Education, Department of Surgery, Inova Fairfax Hospital, Falls Church, Virginia, USA 2Trauma Fellow, Department of Surgery, Inova Fairfax Hospital, Falls Church, Virginia, USA Correspondence: Samir M Fakhry, samir.fakhry@ Published online: 14 June 2004 Critical Care 2004, 8(Suppl 2):S11-S14 (DOI 10.1186/cc2845) This article is online at /content/8/S2/S11 © 2004 BioMed Central Ltd Abstract Despite the increasing availability of data supporting more restrictive transfusion practices, the risks and benefits of transfusing critically ill patients continue to evoke controversy. Past retrospective and observational studies suggested that liberal transfusion strategies were more beneficial in patients whose hematocrit levels fell below 30%. An expanding body of literature suggests that an arbitrary trigger for transfusion (the ‘10/30 rule’) is ill advised. A recent randomized controlled trial provided compelling evidence that similar, and in some cases better, outcomes result if a restrictive transfusion strategy is maintained. The impact of this accumulating evidence on clinical practice is evident in large reports, which show that the average transfusion trigger in critically ill patients was a hemoglobin level in the range 8–8.5 g/dl. Based on the available evidence, transfusion in the critically ill patient without active ischemic heart disease should generally be withheld until the hemoglobi