Low hemoglobin level with low oncotic pressure in critically ill patients : Is it a safe strategy?

Adequate intravascular content is mandatory for tissue perfusion.1 Recent multicenter, randomized trials have ddressed the effect of varying levels of vascular content by modifying red blood cells (RBC) and albumin in patients with severe clinical conditions.2-4 Namely, al-bumin in ALBIOS 2 (severe sepsis/septic shock patientsmaintained at 10 /dL hemoglobin; the albumin group had 30 g/L mean serum al-bumin level, the control-crystalloid group had 23 g/L, ame mortality at 28 and 90 days)and SAFE 3 (mix of ICU patients,blood products at the discretion of the clinicians, the albumin group had 30 g/L mean serum albumin level, the control-crystalloid group had 23 g/L, same outcome at 28 days) studies and hemoglobin in TRISS 4 study (septic shock patients, 7 vs. 9 g/dL hemoglobin thresholds for transfusion, same outcome at 28 and 90 days