An audit of transfusion of red blood cell units in pediatric anesthesia

Keung, Charlotte; Smith, Katherine R.; Savoia, Helen; Davidson, Andrew

doi:10.1111/j.1460-9592.2009.02939.x

Cited by 49 publications

(43 citation statements)

References 7 publications

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“…The total volume of RBC units given in the operating room and ICU was lower in the restrictive than in the liberal group (186 ± 70 vs. 259 ± 90 ml/patient, p \ 0.001). Duration of mechanical ventilation, length of ICU stay and incidence of adverse events were similar in both groups, but length of hospital stay was shorter in the restrictive group [median: 8 (IQR: 7-11) vs. 9 (7)(8)(9)(10)(11)(12)(13)(14) in the liberal group, p = 0.047]. Costs of RBC and plasma were 229 vs. 328 euros per patient.…”

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confidence: 93%

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Do cardiac children need more red blood cell transfusions than other critically ill children?

Pont‐Thibodeau

Lacroix

2013

Intensive Care Med

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Anaemia is associated with a higher risk of mortality in cardiac adults [1,2] and children [3]. Only a red blood cell (RBC) transfusion can rapidly increase a low haemoglobin (Hb) concentration. However, there is no such thing as a perfectly safe RBC transfusion: both transfusion-transmitted infections and non-infectious serious hazards of transfusion (NISHOT) can occur [4]. RBC transfusions are associated with a higher mortality rate in cardiac adults [5] and with more morbidity in cardiac children [6][7][8][9]. An association between RBC transfusions and worse outcomes does not mean that there is a cause-effect relationship; it means only that such a cause-effect relationship is possible, and it questions the assertion that RBC transfusions are actually more useful than harmful in patients with cardiovascular disease.In clinical practice, cardiac patients receive more RBC transfusions than other critically ill children [9][10][11]. The question is what prompts physicians to prescribe an RBC transfusion. According to a self-administered survey, determinants in cardiac children include Hb level, patient's stability, active bleeding, inadequate O 2 delivery (low ScvO 2 , high lactate level, low SaO 2 /FiO 2 ratio) and low blood pressure [10]. However, the Hb level remains the most important determinant of RBC transfusion [10,11]. Therefore, it makes sense to ask ourselves the following questions: in cardiac children, how much anaemia can we tolerate and when do the benefits of RBC transfusions overcome their harms?RBC transfusions are given during the perioperative care of paediatric cardiac surgery in the operating room and in the intensive care unit (ICU). While cardiac surgery accounts for only 5 % of anaesthesia episodes, it represents 58 % of perioperative RBC use and 24 % of total hospital RBC use [12]. The lowest Hb level below which an RBC transfusion must be given during a cardiopulmonary bypass (CPB) is not well characterised. Jonas et al. [13] reported that infants randomised at CPB onset to an haematocrit of 20 % (Hb level: about 7 g/dl) had worse 1-year Bayley psychomotor development scores than those allocated to 30 % (10 g/dl); this suggests that the Hb level should be maintained over 7 during a CPB, but it does not tell us what is the best and safest threshold Hb level for transfusion over 7 g/dl.The uncertainty about the threshold Hb level with the best risk/benefits ratio also arises in the ICU after surgery. Most cardiac children (range: 46-79 %) receive at least one RBC transfusion during their ICU stay after a cardiac surgery [15,16]. However, recent data suggest that a restrictive transfusion strategy might be as safe, if not safer than a liberal transfusion strategy. A subgroup analysis that focussed on 125 cardiac children enrolled in the Transfusion Requirements in Pediatric ICU (TRIPI-CU) randomised clinical trial reported that a threshold Hb level of 7 was as safe as 9.5 g/dl in stable non-cyanotic cardiac infants [14].In this issue, de Gast-Bakker et al.[15] published a randomised clin...

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confidence: 93%

“…While cardiac surgery accounts for only 5 % of anaesthesia episodes, it represents 58 % of perioperative RBC use and 24 % of total hospital RBC use [12]. The lowest Hb level below which an RBC transfusion must be given during a cardiopulmonary bypass (CPB) is not well characterised.…”

mentioning

confidence: 99%

Do cardiac children need more red blood cell transfusions than other critically ill children?

Pont‐Thibodeau

Lacroix

2013

Intensive Care Med

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“…On one hand, RBC (red blood cells) transfusion is frequently needed during paediatric cardiac surgery [8] and intra-operative anaemia increases both morbidity and mortality [9]. On the other hand, excessive RBC transfusion must be avoided insofar as it is not free of complications (infectious agent transmission, transfusionrelated acute lung injury, transfusion errors) [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

A retrospective study about cerebral near-infrared spectroscopy monitoring during paediatric cardiac surgery and intra-operative patient blood management

Lejus

Windt

LeBoeuf-Pouliquen

et al. 2015

Anaesthesia Critical Care & Pain Medicine

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“…Red blood cell (RBC) transfusion is common in the care of pediatric cardiac surgery patients, with reported transfusion rates up to 79 and 55 % for surgery with and without bypass, respectively [1]. However, RBC transfusions are not without risk.…”

Section: Introductionmentioning

confidence: 99%

Red Blood Cell Transfusion in the Postoperative Care of Pediatric Cardiac Surgery: Survey on Stated Practice

et al. 2016

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The optimal red blood cell transfusion threshold for postoperative pediatric cardiac surgery patients is unknown. This study describes the stated red blood cell transfusion practice of physicians who treat postoperative pediatric cardiac surgery patients in intensive care units. A scenario-based survey was sent to physicians involved in postoperative intensive care of pediatric cardiac surgery patients in all Canadian centers that perform such surgery. Respondents reported their red blood cell transfusion practice in four postoperative scenarios: acyanotic or cyanotic cardiac lesion, in a neonate or an infant. In part A of each scenario, the patient was critically ill, but stabilized; in part B, the patient became unstable. Response rate was 58 % (71 of 123), with 45 respondents indicating direct involvement in postoperative intensive care. There was a wide variability in stated transfusion threshold, ranging from <7.0-14.0 g/dL for stabilized cases. There was no significant difference between neonates and infants in stated transfusion threshold. The mean hemoglobin level below which respondents would transfuse a stabilized patient was 9 g/dL for acyanotic and 11.2 g/dL for cyanotic patients, a statistically significant difference (2.2 ± 0.9 g/dL, p < 0.001). All clinical determinants of instability significantly increased transfusion threshold. Hemodynamic instability increased transfusion threshold by 2.3 ± 1.3 g/dL in acyanotic patients and by 1.3 ± 1.1 g/dL in cyanotic patients. Cyanotic lesion and clinical instability, but not patient age, increased stated red blood cell transfusion threshold. Significant variation in reported red blood cell transfusion practice exists among physicians treating pediatric patients in intensive care following cardiac surgery.

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An audit of transfusion of red blood cell units in pediatric anesthesia

Abstract: In a tertiary pediatric hospital surgery accounts for a substantial proportion of total RBC use, with particular procedures accounting for the majority of transfusions.

Cited by 49 publications

References 7 publications

Do cardiac children need more red blood cell transfusions than other critically ill children?

Do cardiac children need more red blood cell transfusions than other critically ill children?

A retrospective study about cerebral near-infrared spectroscopy monitoring during paediatric cardiac surgery and intra-operative patient blood management

Red Blood Cell Transfusion in the Postoperative Care of Pediatric Cardiac Surgery: Survey on Stated Practice

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