Abstract
Objectives: The Surviving Sepsis Campaign guidelines 2008 indicate red cell transfusion to target a hemoglobin of 7–9 g·dl−1 in adults when hemoglobin decreases to < 7 g·dl−1. To evaluate the validity of this recommendation, we systematically reviewed the literature regarding red cell transfusion strategies for the critically ill. Methods: We searched PubMed from January 1966 to May 2008 using the key words, “preoperative, postoperative, perioperative or surgery”, or “intensive care or critical care”, and “hemoglobin and transfusion”, then limited the search to English or Japanese references, and randomized controlled trial (RCT). This strategy resulted in 395 articles. Results: Seven articles were aimed at comparing restrictive and liberal transfusion strategies. Four of the 7 studies were subgroup analyses based on a previous report. All of them found that the restrictive transfusion strategy (for example, Hb 7–9 g·dl−1) was equal to or better than the liberal transfusion strategy (for example, Hb 10–12 g·dl−1) with respect to mortality and morbidity among the critically ill. Conclusions: A restrictive strategy of red cell transfusion is at least as effective as, and possibly superior to a liberal transfusion strategy for the critically ill.
