Transfusion practices in intensive care units: a Hungarian nationwide survey

Abstract Physiological transfusion triggers may support red blood cell transfusion decisions in critically ill patients; however, their use in routine clinical practice remains poorly characterized. We conducted a nationwide questionnaire-based survey to assess transfusion practices in Hungarian Intensive Care Units (ICUs), in order to evaluate the use of physiological transfusion triggers and patient blood management (PBM) implementation. A total of 97 ICU physicians completed the survey. Physiological parameters were applied in transfusion decision-making by 93.8% of respondents, indicating that transfusion decisions were not based exclusively on haemoglobin concentration. Low central venous oxygen saturation (ScvO 2 ), elevated lactate concentration, hypotension, and tachycardia were the most frequently reported transfusion triggers. Considerable heterogeneity was observed in the physiological targets used to define transfusion success. While lactate normalization and ScvO 2 values around 70% were the most commonly reported endpoints, advanced oxygen-metabolism-derived markers such as the arteriovenous oxygen content difference and respiratory exchange ratio were infrequently used. Only 33% of respondents reported an available institutional PBM protocol, whereas dedicated PBM facilities and ICU-specific transfusion protocols were uncommon. These findings demonstrate widespread adoption of physiological transfusion concepts in Hungarian ICUs, while highlighting the need for further education, greater standardization of transfusion targets, and broader implementation of PBM principles.