Nghệ thuật quản lý chất lỏng và huyết động là một trong những khía cạnh khó khăn nhất của thực hành chăm sóc quan trọng hiện nay. Mặc dù hơn một nửa các bệnh nhân trong đơn vị chăm sóc đặc biệt | 1 Transfusion requirements in critical care MARTIN G TWEEDDALE On behalf of the Canadian Critical Care Trials Group and the Transfusion Requirements in Critical Care Investigators PC Hebert Principal Investigator MA Blajchman J Marshall C Martin G Pagliarello I Schweitzer MG Tweeddale and G Wells Introduction The art of fluid administration and haemodynamic support is one of the most challenging aspects of current critical care practice. Although more than half the patients in intensive care units ICU receive blood transfusions there is little in the way of data to guide decisions on when to give transfusions. The American College of Physicians among others has published a transfusion However this is based not on controlled clinical trials but on expert opinion. Despite these guidelines transfusion practice varies widely. Estimates of the frequency of inappropriate transfusion range from 4-66 in the This article describes a multi-centre randomised controlled trial of a liberal versus a restrictive transfusion protocol in ICUs in The trial was sponsored by the Canadian Critical Care Trials Group an informal association of people interested in promoting critical care research and was funded by the Canadian Medical Research Council and Bayer plc. To transfuse or not to transfuse Prior to undertaking a clinical trial it is important to consider the arguments for and against treatment. Box shows some reasons that doctors might give as to why stable patients in ICU should be transfused. In fact transfusion practice is a good example of how some patterns of treatment in critical care have been set prematurely without proper clinical or experimental evidence. The first four possibilities listed in Box are each plausible but none is proven or definitive. For example it has been theorised that improving oxygen delivery and reducing oxygen debt would improve This has led to the assumption that transfusing patients on ICU is
