Approximately 40-50% of patients in the intensive care unit (ICU) receive blood transfusions. Many studies have focused on bleeding in trauma patients who are usually healthy. Patients in the ICU, however, more often have multiple comorbidities and may require a more nuanced transfusion approach. To better understand transfusion practices in massively bleeding and non-massively bleeding patients in the ICU, experts in the transfusion medicine community from North America and Europe compiled 50 questions and distributed an online questionnaire to physicians working in adult ICUs globally. A total of 401 qualified physicians completed the survey from 64 countries—mainly high-income countries (72%). Over half of the respondents reported a massive transfusion protocol at their institution (52%). Furthermore, 46% reported using a fixed blood product ratio for massive transfusions; 1:1:1 (RBC: plasma: platelets) was the most common ratio (33%). In non-massively bleeding patients, respondents reported different hemoglobin (Hb) thresholds for RBC transfusions depending on the patient subpopulation. For the general ICU population, respondents reported using a median Hb threshold of 7.0 g/dL (interquartile range of 7.0 to 7.3 g/dL), but this threshold was higher for cardiothoracic surgery patients (median 8 g/dL, interquartile range 7.9 to 9 g/dL). This survey highlights the need for more research and variability in transfusion practices in the general population of bleeding patients.
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