لقد أنهيت 💉Beta-lactam Antibiotic Resistance!
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General Critical Care
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لقد أنهيت Quiz: 🫁 Assessment of Hypoxemia & Respiratory Failure!
What is your target hemoglobin in patients with traumatic brain injury and anemia?
7 g/dL or more
8 g/dL or more
9 g/dL or more
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- Hussain Al-shabib
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https://www.nejm.org/doi/full/10.1056/NEJMoa2404360
Population:
- Adults with moderate or severe traumatic brain injury (TBI) and anemia
- Total of 742 patients, with 371 patients in each group
Intervention:
- Liberal transfusion strategy: Transfusions initiated at a hemoglobin level of ≤10 g/dL
Comparison:
- Restrictive transfusion strategy: Transfusions initiated at a hemoglobin level of ≤7 g/dL
Outcome:
- Primary Outcome: Unfavorable outcome at 6 months assessed by the Glasgow Outcome Scale–Extended (GOSE)
- Liberal strategy: 68.4% (249/364) unfavorable outcomes
- Restrictive strategy: 73.5% (263/358) unfavorable outcomes
- Adjusted absolute difference: 5.4 percentage points (95% CI, −2.9 to 13.7)
- **Secondary Outcomes:**
- Mortality: No significant difference
- Functional independence and quality of life: Higher scores on some scales in the liberal strategy group among survivors
- Depression: No significant difference
- Venous thromboembolic events: 8.4% in both groups
- Acute respiratory distress syndrome (ARDS): 3.3% in liberal group, 0.8% in restrictive group
Insights for Medical Intensivists
- Neurological Outcomes: The liberal transfusion strategy did not significantly reduce the risk of unfavorable neurological outcomes at 6 months compared to the restrictive strategy. Both strategies had high rates of unfavorable outcomes, but the difference was not statistically significant.
- Functional Outcomes: Among survivors, some improvement in functional independence and quality of life scores was observed with the liberal transfusion strategy, although this was not consistent across all measures.
- Safety Concerns: The occurrence of venous thromboembolic events was similar in both groups, but the liberal strategy was associated with a higher incidence of ARDS.
- Clinical Practice Implication: Given the lack of significant benefit in neurological outcomes and the increased risk of ARDS with the liberal strategy, a restrictive transfusion strategy might be preferable in critically ill TBI patients with anemia to avoid additional complications without compromising overall survival and functional outcomes.