Blood Transfusions for Burn Patients

Burn is a common injury with nearly 500,000 people receiving medical interventions for burn-relate problems in the United States annually. Significant percentage of burn patients will need blood transfusion, especially those patients with 20% or more total body surface area burn injury. While the Transfusion Requirements in Critical Cate Care (TRICC) trial showed restrictive strategy was at least as safe as the liberal strategy with decreased hospital mortality in restrictive group in stable ICU patients, Transfusion Requirement in Burn Care Evaluation (TRIBE) trial is one of the first major prospective randomized controlled clinical trials with a focus on burn patients and their blood transfusion needs. TRIBE study found that maintaining hemoglobin level at 7–8 g/dL (restrictive approach, median 8 units in this group) versus 10–11 g/dL (liberal approach, median 16 units) did not show any inferiority in restrictive group. The median blood transfusion in restrictive group was 8 units, i.e. half of the 16 units in the liberal group throughout the hospitalization. The incidence of blood stream infections, organ dysfunction, mechanical ventilation days, time to wound healing and 30-day mortality was the same in both restrictive and liberal approach.