Restrictive versus liberal transfusion strategies for older mechanically ventilated critically ill patients: a randomized pilot trial

RELIEVE Investigators, Timothy S Walsh, Julia A Boyd, Douglas Watson, David Hope, Steff Lewis, Ashma Krishan, John F Forbes, Pamela Ramsey, Rupert Pearse, Charles Wallis, Christopher Cairns, Stephen Cole, Duncan Wyncoll

Research output: Contribution to journalArticlepeer-review


Objectives: To compare hemoglobin concentration (Hb), RBC use, and patient outcomes when restrictive or liberal blood transfusion strategies are used to treat anemic (Hb≤90 g/L) critically ill patients of age≥55 years requiring≥4 days of mechanical ventilation in ICU.

Design: Parallel-group randomized multicenter pilot trial.

Setting: Six ICUs in the United Kingdom participated between August 2009 and December 2010.

Patients: One hundred patients (51 restrictive and 49 liberal groups).

Interventions: Patients were randomized to a restrictive (Hb trigger, 70 g/L; target, 71-90 g/L) or liberal (90 g/L; target, 91-110 g/L) transfusion strategy for 14 days or the remainder of ICU stay, whichever was longest.

Measurements and main results: Baseline comorbidity rates and illness severity were high, notably for ischemic heart disease (32%). The Hb difference among groups was 13.8 g/L (95% CI, 11.5-16.0 g/L); p<0.0001); mean Hb during intervention was 81.9 (SD, 5.1) versus 95.7 (6.3) g/L; 21.6% fewer patients in the restrictive group were transfused postrandomization (p<0.001) and received a median 1 (95% CI, 1-2; p=0.002) fewer RBC units. Protocol compliance was high. No major differences in organ dysfunction, duration of ventilation, infections, or cardiovascular complications were observed during intensive care and hospital follow-up. Mortality at 180 days postrandomization trended toward higher rates in the liberal group (55%) than in the restrictive group (37%); relative risk was 0.68 (95% CI, 0.44-1.05; p=0.073). This trend remained in a survival model adjusted for age, gender, ischemic heart disease, Acute Physiology and Chronic Health Evaluation II score, and total non-neurologic Sequential Organ Failure Assessment score at baseline (hazard ratio, 0.54 [95% CI, 0.28-1.03]; p=0.061).

Conclusions: A large trial of transfusion strategies in older mechanically ventilated patients is feasible. This pilot trial found a nonsignificant trend toward lower mortality with restrictive transfusion practice.

Original languageEnglish
Pages (from-to)2354-2363
Number of pages10
JournalCritical Care Medicine
Issue number10
Publication statusPublished - Oct 2013


  • clinical trial
  • intensive care
  • anemia
  • blood transfusion
  • critical illness


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