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Red blood cell transfusion in critically ill children (CME)

Authors

  • Pierre Demaret,

    1. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Sainte-Justine Hospital and Université de Montréal, Montreal, Canada
    2. Research Center, Sainte-Justine Hospital and Université de Montréal, Montreal, Canada
    3. Department of Social & Preventive Medicine, Research Center, Sainte-Justine Hospital and Université de Montréal, Montreal, Canada
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  • Marisa Tucci,

    1. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Sainte-Justine Hospital and Université de Montréal, Montreal, Canada
    2. Research Center, Sainte-Justine Hospital and Université de Montréal, Montreal, Canada
    3. Department of Social & Preventive Medicine, Research Center, Sainte-Justine Hospital and Université de Montréal, Montreal, Canada
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  • Thierry Ducruet,

    1. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Sainte-Justine Hospital and Université de Montréal, Montreal, Canada
    2. Research Center, Sainte-Justine Hospital and Université de Montréal, Montreal, Canada
    3. Department of Social & Preventive Medicine, Research Center, Sainte-Justine Hospital and Université de Montréal, Montreal, Canada
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  • Helen Trottier,

    1. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Sainte-Justine Hospital and Université de Montréal, Montreal, Canada
    2. Research Center, Sainte-Justine Hospital and Université de Montréal, Montreal, Canada
    3. Department of Social & Preventive Medicine, Research Center, Sainte-Justine Hospital and Université de Montréal, Montreal, Canada
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  • Jacques Lacroix

    Corresponding author
    1. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Sainte-Justine Hospital and Université de Montréal, Montreal, Canada
    2. Research Center, Sainte-Justine Hospital and Université de Montréal, Montreal, Canada
    3. Department of Social & Preventive Medicine, Research Center, Sainte-Justine Hospital and Université de Montréal, Montreal, Canada
    • Address reprint requests to: Jacques Lacroix, MD, CHU Sainte-Justine, Room 3431, 3175, Chemin de la Côte-Sainte-Catherine, Montréal QC, H3T 1C5, Canada; e-mail: jacques_lacroix@ssss.gouv.qc.ca.

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  • Supported by Fonds de la Recherche en Santé du Québec (Grant 24460).

Abstract

Background

Red blood cell (RBC) transfusions are common in the pediatric intensive care unit (PICU). However, there are no recent data on transfusion practices in the PICU. Our objective was to determine transfusion practice in the PICU, to compare this practice with that observed 10 years earlier, and to estimate the compliance to the recommendation of a large randomized clinical trial, the Transfusion Requirements in Pediatric Intensive Care Unit (TRIPICU) study.

Study Design and Methods

This was a single-center prospective observational study over a 1-year period. Information was abstracted from medical charts. Determinants of transfusion were searched for daily until the first transfusion in transfused cases or until PICU discharge in nontransfused cases. The justifications for transfusions were assessed using a questionnaire.

Results

Of 913 consecutive admissions, 842 were included. At least one RBC transfusion was given in 144 patients (17.1%). The mean hemoglobin (Hb) level before the first transfusion was 77.3 ± 27.2 g/L. The determinants of a first transfusion event retained in the multivariate analysis were young age (<12 months), congenital cardiopathy, lowest Hb level of not more than 70 g/L, severity of illness, and some organ dysfunctions. The three most frequently quoted justifications for RBC transfusion were a low Hb level, intent to improve oxygen delivery, and hemodynamic instability. The main recommendation of the TRIPICU study was applied in 96.4% of the first transfusion events.

Conclusions

RBC transfusions are frequent in the PICU. Young age, congenital heart disease, low Hb level, severity of illness, and some organ dysfunctions are significant determinants of RBC transfusions in the PICU. Most first transfusion events were prescribed according to recent recommendations.

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