Reducing Mortality in Severe Sepsis and Septic Shock

Andrew T. Levinson, M.D., M.P.H.; Brian P. Casserly, M.D.; Mitchell M. Levy, M.D.

Disclosures

Semin Respir Crit Care Med. 2011;32(2):195-205. 

In This Article

Transfusion of Blood Products

It remains unclear whether there is a mortality benefit by transfusing patients with septic shock to a target hematocrit during the initial resuscitation period with the goal of improving global tissue hypoxia. Although the Rivers study showed a reduction in mortality by the use of the entire EGDT protocol, the study was not designed to demonstrate whether transfusion of red cells alone to a targeted hemoglobin has a mortality benefit. At the level of the microcirculation, no change in the sublingual microcirculation has been demonstrated in patients with septic shock before and after transfusion.[59]

The current SSC guidelines recommend that, once tissue hypoperfusion has resolved and in the absence of serious comorbidities, red blood cells only be transfused when hemoglobin decreases to <7.0 g/dL.[14]

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