These authors tried to evaluate the possible benefit of red blood cell (RBC) transfusion on cellular metabolism assessed by the improvement of ScVO2 (>70%) and by the change in Sequential Organ Failure Assessment (SOFA) score in patients with severe sepsis and septic shock receiving early goal-directed therapy (EGDT). Thirty-four patients transfused were compared to 59 patients treated by EGDT without RBC transfusion. Regrettably, no data about the baseline hematocrit were found in the manuscript. Baseline ScVO2 was high and similar between groups (mean 66%). The small number of patients studied and the large number of RBC transfusions received (an average of 4.6 units per patient within 24 hours!) limit the interpretation and can favor on the contrary the side effects of RBC transfusions. Studies on patients with lower ScVO2 and/or low hematocrit may be more interesting to prove the effect of a limited number of RBC transfusions on organ dysfunction.

– Michael Piagnerelli