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The TRISS trial addressed a common ICU dilemma: how low should the haemoglobin threshold be before red-cell transfusion in septic shock? Nearly 1,000 patients with septic shock and haemoglobin concentrations of 9 g/dL or less were randomised to transfusion at a lower threshold of 7 g/dL or a higher threshold of 9 g/dL. Mortality at 90 days was similar between the groups, as were rates of ischaemic events, serious adverse reactions and use of life support. The key difference was exposure to transfusion: patients assigned to the lower threshold received markedly fewer units of blood. The findings support a restrictive transfusion strategy for most patients with septic shock who are not actively bleeding and do not have another compelling indication for a higher haemoglobin target. The trial is particularly useful because transfusion is not a benign intervention; avoiding unnecessary exposure may reduce complications, workload and resource use without sacrificing survival. Clinicians still need to individualise treatment in settings such as active haemorrhage, acute coronary ischaemia or severe hypoxaemia, where a rigid threshold may not apply. TRISS therefore reinforces the broader critical-care principle of using physiologic context rather than a single laboratory value to drive treatment intensity.
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The TRISS trial addressed a common ICU dilemma: how low should the haemoglobin threshold be before red-cell transfusion in septic shock? Nearly 1,000 patients with septic shock and haemoglobin concentrations of 9 g/dL or less were randomised to transfusion at a lower threshold of 7 g/dL or a higher threshold of 9 g/dL. Mortality at 90 days was similar between the groups, as were rates of ischaemic events, serious adverse reactions and use of life support. The key difference was exposure to transfusion: patients assigned to the lower threshold received markedly fewer units of blood. The findings support a restrictive transfusion strategy for most patients with septic shock who are not actively bleeding and do not have another compelling indication for a higher haemoglobin target. The trial is particularly useful because transfusion is not a benign intervention; avoiding unnecessary exposure may reduce complications, workload and resource use without sacrificing survival. Clinicians still need to individualise treatment in settings such as active haemorrhage, acute coronary ischaemia or severe hypoxaemia, where a rigid threshold may not apply. TRISS therefore reinforces the broader critical-care principle of using physiologic context rather than a single laboratory value to drive treatment intensity.
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