Acute Care MedicineEvidence Based MedicineIntensive CareNeuroSMACCWhen to Transfuse in Acute Brain Injury: Oli Flower & Simon Finfer

When to Transfuse in Acute Brain Injury: Oli Flower & Simon Finfer

Simon Finfer argues that the transfusion threshold should be 70 g/L. Simon first raises the Choosing Wisely Guidelines for Critical Care.

These state that one should not transfuse red blood cells in haemodynamically stable patients with a haemoglobin concentration of greater than 70g/L.

He continues to discuss the application of this specifically to patients with an acute brain injury. In doing so he will talk about evidence generally and how one must approach the use of evidence in specific patient subgroups.

Simon continues by raising further research to justify his position.

Oli Flower on the other hand will take the position that the transfusion trigger should be 90g/L. He makes the point that this is the easy position to take. Essentially, he is just explaining why the critical care community does what it does!

As Oli explains, haemoglobin plays a pivotal role in providing oxygen to tissue. In the case of a brain injury, to prevent further injury, one must ensure continued supply of oxygen to said tissue.

Oli will lean on animal studies, human studies as well as trial data to support his position. The transfusion trigger is remarkable heterogeneous around the world and even within individual institutions and this drives critical care professionals mad.

So surely there must be a “right” number. Unfortunately, there is not, which is where understanding all the relevant aspects to the argument becomes important.

Join Oli and Simon as they debate on this important issue.

When to Transfuse in Acute Brain Injury: Oli Flower & Simon Finfer

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Simon Finfer

Simon Finfer is an intensive care clinician and researcher in Sydney, a Professorial Fellow at The George Institute for Global Health, Adjunct Professor at the University of New South Wales, Senior Staff Specialist at Royal North Shore Hospital and Director of Intensive Care at the Sydney Adventist Hospital. Simon was a founding member and is a past-Chair of the Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group, past chair of the Council of the International Sepsis Forum, and current Vice President of the Global Sepsis Alliance. Simon was appointed an Officer (AO) in the Order of Australia in the Queen’s Birthday Honours List June 2020 for “distinguished service to intensive care medicine, to medical research and education, and to global health institutes”.

Oliver Flower

Oliver Flower is a staff specialist in Intensive Care Medicine at Royal North Shore Hospital, Sydney. He, along with Roger Harris & Chris Nickson started SMACC and Coda; he came up with the name & logo, finding inspiration in a chewing gum packet, and is the driver behind the design, graphics, branding and marketing of SMACC and Coda. He is a believer in the power of the big crit care community and is a believer in Cadogan’s FOAMed ethos. He runs the educational and networking crit care website Intensive Care Network.