Restrictive transfusion strategy is more effective in massive burns: Results of the TRIBE multicenter prospective randomized trial

Tina L Palmieri, James H. Holmes, Brett Arnoldo, Michael Peck, Amalia Cochran, Booker T. King, William Dominic, Robert Cartotto, Dhaval Bhavsar, Edward Tredget, Francois Stapelberg, David Mozingo, Bruce Friedman, Soman Sen, Sandra L. Taylor, Bradley H Pollock

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objectives: Studies suggest that a restrictive transfusion strategy is safe in burns, yet the efficacy of a restrictive transfusion policy in massive burn injury is uncertain. Our objective: Compare outcomes between massive burn (.60% total body surface area (TBSA) burn) and major (20.59% TBSA) burn using a restrictive or a liberal blood transfusion strategy. Methods: Patients with burns .20% were block randomized by age and TBSA to a restrictive (transfuse hemoglobin 7 g/dL) or liberal (transfuse hemoglobin 10 g/dL) strategy throughout hospitalization. Data collected included demographics, infections, transfusions, and outcomes. Results: Three hundred and forty-five patients received 7,054 units blood, 2,886 in massive and 4,168 in restrictive. Patients were similar in age, TBSA, and inhalation injury. The restrictive group received less blood (45.57 } 47.63 vs. 77.16 ± 55.0, p 0.03 massive; 11.0 ± 16.70 vs. 16.78 ± 17.39, p 0.001) major). In massive burn, the restrictive group had fewer ventilator days (p > 0.05). Median ICU days and LOS were lower in the restrictive group; wound healing, mortality, and infection did not differ. No significant outcome differences occurred in the major (20.59%) group (p > 0.05). Conclusions:: A restrictive transfusion strategy may be beneficial in massive burns in reducing ventilator days, ICU days and blood utilization, but does not decrease infection, mortality, hospital LOS or wound healing.

Original languageEnglish (US)
Pages (from-to)11-15
Number of pages5
JournalMilitary Medicine
Volume184
DOIs
StatePublished - Mar 1 2019

Fingerprint

Body Surface Area
Burns
Mechanical Ventilators
Wound Healing
Hemoglobins
Wounds and Injuries
Wound Infection
Cross Infection
Hospital Mortality
Blood Transfusion
Inhalation
Hospitalization
Demography
Mortality
Infection

Keywords

  • blood transfusion
  • burn treatment
  • infection
  • outcomes

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Restrictive transfusion strategy is more effective in massive burns : Results of the TRIBE multicenter prospective randomized trial. / Palmieri, Tina L; Holmes, James H.; Arnoldo, Brett; Peck, Michael; Cochran, Amalia; King, Booker T.; Dominic, William; Cartotto, Robert; Bhavsar, Dhaval; Tredget, Edward; Stapelberg, Francois; Mozingo, David; Friedman, Bruce; Sen, Soman; Taylor, Sandra L.; Pollock, Bradley H.

In: Military Medicine, Vol. 184, 01.03.2019, p. 11-15.

Research output: Contribution to journalArticle

Palmieri, TL, Holmes, JH, Arnoldo, B, Peck, M, Cochran, A, King, BT, Dominic, W, Cartotto, R, Bhavsar, D, Tredget, E, Stapelberg, F, Mozingo, D, Friedman, B, Sen, S, Taylor, SL & Pollock, BH 2019, 'Restrictive transfusion strategy is more effective in massive burns: Results of the TRIBE multicenter prospective randomized trial', Military Medicine, vol. 184, pp. 11-15. https://doi.org/10.1093/milmed/usy279
Palmieri, Tina L ; Holmes, James H. ; Arnoldo, Brett ; Peck, Michael ; Cochran, Amalia ; King, Booker T. ; Dominic, William ; Cartotto, Robert ; Bhavsar, Dhaval ; Tredget, Edward ; Stapelberg, Francois ; Mozingo, David ; Friedman, Bruce ; Sen, Soman ; Taylor, Sandra L. ; Pollock, Bradley H. / Restrictive transfusion strategy is more effective in massive burns : Results of the TRIBE multicenter prospective randomized trial. In: Military Medicine. 2019 ; Vol. 184. pp. 11-15.
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abstract = "Objectives: Studies suggest that a restrictive transfusion strategy is safe in burns, yet the efficacy of a restrictive transfusion policy in massive burn injury is uncertain. Our objective: Compare outcomes between massive burn (.60{\%} total body surface area (TBSA) burn) and major (20.59{\%} TBSA) burn using a restrictive or a liberal blood transfusion strategy. Methods: Patients with burns .20{\%} were block randomized by age and TBSA to a restrictive (transfuse hemoglobin 7 g/dL) or liberal (transfuse hemoglobin 10 g/dL) strategy throughout hospitalization. Data collected included demographics, infections, transfusions, and outcomes. Results: Three hundred and forty-five patients received 7,054 units blood, 2,886 in massive and 4,168 in restrictive. Patients were similar in age, TBSA, and inhalation injury. The restrictive group received less blood (45.57 } 47.63 vs. 77.16 ± 55.0, p 0.03 massive; 11.0 ± 16.70 vs. 16.78 ± 17.39, p 0.001) major). In massive burn, the restrictive group had fewer ventilator days (p > 0.05). Median ICU days and LOS were lower in the restrictive group; wound healing, mortality, and infection did not differ. No significant outcome differences occurred in the major (20.59{\%}) group (p > 0.05). Conclusions:: A restrictive transfusion strategy may be beneficial in massive burns in reducing ventilator days, ICU days and blood utilization, but does not decrease infection, mortality, hospital LOS or wound healing.",
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T2 - Results of the TRIBE multicenter prospective randomized trial

AU - Palmieri, Tina L

AU - Holmes, James H.

AU - Arnoldo, Brett

AU - Peck, Michael

AU - Cochran, Amalia

AU - King, Booker T.

AU - Dominic, William

AU - Cartotto, Robert

AU - Bhavsar, Dhaval

AU - Tredget, Edward

AU - Stapelberg, Francois

AU - Mozingo, David

AU - Friedman, Bruce

AU - Sen, Soman

AU - Taylor, Sandra L.

AU - Pollock, Bradley H

PY - 2019/3/1

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N2 - Objectives: Studies suggest that a restrictive transfusion strategy is safe in burns, yet the efficacy of a restrictive transfusion policy in massive burn injury is uncertain. Our objective: Compare outcomes between massive burn (.60% total body surface area (TBSA) burn) and major (20.59% TBSA) burn using a restrictive or a liberal blood transfusion strategy. Methods: Patients with burns .20% were block randomized by age and TBSA to a restrictive (transfuse hemoglobin 7 g/dL) or liberal (transfuse hemoglobin 10 g/dL) strategy throughout hospitalization. Data collected included demographics, infections, transfusions, and outcomes. Results: Three hundred and forty-five patients received 7,054 units blood, 2,886 in massive and 4,168 in restrictive. Patients were similar in age, TBSA, and inhalation injury. The restrictive group received less blood (45.57 } 47.63 vs. 77.16 ± 55.0, p 0.03 massive; 11.0 ± 16.70 vs. 16.78 ± 17.39, p 0.001) major). In massive burn, the restrictive group had fewer ventilator days (p > 0.05). Median ICU days and LOS were lower in the restrictive group; wound healing, mortality, and infection did not differ. No significant outcome differences occurred in the major (20.59%) group (p > 0.05). Conclusions:: A restrictive transfusion strategy may be beneficial in massive burns in reducing ventilator days, ICU days and blood utilization, but does not decrease infection, mortality, hospital LOS or wound healing.

AB - Objectives: Studies suggest that a restrictive transfusion strategy is safe in burns, yet the efficacy of a restrictive transfusion policy in massive burn injury is uncertain. Our objective: Compare outcomes between massive burn (.60% total body surface area (TBSA) burn) and major (20.59% TBSA) burn using a restrictive or a liberal blood transfusion strategy. Methods: Patients with burns .20% were block randomized by age and TBSA to a restrictive (transfuse hemoglobin 7 g/dL) or liberal (transfuse hemoglobin 10 g/dL) strategy throughout hospitalization. Data collected included demographics, infections, transfusions, and outcomes. Results: Three hundred and forty-five patients received 7,054 units blood, 2,886 in massive and 4,168 in restrictive. Patients were similar in age, TBSA, and inhalation injury. The restrictive group received less blood (45.57 } 47.63 vs. 77.16 ± 55.0, p 0.03 massive; 11.0 ± 16.70 vs. 16.78 ± 17.39, p 0.001) major). In massive burn, the restrictive group had fewer ventilator days (p > 0.05). Median ICU days and LOS were lower in the restrictive group; wound healing, mortality, and infection did not differ. No significant outcome differences occurred in the major (20.59%) group (p > 0.05). Conclusions:: A restrictive transfusion strategy may be beneficial in massive burns in reducing ventilator days, ICU days and blood utilization, but does not decrease infection, mortality, hospital LOS or wound healing.

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KW - burn treatment

KW - infection

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