Transfusion Thresholds Should Be Conservative for Patients with Septic Shock

Patients with septic shock are treated with early antibiotics, rapid fluid resuscitation, vasopressor/inotrope support, and blood transfusions. The Surviving Sepsis guidelines' recommendation for a transfusion hemoglobin target of 7 to 9 g/dL reflects the lack of evidence on an optimal threshold value for such patients.

Scandinavian investigators randomized 998 adults with septic shock in 32 intensive care units (ICUs) to a transfusion hemoglobin threshold of 7 g/dL (conservative) or 9 g/dL (liberal). The cohort included patients with chronic cardiovascular disease (53%), chronic lung disease (21%), and hematologic malignancy (7%) but excluded those with acute coronary syndrome or life-threatening bleeding. About half the patients had underg…