Survey of Blood Transfusion Practices in Critically Ill Patients at High Altitude

Encuesta Sobre prácticas de transfusión de glóbulos Rojos en el Paciente crítico Atendido en Unidades de Altura

The purpose of this study is to describe current practice on red blood cell transfusion in critically ill patients of intensive care units located in high altitude areas

Study Overview

• Status: Unknown
• Conditions: Anemia; Critically Ill
• Intervention / Treatment: Procedure: Red blood cells transfusions

Detailed Description

Anemia has been identified as a common complication in the critically ill patient. Approximately 40 and 60% are transfused in normal clinical practice. However transfusions are not free of adverse events including: transfusion-associated lung injury, infectious complications, progression of organ failure, fluid overload associated with transfusion, among others. Therefore, several clinical trials have been designed to define red blood cell transfusion thresholds. Mainly two groups have been compared: 1) liberal schemes in which patients are transfused with higher levels of hemoglobin (generally ≤ 10 g / dL) and restrictive regimens with lower levels (≤ 7 g / dL). Institutions such as the British Committee for Standards in Hematology have developed recommendations in favor of restrictive strategies based mainly on the TRICC (Transfusion Requirements In Critical Care) study conducted by Hebert et al.

On the other hand, it is well known that as consequences of living in places at high altitude physiological modifications occur in the human. One of these adaptations is the increase in hemoglobin levels occurring in people living at high altitude, especially in Andean residents, in whom the hypoxia promotes an increase in the production of red blood cells.

The recommendation of the restrictive strategy in the transfusion of red blood cells has been adopted in several countries with numerous populations living at high altitudes, although this practice has not been evaluated in these patients.

The purpose of this study is to describe the current practice on transfusion of red blood cells in critical patients treated in intensive care units located in high altitude areas (over 1500 m) to determine whether physicians follow the recommendations of restrictive strategies.

This is an observational, non-randomized, cross-sectional survey performed with intensivists of Bolivia, Colombia, Ecuador, México and Perú. The data will be collected from an on-line scenaries based survey. The survey is designated to assessed the effect of severity, need of surgery, severe hypoxia, and alteration in tisular perfusion as modifiers of transfusion thresholds. Besides unit characteristics as geographical altitude and type of unit will be collected.

• Study Type: Observational
• Enrollment (Anticipated): 352

Contacts and Locations

• Study Contact: Name: Nadia Montero, physician; Phone Number: 593 995189435; Email: nadiamonteromd@gmail.com

Study Locations

• Ecuador
  • Pichincha
    • Quito, Pichincha, Ecuador
      • Nadia Montero
      • Contact: Solange Nuñez, physician; Phone Number: 593 958982015; Email: solnun@hotmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 30 years to 70 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

The records of the Latin American Intensive Medicine Research Network in high altitude (RELAMI), which has members from Bolivia, Colombia, Ecuador, Mexico and Peru, will be used as a contact source to identify active intensivists through the mailing list of members. Trying to identify intensive care units that work above 1500 meters above sea level.

Description

Inclusion Criteria:

Intensivists who work in intensive care units localized above 1500 meters above sea level

Exclusion Criteria:

• fellows, retired members and pediatrics intensivists

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cross sectional survey.	the red blood cell transfusion threshold is going to be assessed in specific sceneries raised in the survey	1 day

Collaborators and Investigators

• Sponsor: Universidad Tecnológica Equinoccial
• Collaborators: Red Latinoamericana de Medicina Intensiva de Altura
• Investigators: Principal Investigator: Nadia Montero, physician, Universidad Tecnológica Equinoccial

Study record dates

Study Major Dates

• Study Start: February 1, 2017
• Primary Completion (Anticipated): March 1, 2017
• Study Completion (Anticipated): April 1, 2017

Study Registration Dates

• First Submitted: January 6, 2017
• First Submitted That Met QC Criteria: January 12, 2017
• First Posted (Estimate): January 13, 2017

Study Record Updates

• Last Update Posted (Estimate): January 13, 2017
• Last Update Submitted That Met QC Criteria: January 12, 2017
• Last Verified: January 1, 2017

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Critical Illness
• Other Study ID Numbers: EPTGRA

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO