Hemoglobin levels and transfusions in neurocritically ill patients: a systematic review of comparative studies.

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dc.contributor.authorDesjardins, Philippe
dc.contributor.authorTurgeon, Alexis F
dc.contributor.authorTremblay, Marie-Helene
dc.contributor.authorLauzier, Francois
dc.contributor.authorZarychanski, Ryan
dc.contributor.authorBoutin, Amelie
dc.contributor.authorMoore, Lynne
dc.contributor.authorMcIntyre, Lauralyn A
dc.contributor.authorEnglish, Shane W
dc.contributor.authorRigamonti, Andrea
dc.contributor.authorLacroix, Jacques
dc.contributor.authorFergusson, Dean A
dc.date.accessioned2012-08-03T11:44:08Z
dc.date.available2012-08-03T11:44:08Z
dc.date.issued2012-04-02
dc.date.updated2012-08-03T11:44:08Z
dc.description.abstractAbstract Introduction Accumulating evidence suggests that, in critically ill patients, a lower hemoglobin transfusion threshold is safe. However, the optimal hemoglobin level and associated transfusion threshold remain unknown in neurocritically ill patients. Methods We conducted a systematic review of comparative studies (randomized and nonrandomized) to evaluate the effect of hemoglobin levels on mortality, neurologic function, intensive care unit (ICU) and hospital length of stay, duration of mechanical ventilation, and multiple organ failure in adult and pediatric neurocritically ill patients. We searched MEDLINE, The Cochrane Central Register of Controlled Trials, Embase, Web of Knowledge, and Google Scholar. Studies focusing on any neurocritical care conditions were included. Data are presented by using odds ratios for dichotomous outcomes and mean differences for continuous outcomes. Results Among 4,310 retrieved records, six studies met inclusion criteria (n = 537). Four studies were conducted in traumatic brain injury (TBI), one in subarachnoid hemorrhage (SAH), and one in a mixed population of neurocritically ill patients. The minimal hemoglobin levels or transfusion thresholds ranged from 7 to 10 g/dl in the lower-Hb groups and from 9.3 to 11.5 g/dl in the higher-Hb groups. Three studies had a low risk of bias, and three had a high risk of bias. No effect was observed on mortality, duration of mechanical ventilation, or multiple organ failure. In studies reporting on length of stay (n = 4), one reported a significant shorter ICU stay (mean, -11.4 days (95% confidence interval, -16.1 to -6.7)), and one, a shorter hospital stay (mean, -5.7 days (-10.3 to -1.1)) in the lower-Hb groups, whereas the other two found no significant association. Conclusions We found insufficient evidence to confirm or refute a difference in effect between lower- and higher-Hb groups in neurocritically ill patients. Considering the lack of evidence regarding long-term neurologic functional outcomes and the high risk of bias of half the studies, no recommendation can be made regarding which hemoglobin level to target and which associated transfusion strategy (restrictive or liberal) to favor in neurocritically ill patients.
dc.description.versionPeer Reviewed
dc.identifier.citationCritical Care. 2012 Apr 02;16(2):R54
dc.identifier.doihttp://dx.doi.org/10.1186/cc11293
dc.identifier.urihttp://hdl.handle.net/1993/8148
dc.language.rfc3066en
dc.rightsopen accessen_US
dc.rights.holderPhilippe Desjardins et al.; licensee BioMed Central Ltd.
dc.titleHemoglobin levels and transfusions in neurocritically ill patients: a systematic review of comparative studies.
dc.typeJournal Article
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