What is it about?
This study introduces a practical way to evaluate how effective red blood cell (RBC) transfusions are in critically ill ICU patients—particularly those not suffering from traumatic injuries. It also highlights that SpO₂/FiO₂ (S/F or SF) ratio changes (called ΔSF) better captured improvements in respiratory status than changes in hemoglobin or oxygen saturation (SpO₂) alone. This makes it potentially useful as a clinical tool for tailoring transfusion strategies—especially when considering that transfusions can sometimes lead to complications if not used appropriately.
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Why is it important?
The decision to transfuse is a cornerstone of critical care, but relying on hemoglobin (hgb) alone has its limits. The authors sought to identify if a more dynamic measure—the S/F ratio—could be a better indicator of who truly needs it. This new multi-center study in PLOS ONE put this question to the test using large-scale data from two major hospitals. The results from 17,000+ transfusion episodes are compelling. The authors found that the S/F ratio provides crucial clinical context that hgb alone cannot. Patients with low S/F ratios received the greatest physiological benefit from transfusion.
Perspectives
What's particularly promising is that the S/F ratio can be monitored continuously and non-invasively, giving clinicians a faster, more functional way to track patient response in real time. As a biomedical researcher and data-scientist, I believe it's time to look beyond a single lab value and embrace a more complete physiological picture! Writing this article was a great pleasure, as it involved collaboration with long-standing colleagues whose medical expertise greatly enriched the work. I am especially grateful to Dr. Rishikesan Kamaleswaran for his initial conceptualization and support for the project.
Tilendra Choudhary
Read the Original
This page is a summary of: SpO2/FiO2 ratio as a better metric for assessment of RBC transfusion effectiveness in non-traumatic critically ill patients with physiologic derangements, PLOS One, July 2025, PLOS,
DOI: 10.1371/journal.pone.0327537.
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