Paper reports overview: Restrictive transfusions, experienced radiologists and prone positioning

A continuing theme over recent months has been to reaffirm the potentially harmful effects of specific interventions. The Canadian Clinical Trials Group published the third paper from their investigations into the effects of a restrictive strategy of blood transfusion (see paper report) [1]. Their restrictive strategy sets the threshold for packed red cell transfusion at haemoglobin levels < 8 g/dl, as opposed to their liberal strategy that sets the transfusion threshold at < 10 g/dl. This latest study looks at the effects of the restrictive strategy on weaning from mechanical ventilation. Like the two previous studies from this group [2,3], the restrictive strategy is found to be at least as good as, if not significantly better than, the liberal transfusion strategy. On a similar theme, Putensen and colleagues (see paper report) [4] have published a trial that adds to the growing body of evidence that minimising sedation and maximising patient respiratory effort in patients with acute lung injury/adult respiratory distress syndrome (ARDS) is of significant benefit.