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Clinical practice guideline: Red blood cell transfusion in adult trauma and critical care*

Napolitano, Lena M. MD; Kurek, Stanley DO; Luchette, Fred A. MD; Corwin, Howard L. MD; Barie, Philip S. MD; Tisherman, Samuel A. MD; Hebert, Paul C. MD, MHSc; Anderson, Gary L. DO; Bard, Michael R. MD; Bromberg, William MD; Chiu, William C. MD; Cipolle, Mark D. MD; PhD; Clancy, Keith D. MD; Diebel, Lawrence MD; Hoff, William S. MD; Hughes, K Michael DO; Munshi, Imtiaz MD; Nayduch, Donna RN, MSN, ACNP; Sandhu, Rovinder MD; Yelon, Jay A. MD

doi: 10.1097/CCM.0b013e3181b39f1b
Special Article

Objective: To develop a clinical practice guideline for red blood cell transfusion in adult trauma and critical care.

Design: Meetings, teleconferences and electronic-based communication to achieve grading of the published evidence, discussion and consensus among the entire committee members.

Methods: This practice management guideline was developed by a joint taskforce of EAST (Eastern Association for Surgery of Trauma) and the American College of Critical Care Medicine (ACCM) of the Society of Critical Care Medicine (SCCM). We performed a comprehensive literature review of the topic and graded the evidence using scientific assessment methods employed by the Canadian and U.S. Preventive Task Force (Grading of Evidence, Class I, II, III; Grading of Recommendations, Level I, II, III). A list of guideline recommendations was compiled by the members of the guidelines committees for the two societies. Following an extensive review process by external reviewers, the final guideline manuscript was reviewed and approved by the EAST Board of Directors, the Board of Regents of the ACCM and the Council of SCCM.

Results: Key recommendations are listed by category, including (A) Indications for RBC transfusion in the general critically ill patient; (B) RBC transfusion in sepsis; (C) RBC transfusion in patients at risk for or with acute lung injury and acute respiratory distress syndrome; (D) RBC transfusion in patients with neurologic injury and diseases; (E) RBC transfusion risks; (F) Alternatives to RBC transfusion; and (G) Strategies to reduce RBC transfusion.

Conclusions: Evidence-based recommendations regarding the use of RBC transfusion in adult trauma and critical care will provide important information to critical care practitioners.

The American College of Critical Care Medicine Task Force of the Society of Critical Care Medicine: Howard L. Corwin, MD; Philip S. Barie, MD; Samuel A. Tisherman, MD; Paul C. Hebert, MD, MHSc.

The Eastern Association for the Surgery of Trauma Practice Management Workgroup: Gary L. Anderson, DO; Michael R. Bard, MD; William Bromberg, MD; William C. Chiu, MD; Mark D. Cipolle, MD, PhD; Keith D. Clancy, MD; Lawrence Diebel, MD; William S. Hoff, MD; K. Michael Hughes, DO; Imtiaz Munshi, MD; Donna Nayduch, RN, MSN, ACNP; Rovinder Sandhu, MD; Jay A. Yelon, MD.

The American College of Critical Care Medicine, which honors individuals for their achievements and contributions to multidisciplinary critical care medicine, is the consultative body of the Society of Critical Care Medicine that possesses recognized expertise in the practice parameters for the critical care practitioner. New guidelines and practice parameters are continually developed, and current ones are systematically reviewed and revised.

The Eastern Association for the Surgery of Trauma (EAST) Practice Management Guidelines Committee develops and disseminates evidence-based information to increase the scientific knowledge needed to enhance patient and clinical decision-making, improve healthcare quality and promote efficiency in the organization of public and private systems of healthcare delivery.

The Executive Summary for Critical Care Guideline: Red Blood Cell Transfusion in Adult Trauma and Critical Care is published in the December 2009 issue of J Trauma.

These guidelines are being copublished by the Eastern Association for the Surgery of Trauma ( in the J Trauma.

The authors have not disclosed any potential conflict of interest.

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© 2009 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins