Ar patients was 13.three in 1997 (typical total surgical APACHE II 18.1) versus 15.0 in 1998 (typical total surgical APACHE II 17.six). The average admission and discharge haemoglobins of vascular individuals have been 12.three g/dl and ten.1 g/dl in 1997 versus 10.1 and 9.9 g/dl in 1998.Available on the web http://ccforum.com/supplements/6/SConclusion: Restrictive blood transfusion approach appears to become protected practice, even in sufferers with reasonably high APACHE II scores. There was a reduction of 106 units of RBCs in 1998 in comparison with 1997. This translates into a considerable monetary saving for the hospital (around ?7,000 p.a.) plus a better balanced use of vital blood goods, within a time of national shortage.Reference:1. Herbert P, Wells G, Martin C, Tweedale M, et al.: Variation in red cell transfusion practice in the intensive care unit: a multi-centre study. Crit Care 1999, 3:57-63.P171 Hypoalbuminemia within the acutely ill — dangers and rationale for therapy: a meta-analysisRJ Navickis*, J-L Vincent, M-J Dubois, MM Wilkes* *Hygeia Associates, 17988 Brewer Road, Grass Valley, CA 95949, USA; Department of Intensive Care, Universit?Libre de Bruxelles, H ital Erasme, Brussels, Belgium Hypoalbuminemia is linked with poor outcome; nevertheless, the causal role of low serum albumin concentration and appropriateness of albumin therapy are controversial. We carried out a metaanalysis focusing on two kinds of evidence: (1) cohort research with multivariate analysis capable of a lot more accurately assessing no matter if serum albumin is often a direct contributor to poor outcome instead of merely a marker for other pathological processes; and (two) controlled trials of albumin therapy for hypoalbuminemia reporting data on morbidity, which may afford a comparatively sensitive endpoint. The meta-analysis integrated 66 cohort research with 171,654 total patients evaluating hypoalbuminemia as an outcome predictor by multivariate evaluation and seven potential controlled trials with 449 total individuals on correcting hypoalbuminemia. The pooled results in the incorporated cohort studies revealed hypoalbuminemia to become a potent, dose-dependent, independent predictor of poor outcome. For every ten g/l decline in serum albumin concentration the odds of mortality elevated by 124 (OR, two.24; CI, 1.83?.74), morbidity by 78 (OR, 1.78; CI, 1.45?.18), prolongations in intensive care unit and hospital remain respectively by 22 PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/20726879 (OR, 1.22; CI, 1.06?.41) and 64 (OR, 1.64; CI, 1.26?.14), and enhanced resource utilization by 18 (OR, 1.18; CI, 1.03?.35). These Valrocemide biological activity effects have been independent of each nutritional status and inflammation. In controlled trials, albumin therapy reduced complications in hypoalbuminemic individuals (OR, 0.79; CI, 0.36?.72), despite the fact that the all round impact was not statistically significant. Nonetheless, there was a powerful and important (P = 0.019) inverse connection amongst morbidity and attained serum albumin level for the duration of therapy, which suggested that complication rate may be diminished by exogenous albumin enough to elevate serum albumin level above 30 g/l. The worth of albumin therapy for hypoalbuminemia has to be investigated additional in well-designed trials. At present, the proof suggesting a causal link among hypoalbuminemia and poor outcome plus a dose-dependent impact of exogenous albumin in decreasing complications gives a logical basis for albumin therapy, and there seems to become no compelling argument for withholding albumin therapy if deemed clinically proper.P172 HES.