We are upgrading the repository! A content freeze is in effect until December 6, 2024. New submissions or changes to existing items will not be allowed during this period. All content already published will remain publicly available for searching and downloading. Updates will be posted in the Website Upgrade 2024 FAQ in the sidebar Help menu. Reach out to escholarship@umassmed.edu with any questions.
Recommendations on RBC Transfusions in Critically Ill Children With Acute Respiratory Failure From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative
Authors
Demaret, PierreEmeriaud, Guillaume
Hassan, Nabil E.
Kneyber, Martin C. J.
Valentine, Stacey L.
Bateman, Scot T.
Tucci, Marisa
UMass Chan Affiliations
Division of Pediatric Critical Care, Department of PediatricsDocument Type
Journal ArticlePublication Date
2018-09-01Keywords
anemiachild
hemoglobin
pediatric critical care
respiratory failure
transfusion
Critical Care
Health Services Administration
Hemic and Lymphatic Diseases
Pediatrics
Therapeutics
Metadata
Show full item recordAbstract
OBJECTIVES: To present the recommendations and supporting literature for RBC transfusions in critically ill children with bleeding developed by the Pediatric Critical Care Transfusion and Anemia Expertise Initiative. DESIGN: Consensus conference series of international, multidisciplinary experts in RBC transfusion management of critically ill children. METHODS: The panel of 38 experts developed evidence-based and, when evidence was lacking, expert-based clinical recommendations as well as research priorities for RBC transfusions in critically ill children. The respiratory subgroup included six experts. Electronic searches were conducted using PubMed, EMBASE, and Cochrane Library databases from 1980 to May 2017. Agreement was obtained using the Research and Development/UCLA Appropriateness Method. Results were summarized using the Grading of Recommendations Assessment, Development, and Evaluation method. RESULTS: Transfusion and Anemia Expertise Initiative experts developed seven recommendations focused on children with acute respiratory failure. All recommendations reached agreement ( > 80%). Transfusion of RBCs in children with respiratory failure with an hemoglobin level less than 5 g/dL was strongly recommended. It was strongly recommended that RBCs not be systematically administered to children with respiratory failure who are hemodynamically stable and who have a hemoglobin level greater than or equal to 7 g/dL. Experts could not make a recommendation for children with hemodynamic instability, with severe hypoxemia and/or with an hemoglobin level between 5 and 7 g/dL. Specific RBC transfusion strategies using physiologic-based metrics and biomarkers could not be elaborated. CONCLUSIONS: The Transfusion and Anemia Expertise Initiative Consensus Conference developed specific recommendations regarding RBC transfusion management in critically ill children with respiratory failure, as well as recommendations to guide future research. Clinical recommendations emphasize relevant hemoglobin thresholds. Research recommendations emphasize the need to identify appropriate physiologic thresholds, suggest a better understanding of alternatives to RBC transfusion, and identify the need for better evidence on hemoglobin thresholds that might be used in specific subpopulations of critically ill children.Source
Pediatr Crit Care Med. 2018 Sep;19(9S Suppl 1):S114-S120. doi: 10.1097/PCC.0000000000001619. Link to article on publisher's site
DOI
10.1097/PCC.0000000000001619Permanent Link to this Item
http://hdl.handle.net/20.500.14038/43667PubMed ID
30161065Related Resources
ae974a485f413a2113503eed53cd6c53
10.1097/PCC.0000000000001619