Indeed, blood transfusion was associated with higher mortality in

Indeed, blood transfusion was associated with higher mortality in both the CRIT and ABC trials [1,5]. Nonetheless, it should be noted that among the patients Sunitinib who stayed in the ICU for less than 24 hours, a larger number of patients died in the active group which may have contributed to the improved mortality in the remaining patients.We acknowledge the limitations of our study. First, this was a before-and-after study and given the limitations of historical control study, the results of our study need to be confirmed with prospective RCT. Second, physicians and nurses were not blinded to the device. Nonetheless, we attempted to ensure equal treatment of both groups with the common restrictive transfusion strategy, which was reflected by the similar transfusion thresholds between the two periods.

Third, we only included patients admitted to the medical ICU and expected to stay more than 24 hours. Although the largest volume of blood is drawn during the first 24 hours [18], such a short study period may be insufficient to demonstrate any reduction in the PRBC transfusions. A previous study has shown that the higher mean Hb in the blood conservation group was statistically significant only after 9.5 days of ICU stay [19]. Fourth, we excluded patients with active bleeding where transfusion practices may differ. Fifth, we used the VAMP device and it remains to be seen if our findings are applicable to other blood conservation devices.ConclusionsSince anaemia is the main reason for transfusion in the ICU, and a blood conservation device is associated with better preservation of Hb, it is logical that use of such a device will reduce transfusion requirements.

In this before-and-after study, use of a blood conservation device in the presence of a restrictive transfusion practice was indeed associated with a significant reduction in blood transfusion requirements. The significance of this finding is clear given the current worldwide shortage of PRBCs, but extends far beyond apparent cost-benefit ratio and economic savings. PRBC transfusions are associated with significant morbidity and mortality and any reduction in transfusions may eventually improve overall patient outcome. A larger prospective RCT is currently being planned.Key messages? Anaemia is common in critically ill patients admitted to ICU and as a result, large numbers of patients receive blood transfusions.

? Blood transfusions are in short supply, expensive and have deleterious effects on patient outcome.? Previous studies have Dacomitinib shown that by preserving the discarded volume of blood from indwelling arterial or central line catheters, blood conservation devices can improve anaemia (Hb).? The present study shows that with restrictive transfusion practice, blood conservation devices can reduce blood transfusion requirements.

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