1.
Red blood cell transfusion threshold in postsurgical pediatric intensive care patients: a randomized clinical trial
Rouette J, Trottier H, Ducruet T, Beaunoyer M, Lacroix J, Tucci M, Canadian Critical Care Trials Group, PALISI Network
Annals of Surgery. 2010;251((3):):421-7.
Abstract
BACKGROUND The optimal transfusion threshold after surgery in children is unknown. We analyzed the general surgery subgroup of the TRIPICU (Transfusion Requirements in Pediatric Intensive Care Units) study to determine the impact of a restrictive versus a liberal transfusion strategy on new or progressive multiple organ dysfunction syndrome (MODS). METHODS The TRIPICU study, a prospective randomized controlled trial conducted in 17 centers, enrolled a total of 648 critically ill children with a hemoglobin equal to or below 9. 5 g/dL within 7 days of pediatric intensive care unit (PICU) admission to receive prestorage leukocyte-reduced red-cell transfusion if their hemoglobin dropped below either 7. 0 g/dL (restrictive) or 9. 5 g/dL (liberal). A subgroup of 124 postoperative patients (60 randomized to restrictive and 64 to the liberal group) were analyzed. This study was registered at http://www. controlled-trials. com and carries the following ID ISRCTN37246456. RESULTS Participants in the restrictive and liberal groups were similar at randomization in age (restrictive vs. liberal: 53. 5 +/- 51. 8 vs. 73. 7 +/- 61. 8 months), severity of illness (pediatric risk of mortality [PRISM] score: 3. 5 +/- 4. 0 vs. 4. 4 +/- 4. 0), MODS (35% vs. 29%), need for mechanical ventilation (77% vs. 74%), and hemoglobin level (7. 7 +/- 1. 1 vs. 7. 9 +/- 1. 0 g/dL). The mean hemoglobin level remained 2. 3 g/dL lower in the restrictive group after randomization. No significant differences were found for new or progressive MODS (8% vs. 9%; P = 0. 83) or for 28-day mortality (2% vs. 2%; P = 0. 96) in the restrictive versus liberal group. However, there was a statistically significant difference between groups for PICU length of stay (7. 7 +/- 6. 6 days for the restrictive group vs. 11. 6 +/- 10. 2 days for the liberal group; P = 0. 03). CONCLUSIONS In this subgroup analysis of pediatric general surgery patients, we found no conclusive evidence that a restrictive red-cell transfusion strategy, as compared with a liberal one, increased the rate of new or progressive MODS or mortality.
2.
Comparison of two red-cell transfusion strategies after pediatric cardiac surgery: a subgroup analysis
Willems A, Harrington K, Lacroix J, Biarent D, Joffe AR, Wensley D, Ducruet T, Hébert PC, Tucci M, TRIPICU investigators, et al
Critical Care Medicine. 2010;38((2):):649-56.
Abstract
OBJECTIVE To determine the impact of a restrictive vs. a liberal transfusion strategy on new or progressive multiple organ dysfunction syndrome in children post cardiac surgery. The optimal transfusion threshold after cardiac surgery in children is unknown. DESIGN Randomized, controlled trial. SETTING Tertiary pediatric intensive care units. PATIENTS Participants are a subgroup of pediatric patients post cardiac surgery from the TRIPICU (Transfusion Requirements in Pediatric Intensive Care Units) study. Exclusion criteria specific to the cardiac surgery subgroup included: age <28 days and patients remaining cyanotic. INTERVENTION Critically ill children with a hemoglobin < or = 95 g/L within 7 days of pediatric intensive care unit admission were randomized to receive prestorage leukocyte-reduced red-cell transfusion if their hemoglobin dropped either <70 g/L (restrictive) or 95 g/L (liberal). MEASUREMENTS AND MAIN RESULTS Postoperative cardiac patients (n = 125) from seven centers were enrolled. The restrictive (n = 63) and liberal (n = 62) groups were similar at baseline in age (mean +/- standard deviation = 31. 4 +/- 38. 1 mos vs. 26. 4 +/- 39. 1 mos), surgical procedure, severity of illness (Pediatric Risk of Mortality score = 3. 4 +/- 3. 2 vs. 3. 2 +/- 3. 2), multiple organ dysfunction syndrome (46% vs. 44%), mechanical ventilation (62% vs. 60%), and hemoglobin (83 vs. 80 g/L). Mean hemoglobin remained 21 g/L lower in the restrictive group after randomization. No significant difference was found in new or progressive multiple organ dysfunction syndrome (primary outcome) in the restrictive group vs. liberal group (12. 7% vs. 6. 5%; p = . 36), pediatric intensive care unit length of stay (7. 0 +/- 5. 0 days vs. 7. 4 +/- 6. 4 days) or 28-day mortality (3. 2% vs. 3. 2%). CONCLUSION In this subgroup analysis of cardiac surgery patients, a restrictive red-cell transfusion strategy, as compared with a liberal one, was not associated with any significant difference in new or progressive multiple organ dysfunction syndrome, but this evidence is not definitive.