Anemia:TRICC (transfusion requirements in critical care)

Question 1

TRICC Clinical Q

Answer 1

Among critically ill patients, how does a restrictive transfusion strategy (hemoglobin goal of 7-9 g/dL) compare with a liberal transfusion strategy (hemoglobin goal of 10-12 g/dL) in decreasing mortality?

Question 2

TRICC Bottom line

Answer 2

In critically ill patients, restrictive transfusion (Hgb >7 g/dL) is associated with better survival compared to liberal strategy (Hgb >10).

Question 3

TRICC Primary outcome

Answer 3

30-day mortality

Question 4

TRICC Inclusion Criteria

Answer 4

• Expected ICU stay ≥24 hours
• Hemoglobin concentration of no more than 9.0 g/dL within 72 hours after the ICU admission
• Clinically euvolemic after fluid resuscitation

Question 5

Some Exceptions to transfuse @ 7

Answer 5

MI, severe hypoxemia, hemorrhage

Question 6

TRICC criticisms

Answer 6

• Reduced enrollment of patients with cardiac disease decreases the generalizability of the results
• May not apply to patients at high altitudes
• No subgroup analysis in those with brain injury
• Only 13% of those screened were randomized in the trial, potentially harming external validity