Day or overnight transfusion in critically ill patients: does it matter?

C. Aubron, R. K. Kandane-Rathnayake, N. Andrianopoulos, A. Westbrook, S. Engelbrecht, I. Ozolins, M. Bailey, L. Murray, D. J. Cooper, E. M. Wood, Z. K. McQuilten, The Blood Observational Study investigators, V. Pettilä, A. Nichol, L. E. Phillips, A. Street, C. French, N. Orford, J. Santamaria, R. Bellomo & 111 others S. Vallance, C. McArthur, S. McGuiness, L. Newby, C. Simmonds, R. Parke, H. Buhr, D. Goldsmith, K. O'Sullivan, I. Mercer, R. Gazzard, C. Tauschke, D. Hill, J. Fletcher, C. Boschert, G. Koch, D. Ernest, S. Eliott, F. Hawker, B. Howe, K. Ellem, K. Duff, J. Mehrtens, S. Henderson, D. Milliss, B. O'Bree, K. Shepherd, B. Ihle, S. Ho, M. Graan, A. Bernsten, E. Ryan, J. Botha, J. Vuat, A. Kinmonth, M. Fraser, B. Richards, M. Tallott, R. Whitbread, R. Freebairn, L. Thomas, M. Parr, S. Micallef, K. Deshpande, J. Wood, T. Williams, J. Tai, A. Boase, P. Galt, B. King, R. Price, J. Tomlinson, L. Cole, I. Seppelt, L. Weisbrodt, R. Gresham, M. Nikas, J. Laing, J. Bell, G. McHugh, D. Hancock, S. Kirkham, Y. Shehabi, M. Campbell, V. Stockdale, S. Peake, P. Williams, P. Sharley, S. O'Connor, D. Stephens, J. Thomas, R. Sistla, R. McAllister, K. Marsden, C. MacIsaac, D. Barge, T. Caf, S. Finfer, L. Tan, S. Bird, S. Webb, J. Chamberlain, G. McEntaggart, A. Gould, R. Totaro, D. Rajbhandari, S. Baker, B. Roberts, P. Lavercombe, R. Walker, J. Myburgh, V. Dhiacou, R. Smith, J. Holmes, P. Nair, C. Burns, T. Browne, J. Goodson, F. van Haren, M. La Pine, G. Hart, J. Broadbent, P. Hicks, D. Mackle, L. Andrews, H. Raunow, L. Keen, A. Davey-Quinn, F. Hill, R. Xu, The ANZICS Clinical Trials Group

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background and objectives: The timing of blood administration in critically ill patients is first driven by patients' needs. This study aimed to define the epidemiology and significance of overnight transfusion in critically ill patients. Materials and methods: This is a post hoc analysis of a prospective multicentre observational study including 874 critically ill patients receiving red blood cells, platelets, fresh frozen plasma (FFP) or cryoprecipitate. Characteristics of patients receiving blood only during the day (8 am up until 8 pm) were compared to those receiving blood only overnight (8 pm up until 8 am). Characteristics of transfusion were compared, and factors independently associated with major bleeding were analysed. Results: The 287 patients transfused during the day only had similar severity and mortality to the 258 receiving blood products overnight only. Although bleeding-related admission diagnoses were similar, major bleeding was the indication for transfusion in 12% of patients transfused in daytime only versus 30% of patients transfused at night only (P < 0·001). Similar total amount of blood products were transfused at day and night (2856 versus 2927); however, patients were more likely to receive FFP and cryoprecipitate at night compared with daytime. Overnight transfusion was independently associated with increased odds of major bleeding (odds ratio, 3·16, 95% confidence interval, 2·00–5·01). Conclusion: Transfusion occurs evenly across day and night in ICU; nonetheless, there are differences in type of blood products administered that reflect differences in indication. Critically ill patients were more likely to receive blood for major bleeding at night irrespective of admission diagnosis.

LanguageEnglish
Pages275-282
Number of pages8
JournalVox Sanguinis
Volume113
Issue number3
DOIs
Publication statusPublished - 4 Apr 2018

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Critical Illness
Hemorrhage
Multicenter Studies
Observational Studies
Epidemiology
Blood Platelets
Erythrocytes
Odds Ratio
Confidence Intervals
Mortality

Keywords

  • critically ill patient
  • major bleeding
  • outcome
  • red blood cells
  • timing of care
  • transfusion

Cite this

Aubron, C., Kandane-Rathnayake, R. K., Andrianopoulos, N., Westbrook, A., Engelbrecht, S., Ozolins, I., ... The ANZICS Clinical Trials Group (2018). Day or overnight transfusion in critically ill patients: does it matter? Vox Sanguinis, 113(3), 275-282. https://doi.org/10.1111/vox.12635
Aubron, C. ; Kandane-Rathnayake, R. K. ; Andrianopoulos, N. ; Westbrook, A. ; Engelbrecht, S. ; Ozolins, I. ; Bailey, M. ; Murray, L. ; Cooper, D. J. ; Wood, E. M. ; McQuilten, Z. K. ; The Blood Observational Study investigators ; The ANZICS Clinical Trials Group. / Day or overnight transfusion in critically ill patients : does it matter?. In: Vox Sanguinis. 2018 ; Vol. 113, No. 3. pp. 275-282.
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abstract = "Background and objectives: The timing of blood administration in critically ill patients is first driven by patients' needs. This study aimed to define the epidemiology and significance of overnight transfusion in critically ill patients. Materials and methods: This is a post hoc analysis of a prospective multicentre observational study including 874 critically ill patients receiving red blood cells, platelets, fresh frozen plasma (FFP) or cryoprecipitate. Characteristics of patients receiving blood only during the day (8 am up until 8 pm) were compared to those receiving blood only overnight (8 pm up until 8 am). Characteristics of transfusion were compared, and factors independently associated with major bleeding were analysed. Results: The 287 patients transfused during the day only had similar severity and mortality to the 258 receiving blood products overnight only. Although bleeding-related admission diagnoses were similar, major bleeding was the indication for transfusion in 12{\%} of patients transfused in daytime only versus 30{\%} of patients transfused at night only (P < 0·001). Similar total amount of blood products were transfused at day and night (2856 versus 2927); however, patients were more likely to receive FFP and cryoprecipitate at night compared with daytime. Overnight transfusion was independently associated with increased odds of major bleeding (odds ratio, 3·16, 95{\%} confidence interval, 2·00–5·01). Conclusion: Transfusion occurs evenly across day and night in ICU; nonetheless, there are differences in type of blood products administered that reflect differences in indication. Critically ill patients were more likely to receive blood for major bleeding at night irrespective of admission diagnosis.",
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Aubron, C, Kandane-Rathnayake, RK, Andrianopoulos, N, Westbrook, A, Engelbrecht, S, Ozolins, I, Bailey, M, Murray, L, Cooper, DJ, Wood, EM, McQuilten, ZK, The Blood Observational Study investigators & The ANZICS Clinical Trials Group 2018, 'Day or overnight transfusion in critically ill patients: does it matter?', Vox Sanguinis, vol. 113, no. 3, pp. 275-282. https://doi.org/10.1111/vox.12635

Day or overnight transfusion in critically ill patients : does it matter? / Aubron, C.; Kandane-Rathnayake, R. K.; Andrianopoulos, N.; Westbrook, A.; Engelbrecht, S.; Ozolins, I.; Bailey, M.; Murray, L.; Cooper, D. J.; Wood, E. M.; McQuilten, Z. K.; The Blood Observational Study investigators; The ANZICS Clinical Trials Group.

In: Vox Sanguinis, Vol. 113, No. 3, 04.04.2018, p. 275-282.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Day or overnight transfusion in critically ill patients

T2 - Vox Sanguinis

AU - Aubron, C.

AU - Kandane-Rathnayake, R. K.

AU - Andrianopoulos, N.

AU - Westbrook, A.

AU - Engelbrecht, S.

AU - Ozolins, I.

AU - Bailey, M.

AU - Murray, L.

AU - Cooper, D. J.

AU - Wood, E. M.

AU - McQuilten, Z. K.

AU - The Blood Observational Study investigators

AU - Pettilä, V.

AU - Nichol, A.

AU - Phillips, L. E.

AU - Street, A.

AU - French, C.

AU - Orford, N.

AU - Santamaria, J.

AU - Bellomo, R.

AU - Vallance, S.

AU - McArthur, C.

AU - McGuiness, S.

AU - Newby, L.

AU - Simmonds, C.

AU - Parke, R.

AU - Buhr, H.

AU - Goldsmith, D.

AU - O'Sullivan, K.

AU - Mercer, I.

AU - Gazzard, R.

AU - Tauschke, C.

AU - Hill, D.

AU - Fletcher, J.

AU - Boschert, C.

AU - Koch, G.

AU - Ernest, D.

AU - Eliott, S.

AU - Hawker, F.

AU - Howe, B.

AU - Ellem, K.

AU - Duff, K.

AU - Mehrtens, J.

AU - Henderson, S.

AU - Milliss, D.

AU - O'Bree, B.

AU - Shepherd, K.

AU - Ihle, B.

AU - Ho, S.

AU - Graan, M.

AU - Bernsten, A.

AU - Ryan, E.

AU - Botha, J.

AU - Vuat, J.

AU - Kinmonth, A.

AU - Fraser, M.

AU - Richards, B.

AU - Tallott, M.

AU - Whitbread, R.

AU - Freebairn, R.

AU - Thomas, L.

AU - Parr, M.

AU - Micallef, S.

AU - Deshpande, K.

AU - Wood, J.

AU - Williams, T.

AU - Tai, J.

AU - Boase, A.

AU - Galt, P.

AU - King, B.

AU - Price, R.

AU - Tomlinson, J.

AU - Cole, L.

AU - Seppelt, I.

AU - Weisbrodt, L.

AU - Gresham, R.

AU - Nikas, M.

AU - Laing, J.

AU - Bell, J.

AU - McHugh, G.

AU - Hancock, D.

AU - Kirkham, S.

AU - Shehabi, Y.

AU - Campbell, M.

AU - Stockdale, V.

AU - Peake, S.

AU - Williams, P.

AU - Sharley, P.

AU - O'Connor, S.

AU - Stephens, D.

AU - Thomas, J.

AU - Sistla, R.

AU - McAllister, R.

AU - Marsden, K.

AU - MacIsaac, C.

AU - Barge, D.

AU - Caf, T.

AU - Finfer, S.

AU - Tan, L.

AU - Bird, S.

AU - Webb, S.

AU - Chamberlain, J.

AU - McEntaggart, G.

AU - Gould, A.

AU - Totaro, R.

AU - Rajbhandari, D.

AU - Baker, S.

AU - Roberts, B.

AU - Lavercombe, P.

AU - Walker, R.

AU - Myburgh, J.

AU - Dhiacou, V.

AU - Smith, R.

AU - Holmes, J.

AU - Nair, P.

AU - Burns, C.

AU - Browne, T.

AU - Goodson, J.

AU - van Haren, F.

AU - La Pine, M.

AU - Hart, G.

AU - Broadbent, J.

AU - Hicks, P.

AU - Mackle, D.

AU - Andrews, L.

AU - Raunow, H.

AU - Keen, L.

AU - Davey-Quinn, A.

AU - Hill, F.

AU - Xu, R.

AU - The ANZICS Clinical Trials Group

PY - 2018/4/4

Y1 - 2018/4/4

N2 - Background and objectives: The timing of blood administration in critically ill patients is first driven by patients' needs. This study aimed to define the epidemiology and significance of overnight transfusion in critically ill patients. Materials and methods: This is a post hoc analysis of a prospective multicentre observational study including 874 critically ill patients receiving red blood cells, platelets, fresh frozen plasma (FFP) or cryoprecipitate. Characteristics of patients receiving blood only during the day (8 am up until 8 pm) were compared to those receiving blood only overnight (8 pm up until 8 am). Characteristics of transfusion were compared, and factors independently associated with major bleeding were analysed. Results: The 287 patients transfused during the day only had similar severity and mortality to the 258 receiving blood products overnight only. Although bleeding-related admission diagnoses were similar, major bleeding was the indication for transfusion in 12% of patients transfused in daytime only versus 30% of patients transfused at night only (P < 0·001). Similar total amount of blood products were transfused at day and night (2856 versus 2927); however, patients were more likely to receive FFP and cryoprecipitate at night compared with daytime. Overnight transfusion was independently associated with increased odds of major bleeding (odds ratio, 3·16, 95% confidence interval, 2·00–5·01). Conclusion: Transfusion occurs evenly across day and night in ICU; nonetheless, there are differences in type of blood products administered that reflect differences in indication. Critically ill patients were more likely to receive blood for major bleeding at night irrespective of admission diagnosis.

AB - Background and objectives: The timing of blood administration in critically ill patients is first driven by patients' needs. This study aimed to define the epidemiology and significance of overnight transfusion in critically ill patients. Materials and methods: This is a post hoc analysis of a prospective multicentre observational study including 874 critically ill patients receiving red blood cells, platelets, fresh frozen plasma (FFP) or cryoprecipitate. Characteristics of patients receiving blood only during the day (8 am up until 8 pm) were compared to those receiving blood only overnight (8 pm up until 8 am). Characteristics of transfusion were compared, and factors independently associated with major bleeding were analysed. Results: The 287 patients transfused during the day only had similar severity and mortality to the 258 receiving blood products overnight only. Although bleeding-related admission diagnoses were similar, major bleeding was the indication for transfusion in 12% of patients transfused in daytime only versus 30% of patients transfused at night only (P < 0·001). Similar total amount of blood products were transfused at day and night (2856 versus 2927); however, patients were more likely to receive FFP and cryoprecipitate at night compared with daytime. Overnight transfusion was independently associated with increased odds of major bleeding (odds ratio, 3·16, 95% confidence interval, 2·00–5·01). Conclusion: Transfusion occurs evenly across day and night in ICU; nonetheless, there are differences in type of blood products administered that reflect differences in indication. Critically ill patients were more likely to receive blood for major bleeding at night irrespective of admission diagnosis.

KW - critically ill patient

KW - major bleeding

KW - outcome

KW - red blood cells

KW - timing of care

KW - transfusion

UR - http://www.scopus.com/inward/record.url?scp=85041364730&partnerID=8YFLogxK

U2 - 10.1111/vox.12635

DO - 10.1111/vox.12635

M3 - Article

VL - 113

SP - 275

EP - 282

JO - Vox Sanguinis

JF - Vox Sanguinis

SN - 0042-9007

IS - 3

ER -

Aubron C, Kandane-Rathnayake RK, Andrianopoulos N, Westbrook A, Engelbrecht S, Ozolins I et al. Day or overnight transfusion in critically ill patients: does it matter? Vox Sanguinis. 2018 Apr 4;113(3):275-282. https://doi.org/10.1111/vox.12635