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One of the most controversial issues in critical care medicine is the proper threshold for blood transfusion. This multicenter Canadian trial enrolled 838 patients without active bleeding and with hemoglobin levels of 9.0 g/dl or lower during their first 3 days in intensive care units. Patients were randomized to a "restrictive" strategy (i.e., transfuse when hemoglobin drops below 7.0 g/dl, maintaining a range of 7.0 to 9.0 g/dl) or a "liberal" strategy (i.e., transfuse when hemoglobin drops below 10.0 g/dl, maintaining a range of 10.0 to 12.0 g/dl).
The 30-day mortality rate was 18.7 percent with restrictive transfusion and 23.3 percent with liberal transfusion, a nonsignificant difference. However, in-hospital mortality was significantly …