Clearly defining pediatric massive transfusion

Neff, Lucas P.; Cannon, Jeremy W.; Morrison, Jonathan J.; Edwards, Mary J.; Spinella, Philip C.; Borgman, Matthew A.

doi:10.1097/ta.0000000000000488

Cited by 125 publications

(72 citation statements)

References 24 publications

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“…Children who received a large‐volume blood transfusion were likely treated in the context of acute surgical blood loss to treat severe anemia. Massive blood transfusion in pediatric victims of combat trauma, defined as RBC transfusion volumes ≥40 mL/kg, has been identified as an independent predictor of multiple organ failure, systemic inflammatory response syndrome, increased infection, and increased mortality . Studies in pediatric liver transplant recipients show a similar trend .…”

Section: Discussionmentioning

confidence: 92%

Relationship between transfusion volume and outcomes in children undergoing noncardiac surgery

2016

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RBC transfusion is associated with an increased incidence of 30-day mortality and postoperative infections in children undergoing noncardiac surgery, and there is a correlation between the volume of red blood cells transfused and the incidences of adverse outcomes. Potential associations related to the reason to transfuse, the cause of the bleeding, or the actual blood products themselves need to be studied in further prospective trials.

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Section: Discussionmentioning

confidence: 92%

Relationship between transfusion volume and outcomes in children undergoing noncardiac surgery

2016

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“…To avoid medication-related side effects, intensive care protocol for patients who were administered mannitol and/ or 3% NaCl included the following: if serum osmolality was >320 mosm/L, discontinue mannitol; if serum osmolality was 320-350 mosml/L, decrease the infusion rate of 3% NaCl; or if serum osmolality was >350 mosm/L, discontinue NaCl infusion. We also examined patient records for diabetes insipidus, anti-convulsive therapy (decision of initiating antiseizure drug regimen was made by the pediatric neurologists based on the severity of parenchymal damage and neurological status of the patient without routine EEG monitoring) and if present, hemodynamic instability as well as transfused blood products and massive transfusion rates (administered upon the advice of Neff et al; [9] 40 ml/kg of all blood products transfused per 24 h). Rate of neurosurgical operations during PICU admission, axonal injury observed in cranial magnetic resonance (MR) imaging, assessment of GCS of the patients based on the records at the time of admission to emergency care, injury severity score (ISS), Rotterdam computerized tomography scores (Ro-CT), [10] and PRISM-III scores after admission to PICU were performed.…”

Section: Methodsmentioning

confidence: 99%

Prediction of Mortality in Pediatric Traumatic Brain Injury: Implementations from a Tertiary Pediatric Intensive Care Facility

Ongun

Dursun²

2017

Ulus Travma Acil Cerrahi Derg

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Mortality rate was 12.5%; six patients progressed to brain death with organ donor approvals in five. Initial hypotension, lung contusion, injury severity scores and Rotterdam-CT scores were related with mortality. Rotterdam-CT score was determined as the independent risk factor for mortality; one increment in the score increased the odd of recovery by 20.334 times (%95 CI 1.999-206.879). ISS score was also borderline significant (p=0.052; OR:1.195 %95 CI 0.999-1.430).

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“…Massive transfusion (MT) in children has been defined as greater than 40 ml/kg of all blood products given at any time in the first 24 h [ 1 ]. Diab, Wong, and Luban suggested defining pediatric MT as transfusion of >50% total blood volume (TBV) in 3 h, transfusion >100% TBV in 24 h, or transfusion support to replace ongoing blood loss of >10% TBV per min [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

Massive Transfusion of 5 U Packed Redblood Cells, 3 U Fresh Frozen Plasma, and 160 cc of Platelets in a 14-Month-Old Patient

Sparkle

Cameron

2016

Am J Case Rep

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Patient: Female, 1Final Diagnosis: Parietooccipital brain tumorSymptoms: Drowsiness • failure to thrive • irritability • seizure-like activityMedication: —Clinical Procedure: Massive transfusion during tumor resectionSpecialty: AnesthesiologyObjective:Management of emergency careBackground:We present a case in which extremely rapid massive transfusion was successfully used to combat severe acute bleeding during a parietooccipital tumor resection in a 14-month-old patient.Case Report:An 8-kg patient was found to have a 4×5×5-cm parietooccipital tumor on computed tomography scan, for which resection was urgently planned. Sudden acute bleeding was encountered, which was communicated to the anesthesia team. Transfusion was initiated and a total of 5 units of packed red blood cells, 3 units of fresh frozen plasma, 160 ml of platelets, 200 ml of albumin, and 500 ml of 0.9% normal saline were transfused during a 4-h period. We administered 4 g of mannitol and 0.8 mg of furosemide to deal with anticipated fluid overload. The patient was sent to the intensive care unit and extubated the next day. No clinically significant hemostatic or fluid overload complications were noted after the treatment.Conclusions:Massive transfusion (MT) was found to be safe and effective in this case. Most of what we know about pediatric MT is an extrapolation of data from adult studies. Although practical, it might not be ideal due to the differences in the physiology and incomplete development of hemostatic mechanisms in children, especially those younger than 12 months. Studies evaluating the use of pediatric MT protocols have not shown a significant advantage over transfusion per clinician discretion.

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Clearly defining pediatric massive transfusion

Abstract: Diagnostic study, level II. Prognostic/epidemiologic study, level III.

Cited by 125 publications

References 24 publications

Relationship between transfusion volume and outcomes in children undergoing noncardiac surgery

Relationship between transfusion volume and outcomes in children undergoing noncardiac surgery

Prediction of Mortality in Pediatric Traumatic Brain Injury: Implementations from a Tertiary Pediatric Intensive Care Facility

Massive Transfusion of 5 U Packed Redblood Cells, 3 U Fresh Frozen Plasma, and 160 cc of Platelets in a 14-Month-Old Patient

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