Physiological determinants and the red blood cells transfusion decision-making process in non-bleeding critically ill patients: a comprehensive narrative review

There is a need for additional determinants in the RBC transfusion decision process to offset the limitations of RBC transfusion based only on Hb level in non-bleeding critically ill patients. A multimodal strategy, including comorbidities, underlying diseases, clinical signs, ECG changes, biochemical markers, and microcirculatory assessment, may optimise transfusion timing and avoid unnecessary red blood cell administration. However, further research is warranted to determine the potential benefit of integrating tissue oxygenation and microcirculatory parameters in the transfusion decision-making process.