Comprehensive Analysis of Liberal and Restrictive Transfusion Strategies in Pediatric Intensive Care Unit

Akyıldız, Başak Nur; Tekerek, Nazan Ülgen; Pamukçu, Özge; Dursun, Adem; Karakükçü, Musa; Narın, Nazmi; Yay, Mehmet; Elmalı, Ferhan

doi:10.1093/tropej/fmx037

Cited by 18 publications

(19 citation statements)

References 26 publications

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“…In addition, data reported by other authors did not reveal any significant positive effect of transfusion on tissue oxygenation in cases of sepsis, trauma, or acute lung injury. [36][37][38][39] Akyildiz et al 40 found that restrictive strategy is better than liberal transfusion as regards oxygen saturation, perfusion index, serum lactate, and other laboratory and hemodynamic parameters in PICU setting.…”

Section: Discussionmentioning

confidence: 99%

Sepsis‐related anemia in a pediatric intensive care unit: transfusion‐associated outcomes

et al. 2020

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BACKGROUND Pediatric patients with sepsis in intensive care units are at high risk of developing anemia, which might have adverse effects on their prognosis. This study aimed to evaluate the impact of red blood cell (RBC) transfusion on the outcomes of patients admitted to a pediatric intensive care unit (PICU) with sepsis. METHODS We conducted a prospective randomized clinical trial, enrolling 67 children, aged 2 to 144 months who were admitted to a PICU with a new episode of sepsis from November 2017 to April 2018. Patients were allocated randomly to two groups: Group 1, liberal transfusion strategy group, including 33 patients who had initial hemoglobin (Hb) between 7 or greater and less than 10 g/dL and received an RBC top‐up transfusion to 12 g/dL; and Group 2, restrictive strategy group, including 34 patients who had the same Hb range and did not receive RBCs. Patients with Hb less than 7 or greater than 10 g/dL were excluded. RESULTS Of 33 patients who received liberal transfusions, 31 (93.94%) required ventilation, and 29 (87.88%) had multiorgan dysfunction. They had a significantly lengthier hospital stay and a higher incidence of acute respiratory distress syndrome and acute lung injury. Moreover, mortality was significantly higher in the liberal transfusion group (42.4% vs. 17.6%). CONCLUSIONS Compared to the restrictive transfusion strategy, liberal transfusion might be associated with a worse outcome. However, the possible role of other known and unknown confounding factors and minor protocol violations should be taken into consideration. We recommend minimizing factors worsening anemia in PICU patients to reduce the need for transfusion.

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Section: Discussionmentioning

confidence: 99%

Sepsis‐related anemia in a pediatric intensive care unit: transfusion‐associated outcomes

et al. 2020

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“…The thresholds of red blood cell transfusion should be carefully considered in pediatric intensive care in terms of the diversity of disease backgrounds, the handling of patients with a wide range of ages and body weights, and avoiding unnecessary transfusion. We conducted a systematic review of the transfusion threshold among critically ill children with stable hemodynamics, and 2 RCTs were included in the analysis [ 826 , 882 ].…”

Section: Methods Used For Creating This Guidelinementioning

confidence: 99%

“…In both RCTs, the threshold of the hemoglobin concentration for initiating blood transfusion was lower in the intervention group (7 g/dL in both trials) and higher in the control group (Lacroix et al, 2007: 9.5 g/dL [ 882 ] and Akyildiz et al, 2018: 10 g/dL [ 826 ]). With regard to all-cause mortality (2 RCTs, n = 797), the estimated effects of the intervention yielded a RD of 6 fewer per 1000 (95%CI: 28 fewer to 38 more).…”

Section: Methods Used For Creating This Guidelinementioning

confidence: 99%

“…With regard to blood transfusion complications (1 RCT, n = 637), the estimated effects of the intervention yielded a risk difference of 28 more per 1000 (95%CI: 62 fewer to 153 more) [ 882 ]. Furthermore, with regard to the length of stay in the ICU (2 RCTs, n = 797) and the duration of mechanical ventilation (2 RCTs, n = 797), the estimated effects of the intervention yielded a MD of 0.62 days shorter (95%CI: 1.76 shorter to 0.51 longer) and a MD of 0.00 days (95%CI: 0.84 shorter to 0.84 longer), respectively [ 826 , 882 ]. Therefore, it was adjudged that neither the intervention nor the comparative control was superior to the other.…”

Section: Methods Used For Creating This Guidelinementioning

confidence: 99%

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The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020)

et al. 2021

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The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020), a Japanese-specific set of clinical practice guidelines for sepsis and septic shock created as revised from J-SSCG 2016 jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in September 2020 and published in February 2021. An English-language version of these guidelines was created based on the contents of the original Japanese-language version. The purpose of this guideline is to assist medical staff in making appropriate decisions to improve the prognosis of patients undergoing treatment for sepsis and septic shock. We aimed to provide high-quality guidelines that are easy to use and understand for specialists, general clinicians, and multidisciplinary medical professionals. J-SSCG 2016 took up new subjects that were not present in SSCG 2016 (e.g., ICU-acquired weakness [ICU-AW], post-intensive care syndrome [PICS], and body temperature management). The J-SSCG 2020 covered a total of 22 areas with four additional new areas (patient- and family-centered care, sepsis treatment system, neuro-intensive treatment, and stress ulcers). A total of 118 important clinical issues (clinical questions, CQs) were extracted regardless of the presence or absence of evidence. These CQs also include those that have been given particular focus within Japan. This is a large-scale guideline covering multiple fields; thus, in addition to the 25 committee members, we had the participation and support of a total of 226 members who are professionals (physicians, nurses, physiotherapists, clinical engineers, and pharmacists) and medical workers with a history of sepsis or critical illness. The GRADE method was adopted for making recommendations, and the modified Delphi method was used to determine recommendations by voting from all committee members.As a result, 79 GRADE-based recommendations, 5 Good Practice Statements (GPS), 18 expert consensuses, 27 answers to background questions (BQs), and summaries of definitions and diagnosis of sepsis were created as responses to 118 CQs. We also incorporated visual information for each CQ according to the time course of treatment, and we will also distribute this as an app. The J-SSCG 2020 is expected to be widely used as a useful bedside guideline in the field of sepsis treatment both in Japan and overseas involving multiple disciplines.

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“…[7] Other adverse effects, including transfusion-associated lung injury, infections and transfusion reactions have been described among ICU patients who received RBC transfusions. [1,8,12,13] Against this background, and considering the high cost of transfusions and the limited and erratic supply of blood products in Africa, [14] we undertook a retrospective chart review to describe the outcomes and costs associated with different transfusion strategies used to treat critically ill anaemic children in a PICU.…”

Section: Articlementioning

confidence: 99%

Red blood cell concentrate transfusion strategies utilised at a tertiary-level paediatric intensive care unit: A descriptive study on impact and cost

Radebe

Jeena

2018

S Afr J CH

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Comprehensive Analysis of Liberal and Restrictive Transfusion Strategies in Pediatric Intensive Care Unit

Abstract: Restrictive blood transfusion strategy is better than liberal transfusion strategy with regard to the hemodynamic and laboratory values during the early period. PI also provides valuable information regarding the efficacy of PRBC transfusion in clinical practice.

Cited by 18 publications

References 26 publications

Sepsis‐related anemia in a pediatric intensive care unit: transfusion‐associated outcomes

Sepsis‐related anemia in a pediatric intensive care unit: transfusion‐associated outcomes

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020)

Red blood cell concentrate transfusion strategies utilised at a tertiary-level paediatric intensive care unit: A descriptive study on impact and cost

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