Successful Implementation of a Packed Red Blood Cell and Fresh Frozen Plasma Transfusion Protocol in the Surgical Intensive Care Unit

<div><p>Background</p><p>Blood product transfusions are associated with increased morbidity and mortality. The purpose of this study was to determine if implementation of a restrictive protocol for packed red blood cell (PRBC) and fresh frozen plasma (FFP) transfusion safely reduces blood product utilization and costs in a surgical intensive care unit (SICU).</p><p>Study Design</p><p>We performed a retrospective, historical control analysis comparing before (PRE) and after (POST) implementation of a restrictive PRBC/FFP transfusion protocol for SICU patients. Univariate analysis was utilized to compare patient demographics and blood product transfusion totals between the PRE and POST cohorts. Multivariate logistic regression models were developed to determine if implementation of the restrictive transfusion protocol is an independent predictor of adverse outcomes after controlling for age, illness severity, and total blood products received.</p><p>Results</p><p>829 total patients were included in the analysis (PRE, n=372; POST, n=457). Despite higher mean age (56 vs. 52 years, p=0.01) and APACHE II scores (12.5 vs. 11.2, p=0.006), mean units transfused per patient were lower for both packed red blood cells (0.7 vs. 1.2, p=0.03) and fresh frozen plasma (0.3 vs. 1.2, p=0.007) in the POST compared to the PRE cohort, respectively. There was no difference in inpatient mortality between the PRE and POST cohorts (7.5% vs. 9.2%, p=0.39). There was a decreased risk of urinary tract infections (OR 0.47, 95%CI 0.28-0.80) in the POST cohort after controlling for age, illness severity and amount of blood products transfused.</p><p>Conclusions</p><p>Implementation of a restrictive transfusion protocol can effectively reduce blood product utilization in critically ill surgical patients with no increase in morbidity or mortality.</p></div

Restrictive transfusion protocol for FFP.

<p>Restrictive transfusion protocol for FFP.</p

Multivariate Analysis of early transfusion and urinary tract infection rates.

<p>Abbreviations. RR, relative risk; CI, confidence interval.</p><p>Abbreviations. APACHE, Acute Physiology and Chronic Health Evaluation; PRBC, packed red blood cells; FFP, fresh frozen plasma; CI, confidence interval.</p><p>Multivariate Analysis of early transfusion and urinary tract infection rates.</p

Restrictive transfusion protocol for PRBC.

<p>Restrictive transfusion protocol for PRBC.</p

Demographics—Pre vs. Post Restrictive Transfusion Protocol.

<p>Abbreviations: APACHE, Acute Physiology and Chronic Health Evaluation; PT, prothrombin time; INR, international normalized ratio; Hgb, hemoglobin; SD, standard deviation.</p><p>All percentages were calculated as column percentages.</p><p>^a Pre n = 327, Post n = 390;</p><p>^b Pre n = 326, Post n = 390;</p><p>^c Pre n = 370, Post n = 456;</p><p>^d Post n = 456;</p><p>Demographics—Pre vs. Post Restrictive Transfusion Protocol.</p