Critical Care/Respiratory CareTransfusion for Patients With Sepsis in 2018Dupuis, Claire MD*,†; Sonneville, Romain MD, PhD*,†; Neuville, Mathilde MD†; Vinclair, Camille MD†; Abid, Sonia MD†; Papin, Gregory MD†; Cally, Radj MD†; Sinnah, Fabrice MD†; Mourvillier, Bruno MD, PhD*,†; Bouadma, Lila MD, PhD*,†; Timsit, Jean-François MD, PhD*,†Author Information *UMR 1137-IAME Team 5-DeSCID: Decision SCiences in Infectious Diseases control and care Inserm/Univ Paris Diderot, Sorbonne Paris Cité †Medical and Infectious Intensive Care Unit, Bichat Claude Bernard University Hospital, AP-HP, Paris, France Disclosure: The authors declare that they have no conflicts of interest. Address correspondence to: Claire Dupuis, MD, Medical and Infectious Intensive Care Unit, Bichat Claude Bernard University Hospital, AP-HP 75018 Paris, France. E-mail: [email protected]. Clinical Pulmonary Medicine: July 2018 - Volume 25 - Issue 4 - p 138-143 doi: 10.1097/CPM.0000000000000266 Buy Metrics Abstract Red blood cell transfusion (RBCT) threshold in patients with sepsis remains a matter of controversy. In this review, we report a summary of the benefits and risks of RBCT. We then focus on the latest studies addressing this controversy, including the randomized controlled trials dealing with the early goal-directed therapy, the randomized controlled trials comparing liberal versus restrictive transfusion strategies, and finally the cohort studies assessing the impact of RBCT. The conclusions of these studies no longer argue for a 10 g/dL (30% hematocrit) transfusion threshold during the early phase of septic shock. Similarly, following the initial stabilization, most septic patients can be managed with a restrictive transfusion strategy using a 7 g/dL hemoglobin threshold. A more liberal transfusion strategy should be adopted if patients are not stabilized or for patients at risk of bleeding, with myocardial ischemia, or oncohematologic patients with potential hemostasis disorders. Triggers of RBCT other than hemoglobin level, more related to macrocirculation or microcirculation failures, should be developed to decide RBCT in septic patients. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.