{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T13:43:59Z","timestamp":1792158239676,"version":"4.4.0"},"reference-count":26,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transfusion"],"published-print":{"date-parts":[[2026,10]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n The reasons and physiological triggers for blood transfusion in critically ill patients are not well characterized. Beyond hemoglobin levels, hemodynamic instability is frequently cited, but its role across clinical contexts remains unclear.<\/jats:p>\n <\/jats:sec>\n \n Aims<\/jats:title>\n (1) To determine whether reasons and triggers for RBC transfusion differ across intensive care unit (ICU) days with varying transfusion intensity. (2) To describe reasons for non\u2010RBC transfusions across these intensity groups.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This sub\u2010study of the prospective\n International Point Prevalence Study of Intensive Care Unit Transfusion Practices<\/jats:italic>\n (InPUT) classified ICU days by transfusion intensity: nonmajor (1 RBC unit), major (\u22652\u2009units), and massive (\u22656\u2009units in a single event, \u226510 per day, or Massive Transfusion Protocol activation). ICU days without transfusion for active bleeding were classified as no bleeding.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Significant differences in the multivariate composition of reasons for RBC transfusion were observed across intensity groups on permutational analysis of variance (PERMANOVA). Hypotension was the most frequently cited physiological trigger in nonmajor (54%,\n n<\/jats:italic>\n \u2009=\u200980\/148) and major transfusions (68%,\n n<\/jats:italic>\n \u2009=\u2009196\/288), but less frequent in massive transfusions (30%,\n n<\/jats:italic>\n \u2009=\u200914\/64). Tachycardia was the second most common trigger in nonmajor (37%,\n n<\/jats:italic>\n \u2009=\u200980\/148), major (40%,\n n<\/jats:italic>\n \u2009=\u2009116\/288), and massive transfusions (22%,\n n<\/jats:italic>\n \u2009=\u200919\/64).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n RBC transfusions are administered for distinct, intensity\u2010dependent combinations of reasons and triggers. Transfusion intensity and clinical context are therefore key factors in evaluating transfusion practices. Among bleeding critically ill patients, hypotension and tachycardia are the most frequently cited physiological triggers.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/trf.70350","type":"journal-article","created":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T13:19:26Z","timestamp":1785590366000},"page":"1963-1973","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Transfusion intensity in the\n ICU<\/scp>\n : Reasons and triggers"],"prefix":"10.1111","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-3738-0397","authenticated-orcid":false,"given":"Merijn C.","family":"Reuland","sequence":"first","affiliation":[{"name":"Department of Intensive Care Amsterdam University Medical Center Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Senta J.","family":"Raasveld","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Amsterdam University Medical Center Amsterdam The Netherlands"},{"name":"Department of Anesthesiology Amsterdam University Medical Center Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jimmy","family":"Schenk","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Amsterdam University Medical Center Amsterdam The Netherlands"},{"name":"Department of Anesthesiology Amsterdam University Medical Center Amsterdam The Netherlands"},{"name":"Department of Epidemiology and Data Science Amsterdam University Medical Center, location AMC Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia van den","family":"Oord","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Amsterdam University Medical Center Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanne de","family":"Bruin","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Amsterdam University Medical Center Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline M.","family":"Schaap","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Amsterdam University Medical Center Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew W. J.","family":"Flint","sequence":"additional","affiliation":[{"name":"School of Public Health and Preventive Medicine Monash University Melbourne Australia"},{"name":"Australian and New Zealand Intensive Care Research Centre (ANZIC\u2010RC) Monash University Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Bakker","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Adults Erasmus MC University Medical Center Rotterdam The Netherlands"},{"name":"Department of Intensive Care Pontificia Universidad Cat'olica de Chile Santiago Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio","family":"Cecconi","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care IRCCS Humanitas Research Hospital Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0014-8879","authenticated-orcid":false,"given":"Aarne","family":"Feldheiser","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy EvangKliniken Essen\u2010Mitte Essen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"Meier","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Kepler University Clinic Linz Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas W. L.","family":"Scheeren","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology University Medical Center Groningen Groningen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarikul","family":"Hamid","sequence":"additional","affiliation":[{"name":"Department of Critical Care Asgar Ali Hospital Dhaka Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Micha\u00ebl","family":"Piagnerelli","sequence":"additional","affiliation":[{"name":"Department of Intensive Care CHU Charleroi Marie Curie Charleroi Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2470-6238","authenticated-orcid":false,"given":"Tina Tomi\u0107","family":"Mahe\u010di\u0107","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care University Clinical Hospital Center Zagreb Zagreb Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Benes","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine University Hospital Plzen Plzen Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7352-8728","authenticated-orcid":false,"given":"Lene","family":"Russell","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark"},{"name":"Department of Anesthesia and Intensive Care Medicine Copenhagen University Copenhagen Denmark"},{"name":"Department of Clinical Medicine University of Copenhagen Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hernan","family":"Aguirre\u2010Bermeo","sequence":"additional","affiliation":[{"name":"Unidad de Cuidados Intensivos Hospital Vicente Corral Moscoso Cuenca Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantina","family":"Triantafyllopoulou","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery European Interbalkan Medical Center Thessaloniki Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasiliki","family":"Chantziara","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Sotiria Chest Hospital National and Kapodistrian University of Athens Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8489-0324","authenticated-orcid":false,"given":"Mohan","family":"Gurjar","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheila Nainan","family":"Myatra","sequence":"additional","affiliation":[{"name":"Department of 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Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9322-5959","authenticated-orcid":false,"given":"Juan V.","family":"Llau","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Post\u2010surgical Critical Care University Hospital Doctor Peset Valencia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Quintana\u2010Diaz","sequence":"additional","affiliation":[{"name":"Intensive Care Service Hospital Universitario La Paz Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0444-8553","authenticated-orcid":false,"given":"Maria","family":"Cronhjort","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Education, S\u00f6dersjukhuset Karolinska Institutet Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen A.","family":"Pfortmueller","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Inselspital, Bern University Hospital Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nihan","family":"Yapici","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation University of Health Sciences, Dr. Siyami Ersek Cardiovascular Surgery Center Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan D.","family":"Nielsen","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care and Sleep Medicine University of New Mexico Albuquerque New Mexico USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akshay","family":"Shah","sequence":"additional","affiliation":[{"name":"Nuffield Department of Clinical Neurosciences University of Oxford Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harm\u2010Jan 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