Abstract:
OBJECTIVE:Increasing evidence, including publication of the Transfusion Requirements in Critical Care trial in 1999, supports a lower hemoglobin threshold for RBC transfusion in ICU patients. However, little is known regarding the influence of this evidence on clinical practice over time in a large population-based cohort. DESIGN:Retrospective population-based cohort study. SETTING:Thirty-five Maryland hospitals. PATIENTS:Seventy-three thousand three hundred eighty-five nonsurgical adults with an ICU stay greater than 1 day between 1994 and 2007. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:The unadjusted odds of patients receiving an RBC transfusion increased from 7.9% during the pre-Transfusion Requirements in Critical Care baseline period (1994-1998) to 14.7% during the post-Transfusion Requirements in Critical Care period (1999-2007). A logistic regression model, including 40 relevant patient and hospital characteristics, compared the annual trend in the adjusted odds of RBC transfusion during the pre- versus post-Transfusion Requirements in Critical Care periods. During the pre-Transfusion Requirements in Critical Care period, the trend in the adjusted odds of RBC transfusion did not differ between hospitals averaging>200 annual ICU discharges and hospitals averaging≤200 annual ICU discharges (odds ratio, 1.07 [95% CI, 1.01-1.13] annually and 1.03 [95% CI, 0.99-1.07] annually, respectively; p=0.401). However, during the post-Transfusion Requirements in Critical Care period, the adjusted odds of RBC transfusion decreased over time in higher ICU volume hospitals (odds ratio, 0.96 [95% CI, 0.93-0.98] annually) but continued to increase in lower ICU volume hospitals (odds ratio, 1.10 [95% CI, 1.08-1.13] annually), p<0.001. CONCLUSIONS:In this population-based cohort of ICU patients, the unadjusted odds of RBC transfusion increased in both higher and lower ICU volume hospitals both before and after Transfusion Requirements in Critical Care publication. After adjusting for relevant characteristics, the odds continued to increase in lower ICU volume hospitals in the post-Transfusion Requirements in Critical Care period, but it decreased in higher ICU volume hospitals. This suggests that evidence supporting restrictive RBC transfusion thresholds may not be uniformly translated into practice in different hospital settings.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Murphy DJ,Needham DM,Netzer G,Zeger SL,Colantuoni E,Ness P,Pronovost PJ,Berenholtz SMdoi
10.1097/CCM.0b013e31828e9a49subject
Has Abstractpub_date
2013-10-01 00:00:00pages
2344-53issue
10eissn
0090-3493issn
1530-0293journal_volume
41pub_type
杂志文章abstract:OBJECTIVE:Acute lung injury is a detrimental complication for victims of burn accidents. Airway obstruction plays an important role in pulmonary dysfunction in these patients. In this study, we tested the hypothesis that aerosolized anticoagulants will reduce the degree of airway obstruction and improve pulmonary funct...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000291647.18329.83
更新日期:2007-12-01 00:00:00
abstract:OBJECTIVE:To test the hypothesis that the hypocalcemia and hypoparathyroidism that follow severe burn injury are related to up-regulation of the parathyroid gland calcium-sensing receptor (CaR), which may reduce the set-point for suppression of circulating parathyroid hormone by blood calcium. DESIGN:A controlled but ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200012000-00024
更新日期:2000-12-01 00:00:00
abstract:OBJECTIVE:To evaluate the role of cholesterol and lipoproteins in children with severe meningococcal sepsis. DESIGN:Retrospective observational study. SETTING:A university-affiliated pediatric intensive care unit. PATIENTS:Fifty-seven patients admitted to the pediatric intensive care unit with meningococcal sepsis o...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000171272.50888.ad
更新日期:2005-07-01 00:00:00
abstract:OBJECTIVE:To measure exhaled nitric oxide (NO) and compare it with lung function after cardiopulmonary bypass (CPB) in adult patients. Pulmonary dysfunction is sometimes observed after CPB. Impaired production of NO may account for this dysfunction. DESIGN:Prospective, single-center, observational study. SETTING:Univ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200012000-00012
更新日期:2000-12-01 00:00:00
abstract::Flow rates and pressure recording accuracy were compared for Argyle 14-, 16-, and 18-ga double-lumen and Edwards 7-Fr triple-lumen CVP catheters. Physiologic saline solution was pressure-infused into dogs through one lumen and CVP was measured via the other lumen. CVP accuracy was unaltered by simultaneous rapid infus...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198507000-00017
更新日期:1985-07-01 00:00:00
abstract:OBJECTIVE:Develop a scoring system that can assess the management of septic shock by individuals and teams. DESIGN:Retrospective review of videotapes of critical care house staff managing a standardized simulation of septic shock. SETTING:Academic medical center; videotapes were made in a recreated intensive care uni...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000256849.75799.20
更新日期:2007-03-01 00:00:00
abstract:BACKGROUND:Endotoxin (lipopolysaccharide [LPS]) has been associated with sepsis and the high mortality rate seen in septic shock. The administration of a small amount of LPS to healthy subjects produces a mild syndrome qualitatively similar to that seen in clinical sepsis. We used this model to test the efficacy of an ...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-200008000-00005
更新日期:2000-08-01 00:00:00
abstract:OBJECTIVES:The main objective of the study was to determine the prevalence of venous thromboembolism events in patients infected with severe acute respiratory syndrome coronavirus 2 requiring venovenous extracorporeal membrane oxygenation. The secondary objective was to compare venous thromboembolism events and coagula...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004504
更新日期:2020-10-01 00:00:00
abstract:OBJECTIVE:To evaluate the impact of a newly appointed neurointensivist on neurosciences intensive care unit (NICU) patient outcomes and quality of care variables. DESIGN:Observational cohort with historical controls. SETTING:Ten-bed neurointensive care unit in tertiary university hospital. PATIENTS:Mortality, length...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000146131.03578.21
更新日期:2004-11-01 00:00:00
abstract::Recorded values (SpO2) of oxygen saturation from six noninvasive pulse oximeters were compared to each other and to the value from a cooximeter. Simultaneous measurements were obtained from each instrument in eight healthy nonsmoking volunteers rendered hypoxic greater than 70% SpO2. Functional arterial oxygen saturat...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198907000-00016
更新日期:1989-07-01 00:00:00
abstract:OBJECTIVE:This study tested the hypothesis that intra-coronary transfusion of circulation-derived autologous CD34+ cells can improve ischemia-related left ventricular dysfunction in patients with severe diffuse coronary artery disease refractory to medication and unsuitable for coronary intervention. DESIGN:A prospect...
journal_title:Critical care medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/CCM.0000000000001138
更新日期:2015-10-01 00:00:00
abstract:OBJECTIVES:The absence of N20 somatosensory evoked potential after cardiac arrest is related to poor outcome. However, discrimination between the low-amplitude and the absence of N20 is challenging. P25 and P30 are short-latency positive peaks with latencies between 25 and 30 ms following N20 (P25/30). P25/30 is eviden...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003083
更新日期:2018-06-01 00:00:00
abstract:BACKGROUND:Pneumonia accounts for almost half of intensive care unit (ICU) infections and nearly 60% of deaths from nosocomial infections. It increases hospital stay by 7-9 days, crude mortality by 70% and attributable mortality by 30%. OBJECTIVE:Our purpose was to assess the impact of standard operating procedures ad...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181934f1b
更新日期:2009-01-01 00:00:00
abstract:OBJECTIVE:The use of corticosteroids in patients with sepsis or septic shock has been controversial for many decades. Clinical studies have reported beneficial, as well as negative results. We conducted a meta-analysis to assess the clinical evidence and to evaluate treatment effects in specific subgroups of patients. ...
journal_title:Critical care medicine
pub_type: 杂志文章,meta分析
doi:10.1097/00003246-199507000-00021
更新日期:1995-07-01 00:00:00
abstract:OBJECTIVES:To evaluate knowledge translation after publication of the target temperature management 33°C versus 36°C after out-of-hospital cardiac arrest trial and associated patient outcomes. Our primary hypothesis was that target temperature management at 36°C was rapidly adopted in Australian and New Zealand ICUs. S...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003339
更新日期:2018-11-01 00:00:00
abstract:OBJECTIVE:Hypoxemic reperfusion attenuates brain injury secondary to severe cerebral ischemia, myocardial, and intestinal injury occurring in intestinal postischemic shock, and offers hemodynamic stabilization and attenuation of inflammatory response when applied in the resuscitation from hemorrhagic shock. In this stu...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31819b81ec
更新日期:2009-03-01 00:00:00
abstract:OBJECTIVES:Vital organ hypoperfusion significantly contributes to the dismal survival rates observed with manual cardiopulmonary resuscitation after cardiac arrest. The impedance threshold device is a valve which reduces air entry into lungs during chest recoil between chest compressions, producing a potentially benefi...
journal_title:Critical care medicine
pub_type: 杂志文章,meta分析
doi:10.1097/CCM.0b013e318170ba80
更新日期:2008-05-01 00:00:00
abstract:OBJECTIVE:We previously reported improved oxygenation, but no change, in rates of extracorporeal membrane oxygenation (ECMO) use or death among infants with persistent pulmonary hypertension of the newborn who received inhaled nitric oxide (NO) with conventional ventilation, irrespective of lung disease. The goal of ou...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-200011000-00031
更新日期:2000-11-01 00:00:00
abstract::Many clinical conditions are associated with an increase in abdominal pressure. While the effects on venous return have been studied in the past, little attention has been given to the effect of abdominal pressure on left-sided hemodynamic events. The effects of acute changes in abdominal pressure (Pab) on left ventri...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198510000-00006
更新日期:1985-10-01 00:00:00
abstract:OBJECTIVES:Sepsis results in organ dysfunction caused by a dysregulated host response, in part related to the immune response of a severe infection. Mesenchymal stromal cells are known to modulate the immune response, and expression of stromal cell-derived factor-1 regulates mobilization of neutrophils from the bone ma...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004244
更新日期:2020-05-01 00:00:00
abstract::Transcutaneous PO2 (PtcO2), PaO2, PtcO2 arterial index (ARI; PtcO2/PaO2), and the initial slope index (ISI; [delta PO2/min]/starting PtcO2) were measured in 42 healthy volunteers, 12 patients with stable circulation and respiratory insufficiency, and ten patients with insufficient peripheral circulation in cardiogenic...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198804000-00009
更新日期:1988-04-01 00:00:00
abstract:OBJECTIVE:To assess the value of soluble triggering receptor expressed on myeloid cells-1 as a biomarker of infection in patients with neutropenic fever comparing with procalcitonin and C-reactive protein. DESIGN:Prospective, comparative, single-center study. SETTING:Hematology ward at a university hospital. SUBJECT...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31820a92dc
更新日期:2011-05-01 00:00:00
abstract:OBJECTIVE:To study the epidemiology, style of management, and outcome of intensive care patients with acute renal failure requiring replacement therapy in Australia. DESIGN:Prospective epidemiologic study. SETTING:Australian adult intensive care units providing acute renal replacement therapy. PATIENTS:Adult intensi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200110000-00010
更新日期:2001-10-01 00:00:00
abstract:OBJECTIVE:To compare intraosseous with central venous blood samples for biochemical analyses and hemoglobin levels during cardiopulmonary resuscitation (CPR) and during cardiopulmonary resuscitation with infusion of sodium bicarbonate, epinephrine, and saline boluses through the intraosseous site. DESIGN:Prospective, ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199906000-00039
更新日期:1999-06-01 00:00:00
abstract::Human hemoglobin (Hb) solution is being developed for use as an oxygen-delivering resuscitation fluid. Substantial improvements in the general purity and quality of experimental Hb solutions have been achieved by recent research efforts. Hb solutions now appear to be free of the undesirable biological effects that wer...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/00003246-198204000-00002
更新日期:1982-04-01 00:00:00
abstract:OBJECTIVE:To determine whether continuous gas flow in the breathing circuit or an airleak around the tracheal tube cuff will introduce errors into the measurement of oxygen consumption (VO2) with indirect calorimetry. DESIGN:Nonrandomized, controlled trial. SETTING:Experimental laboratory. SUBJECTS:Ten healthy, anes...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199209000-00023
更新日期:1992-09-01 00:00:00
abstract:OBJECTIVES:Over-utilization of tests, treatments, and procedures is common for hospitalized patients in ICU settings. American Board of Internal Medicine Foundation's Choosing Wisely campaign tasked professional societies to identify sources of overuse in specialty care practice. The purpose of this study was to assess...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003496
更新日期:2019-03-01 00:00:00
abstract:OBJECTIVE:To determine the limits of agreement between the cardiac output and volumetric data estimated by impedance cardiography with the cardiac output determined by thermodilution and the left ventricular ejection fraction and end-diastolic volume estimated from left ventriculography. DESIGN:A prospective study. S...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199709000-00023
更新日期:1997-09-01 00:00:00
abstract:BACKGROUND:Although survival is traditionally modeled using Cox proportional hazards modeling, this approach may be inappropriate in sepsis, in which the proportional hazards assumption does not hold. Newer, more flexible models, such as Gray's model, may be more appropriate. OBJECTIVES:To construct and compare Gray's...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/01.ccm.0000114819.37569.4b
更新日期:2004-03-01 00:00:00
abstract:OBJECTIVE:This study evaluates the ability of perflubron to inhibit pulmonary neutrophil accumulation during partial liquid ventilation (PLV) in the setting of acute lung injury. DESIGN:Randomized, controlled, nonblinded study. SETTING:Research laboratory at a university. SUBJECTS:Male, Sprague-Dawley rats (n = 120,...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199810000-00028
更新日期:1998-10-01 00:00:00