Transfusion trigger Hct 25%:: Above or below, which is better?: Pro:: Hct <25% is better

There is currently no justification for a policy of routine transfusion to maintain Hct > 25% in patients undergoing CPB. Appropriate management of PaCO2 with avoidance of inadvertent hypocapnia and a strategy of hyperoxia should result in optimal cerebral oxygenation. In select patients at risk, use of specific cerebral monitoring techniques (eg, cerebral oximetry) may identify subsets of patients who may benefit from an increase in Hct and in whom increased Hct would be appropriate as a component of individualized care and guided therapy. As a routine practice, therefore, there is no necessity to increase the transfusion threshold to 25% in the absence of a low-output state or other clinical modifiers. Transfusion practice must be individualized to the specifics of a particular patient rather than generalized based on an arbitrary threshold.