The Red-cell Transfusion Strategy Dilemma in Critically Ill Patients in ICU: Is Restrictive or Liberal the Answer?

Background: The primary therapeutic approach for promptly increasing haemoglobin concentration is red blood cell transfusion. However, the risk associated with RBC transfusion and the overall accessibility exhibit significant variation. Objective: This meta-analysis evaluates the comparison and outcome of restrictive and liberal transfusion strategies in intensive care unit. Methods: A comprehensive search was carried out on various databases, including CENTRAL, PubMed, MEDLINE, and ScienceDirect for randomized control clinical trials evaluating the comparison of clinical outcomes of restrictive and liberal transfusion strategies in critically ill patients. The primary outcomes measure was mortality, which included ICU mortality and hospital mortality. In addition, data were pooled using random-effect models and heterogeneity was evaluated through I² statistics. Results: Out of 15 eligible RCTs obtained, involving 12,439 patients. The result demonstrated no significant difference of restrictive red-cell transfusion strategy over liberal red-cell transfusion strategy in reducing mortality outcomes with a pooled effect size (relative risk [RR] 0.92; 95% confidence interval [CI] 0.78 – 1.08; I2 = 0%, indicating minimal to no difference. Similarly, analyses of secondary outcomes identified no significant differences in several clinical results. Conclusion: This present meta-analysis provides evidence that restrictive red-cell transfusion strategy doesn’t significantly difference in overall mortality and several secondary clinical results of critically ill patients in ICU compared to liberal red-cell transfusion strategy. Otherwise, restrictive transfusion strategy lowered RBC transfusion requirements, and was expected to be more cost-effective.