***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Background : Several studies have indicated that a restrictive erythrocyte transfusion strategy is as safe as a liberal one in critically ill patients , but there is no clear evidence to support the superiority of any perioperative transfusion strategy in patients with cancer . Methods : In a r and omized , controlled , parallel-group , double-blind ( patients and outcome assessors ) superiority trial in the intensive care unit of a tertiary oncology hospital , the authors evaluated whether a restrictive strategy of erythrocyte transfusion ( transfusion when hemoglobin concentration < 7 g/dl ) was superior to a liberal one ( transfusion when hemoglobin concentration < 9 g/dl ) for reducing mortality and severe clinical complications among patients having major cancer surgery . All adult patients with cancer having major abdominal surgery who required postoperative intensive care were included and r and omly allocated to treatment with the liberal or the restrictive erythrocyte transfusion strategy . The primary outcome was a composite endpoint of mortality and morbidity . Results : A total of 198 patients were included as follows : 101 in the restrictive group and 97 in the liberal group . The primary composite endpoint occurred in 19.6 % ( 95 % CI , 12.9 to 28.6 % ) of patients in the liberal- strategy group and in 35.6 % ( 27.0 to 45.4 % ) of patients in the restrictive- strategy group ( P = 0.012 ) . Compared with the restrictive strategy , the liberal transfusion strategy was associated with an absolute risk reduction for the composite outcome of 16 % ( 3.8 to 28.2 % ) and a number needed to treat of 6.2 ( 3.5 to 26.5 ) . Conclusion : A liberal erythrocyte transfusion strategy with a hemoglobin trigger of 9 g/dl was associated with fewer major postoperative complications in patients having major cancer surgery compared with a restrictive strategy Objectives : To assess the transfusion practice in the intensive care unit ( ICU ) in a general hospital in Kuwait relative to indications , pretransfusion hemoglobin , red blood cell ( RBC ) use and outcome . Subjects and Methods : 475 patients were admitted to the ICU during the study period ( January 2009 to February 2010 ) . Ninety-nine received RBC transfusion .  Demographic , clinical and transfusion data were prospect ively collected for the 99 patients who were followed up for 30 days , until hospital discharge , or death , whichever occurred first . Indications for RBC transfusion included hemorrhage in 39 patients , improving oxygen-carrying capacity in 55 , and hemolysis in 5 . Results : Of the 99 transfused patients , 22 ( 22.22 % ) were also transfused after discharge from the ICU . Transfusions were more frequent in patients admitted with respiratory failure ( 30 , 30.3 % ) , hemorrhagic shock ( 24 , 24.2 % ) , and septic shock ( 18 , 18.4 % ) . The mean pretransfusion hemoglobin in ICU transfusions was statistically different ( 70.9 ± 12.7 g/l ) from transfusions after discharge ( 79.7 ± 9.4 g/l ) ( p < 0.001 ) . Longer ICU stay was associated with more RBC units transfused per transfusion episode per patient ( p < 0.001 ) . The Sequential Organ Failure Assessment ( SOFA ) score was significantly associated with the number of RBC units transfused per patient ( p = 0.006 ) . Mortality was significantly associated with Acute Physiology and Chronic Health Evaluation II and SOFA scores , the need and duration for mechanical ventilation , and the length of stay in hospital . Conclusion : Intensivists in our center followed a restrictive transfusion practice , by adopting a low pretransfusion hemoglobin threshold . Decisions on RBC transfusions seemed in most cases to be based on a ‘ transfusion trigger ’ rather than a physiologic need Background Although the optimum hemoglobin ( H ) concentration for patients with septic shock ( SS ) has not been specifically investigated , current guidelines suggest that H of 7 - 9 g/dL , compared with 10 - 12 g/dL , was not associated with increased mortality in critically ill adults . This contrasts with early goal -directed resuscitation protocol s that use a target hematocrit of 30 % in patients with low central venous oxygen saturation ( ScvO2 ) during the first 6 hours of resuscitation of SS . Methods Data elements were prospect ively collected on all patients with SS patients ( lactic acid ( LA ) > 4 mmol/L , or hypotension ) . Out of a total of 396 SS patients , 46 patients received red blood cell ( RBC ) transfusion for ScvO2 < 70 % ( RBC group ) . We then matched 71 SS patients  that did not receive RBC transfusion ( NRBC group ) on the following goals ( G ) : LA obtained within 6 hours ( G1 ) , antibiotics given within 3 hours ( G2 ) , 20 mL/kg fluid bolus followed by vasopressors ( VP ) if needed to keep mean arterial pressure > 65 mm Hg ( G3 ) , central venous pressure > 8 mm Hg within 6 hours ( G4 ) and ScvO2 > 70 % within 6 hours ( G5 ) . Results In the RBC group , after one unit of RBC transfusion , ScvO2 improved from average of 63 % ( ± 12 % ) to 68 % ( ± 10 % ) ( P = 0.02 ) . Sixteen patients required another unit of RBC , and this result ed in increase of ScvO2 to 78 % ( ± 11 % ) ( P < 0.01 ) . The RBC and NRBC groups were matched on sequential organ failure assessment ( SOFA ) scores and all five goals . There was no difference in mortality between the two groups : 41 % vs. 39.4 % ( OR : 0.8 , 95 % CI : 0.4 - 1.7 , P = 0.6 ) . Conclusions In our study , transfusion of RBC was not associated with decreased mortality in SS patients CONTEXT Anemia is a common problem in critically ill patients admitted to intensive care units ( ICUs ) , but the consequences of anemia on morbidity and mortality in the critically ill is poorly defined . OBJECTIVES To prospect ively define the incidence of anemia and use of red blood cell ( RBC ) transfusions in critically ill patients and to explore the potential benefits and risks associated with transfusion in the ICU . DESIGN Prospect i ve observational study conducted November 1999 , with 2 components : a blood sampling study and an anemia and blood transfusion study . SETTING AND PATIENTS The blood sampling  study included 1136 patients from 145 western European ICUs , and the anemia and blood transfusion study included 3534 patients from 146 western European ICUs . Patients were followed up for 28 days or until hospital discharge , interinstitutional transfer , or death . MAIN OUTCOME MEASURES Frequency of blood drawing and associated volume of blood drawn , collected over a 24-hour period ; hemoglobin levels , transfusion rate , organ dysfunction ( assessed using the Sequential Organ Failure Assessment score ) , and mortality , collected throughout a 2-week period . RESULTS The mean ( SD ) volume per blood draw was 10.3 ( 6.6 ) mL , with an average total volume of 41.1 ( 39.7 ) mL during the 24-hour period . There was a positive correlation between organ dysfunction and the number of blood draws ( r = 0.34 ; P<.001 ) and total volume drawn ( r = 0.28 ; P<.001 ) . The mean hemoglobin concentration at ICU admission was 11.3 ( 2.3 ) g/dL , with 29 % ( 963/3295 ) having a concentration of less than 10 g/dL. The transfusion rate during the ICU period was 37.0 % ( 1307/3534 ) . Older patients and those with a longer ICU length of stay were more commonly transfused . Both ICU and overall mortality rates were significantly higher in patients who had vs had not received a transfusion ( ICU rates : 18.5 % vs 10.1 % , respectively ; chi(2 ) = 50.1 ; P<.001 ; overall rates : 29.0 % vs 14.9 % , respectively ; chi(2 ) = 88.1 ; P<.001 ) . For similar degrees of organ dysfunction , patients who had a transfusion had a higher mortality rate . For matched patients in the propensity analysis , the 28-day mortality was 22.7 % among patients with transfusions and 17.1 % among those without ( P = .02 ) ; the Kaplan-Meier log-rank test confirmed this difference . CONCLUSIONS This multicenter observational study reveals the common occurrence of anemia and the large use of blood transfusion in critically ill patients . Additionally , this epidemiologic study provides evidence of an association between transfusions and diminished organ function as well as between transfusions and mortality BACKGROUND In a single-center study published more than a decade ago involving patients presenting to the emergency department with severe sepsis and septic shock , mortality was markedly lower among those who were treated according to a 6-hour protocol of early goal -directed therapy ( EGDT )  , in which intravenous fluids , vasopressors , inotropes , and blood transfusions were adjusted to reach central hemodynamic targets , than among those receiving usual care . We conducted a trial to determine whether these findings were generalizable and whether all aspects of the protocol were necessary . METHODS In 31 emergency departments in the United States , we r and omly assigned patients with septic shock to one of three groups for 6 hours of resuscitation : protocol -based EGDT ; protocol -based st and ard therapy that did not require the placement of a central venous catheter , administration of inotropes , or blood transfusions ; or usual care . The primary end point was 60-day in-hospital mortality . We tested sequentially whether protocol -based care ( EGDT and st and ard-therapy groups combined ) was superior to usual care and whether protocol -based EGDT was superior to protocol -based st and ard therapy . Secondary outcomes included longer-term mortality and the need for organ support . RESULTS We enrolled 1341 patients , of whom 439 were r and omly assigned to protocol -based EGDT , 446 to protocol -based st and ard therapy , and 456 to usual care .  Resuscitation strategies differed significantly with respect to the monitoring of central venous pressure and oxygen and the use of intravenous fluids , vasopressors , inotropes , and blood transfusions . By 60 days , there were 92 deaths in the protocol -based EGDT group ( 21.0 % ) , 81 in the protocol -based st and ard-therapy group ( 18.2 % ) , and 86 in the usual-care group ( 18.9 % ) ( relative risk with protocol -based therapy vs. usual care , 1.04 ; 95 % confidence interval [ CI ] , 0.82 to 1.31 ; P=0.83 ; relative risk with protocol -based EGDT vs. protocol -based st and ard therapy , 1.15 ; 95 % CI , 0.88 to 1.51 ; P=0.31 ) . There were no significant differences in 90-day mortality , 1-year mortality , or the need for organ support . CONCLUSIONS In a multicenter trial conducted in the tertiary care setting , protocol -based resuscitation of patients in whom septic shock was diagnosed in the emergency department did not improve outcomes . ( Funded by the National Institute of General Medical Sciences ; ProCESS Clinical Trials.gov number , NCT00510835 . ) Background Treating anaemia with red blood cell ( RBC ) transfusion is frequent , but controversial , in patients with septic shock . Therefore we assessed characteristics and outcome associated with RBC transfusion in this group of high risk patients . Methods We did a prospect i ve cohort study at 7 general intensive care units ( ICUs ) including all adult patients with septic shock in a 5-month period . Results Ninety-five of the 213 included patients ( 45 % ) received median 3 ( interquartile range 2–5 ) RBC units during shock . The median pre-transfusion haemoglobin level was 8.1 ( 7.4–8.9 ) g/dl and independent of shock day and bleeding . Patients with cardiovascular disease were transfused at higher haemoglobin levels . Transfused patients had higher Simplified Acute Physiology Score ( SAPS ) II ( 56 ( 45 - 69 ) vs. 48 ( 37 - 61 ) , p = 0.0005 ) , more bleeding episodes , lower haemoglobin levels days 1 to 5 , higher Sepsis-related Organ Failure Assessment ( SOFA ) scores ( days 1 and 5 ) , more days in shock ( 5 ( 3 - 10 ) vs. 2 ( 2 - 4 ) , p = 0.0001 ) , more days in ICU ( 10 ( 4 - 19 ) vs. 4 ( 2 - 8 ) , p = 0.0001 ) and higher 90-day mortality ( 66 vs. 43 % , p = 0.001 ) . The latter association was lost after adjustment for admission category and SAPS II and SOFA-score on day 1 . Conclusions The decision to transfuse patients with septic 
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The restrictive RBCT strategy was not associated with harm or benefit compared to liberal strategy .
As a result , the safety of a RBCT restrictive strategy was confirmed , although only one study specifically focused on ICU patients with sepsis .
Then , RBCT was not associated with increased mortality rate , but was associated with increased in occurrence of NI , ALI and AKI .