There is a positive correlation between organ dysfunction and the number of blood draws [2,3,5]. The presence of indwelling central venous or arterial catheters makes selleck Axitinib blood sampling easier but contributes to iatrogenic anaemia as the first few millilitres of infusate-blood mixture obtained while collecting blood from such catheters are discarded [6-8]. In two large trials, 37 to 44% of patients in ICU received PRBC transfusions [1,5] often at high transfusion thresholds, despite evidence to support a restrictive transfusion practice to keep haemoglobin (Hb) levels in the range of 7 to 9 g/dL [9].

Importantly, PRBC transfusions are associated with adverse effects, including allergic, anaphylactic and haemolytic transfusion reactions, transfusion-related acute lung injury (TRALI), transfusion-associated circulatory overload (TACO), acute respiratory distress syndrome (ARDS), infections, and ventilator-associated pneumonia, all of which lead to significant morbidity and mortality [10-14].Reduction of the discarded blood volume is possible using a three-way connection [15] or a dedicated blood conservation system [16]. While data exist to show that such devices may reduce the degree of blood loss [17,18] resulting in higher Hb levels [19], no previous study has demonstrated any significant effect of these devices on the amount of blood transfusion. This apparent paradox may be related to the inadequate sample sizes or study design issues including the lack of standardised thresholds for transfusions [20].

The primary objective of the present study is therefore to investigate if the use of a blood conservation device in the presence of a standardised restrictive transfusion practice can reduce the number of units of PRBC transfused. The secondary objective is to investigate if the use of the device is associated with a smaller decrease in Hb levels from ICU admission to discharge.Materials and methodsStudy designThis was a before-and-after study conducted in the 12-bed medical ICU of our university hospital. The before-study period included patients from January to June 2008 (control group). The blood conservation device was introduced to the active group at the start of the after period from July 2008 to March 2009 (active group).PatientsWe included all patients admitted to the ICU who were 1) 18 years and above, 2) expected to stay more than 24 hours and 3) had an indwelling intra-arterial catheter inserted.

We excluded patients who 1) were expected to stay less than 24 hours and 2) had active gastrointestinal or other bleeding as the primary cause of ICU admission. Patients were followed up till hospital discharge, death or up to 28 days of ICU stay, whichever was later.DeviceWe used the Venous Arterial blood Management Protection (VAMP) system (Edwards Carfilzomib Lifesciences, Irvine, CA, USA) for the active group. This device has been described previously [16]. Briefly, it is attached to the existing arterial catheter.