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Management and prevention of anemia (acute bleeding excluded) in adult critical care patients

Département d'anesthésie-réanimation, Pôle ASUR, CHU Angers, UMR INSERM 1084, CNRS 6214, Université d'Angers, 49000, Angers, France. sigismond@lasocki.com. Service de Médecine Intensive et Réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris. Centre, Université de Paris, Paris, France. Service de Médecine Intensive et Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie Paris, Paris, France. Médecine Intensive Réanimation, CHRU de Brest, Université de Bretagne Occidentale, 29200, Brest, France. Ecoles Militaires de Santé de Lyon-Bron, 69500, Bron, France. Université de Paris, UMRS 1134, Inserm, 75015, Paris, France. Laboratory of Excellence GREx, 75015, Paris, France. Département d'Anesthésie Réanimation, Hôpital de la Cavale-Blanche, CHRU de Brest, 29200, Brest, France. UFR de Médecine de Brest, Université de Bretagne Occidentale, 29200, Brest, France. Critical Care Unit, Department of Anaesthesia, Critical Care Medicine and Perioperative Medicine, Rennes University Hospital, 2, Rue Henri-Le-Guilloux, 35033, Rennes, France. Department of Anaesthesiology and Perioperative Care, University of California San Francisco, San Francisco, CA, USA. Département d'Anesthésie-Réanimation, Hôpital Saint-Antoine, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Paris, France. AP-HP, Hôpitaux Universitaires Henri-Mondor, DMU Médecine, Service de Médecine Intensive Réanimation, 94010, Créteil, France. Intensive Care, CHU-Charleroi Marie-Curie, Experimental Medicine Laboratory, Université Libre de Bruxelles, (ULB 222) Unit, 140, Chaussée de Bruxelles, 6042, Charleroi, Belgium. Réanimation Médico-Chirurgicale, Hôpital Pasteur 2, CHU Nice, 30, Voie Romaine, Nice, France. AP-HM, Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, 13005, Marseille, France. Aix Marseille University, CNRS, Inst Neurosci Timone, UMR7289, Marseille, France. Service de Médecine Intensive et Réanimation Brabois, Université de Lorraine, CHRU de Nancy, Inserm U1116, Nancy, France. Department of Anaesthesia and Intensive Care, Montpellier University Saint-Eloi Hospital, and PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France.

Ann Intensive Care. 2020;10(1):97
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Abstract
OBJECTIVE Anemia is very common in critical care patients, on admission (affecting about two-thirds of patients), but also during and after their stay, due to repeated blood loss, the effects of inflammation on erythropoiesis, a decreased red blood cell life span, and haemodilution. Anemia is associated with severity of illness and length of stay. METHODS A committee composed of 16 experts from four scientific societies, SFAR, SRLF, SFTS and SFVTT, evaluated three fields: (1) anemia prevention, (2) transfusion strategies and (3) non-transfusion treatment of anemia. Population, Intervention, Comparison, and Outcome (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Analysis of the literature and formulation of recommendations were then conducted according to the GRADE(®) methodology. RESULTS The SFAR-SRLF guideline panel provided ten statements concerning the management of anemia in adult critical care patients. Acute haemorrhage and chronic anemia were excluded from the scope of these recommendations. After two rounds of discussion and various amendments, a strong consensus was reached for ten recommendations. Three of these recommendations had a high level of evidence (GRADE 1±) and four had a low level of evidence (GRADE 2±). No GRADE recommendation could be provided for two questions in the absence of strong consensus. CONCLUSIONS The experts reached a substantial consensus for several strong recommendations for optimal patient management. The experts recommended phlebotomy reduction strategies, restrictive red blood cell transfusion and a single-unit transfusion policy, the use of red blood cells regardless of storage time, treatment of anaemic patients with erythropoietin, especially after trauma, in the absence of contraindications and avoidance of iron therapy (except in the context of erythropoietin therapy).
Study details
Study Design : Systematic Review
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine