Implementation of a patient blood management programme in pediatric scoliosis surgery

Pérez-Ferrer, Antonio; Gredilla-Díaz, E.; Vicente-Sánchez, J. de; Pérez-Grueso, F. Sánchez; Gilsanz-Rodríguez, F.

doi:10.1016/j.redare.2015.08.001

Cited by 5 publications

(7 citation statements)

References 28 publications

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“…Implementing principles to optimize erythropoiesis, minimizing blood loss and managing anaemia leading to minimization of allogenic blood transfusion are essences of this program [ 18 , 19 ]. Giving attention to the point that incidence of adverse outcome in transfused pediatric patients is 1.3 times higher in children and 2.8 higher in neonates when compared with adults [ 20 ], implementing PBM programs in paediatric settings is a relevant and current topic [ 21 – 24 ]. Several strategies already implemented in adult PBM Programs can easily be implemented in paediatric care.…”

Section: Discussionmentioning

confidence: 99%

Changes in transfusion and fluid therapy practices in severely injured children: an analysis of 5118 children from the TraumaRegister DGU®

Piekarski

Kaufmann

Engelhardt

et al. 2020

Eur J Trauma Emerg Surg

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Purpose Trauma is the leading cause of death in children. In adults, blood transfusion and fluid resuscitation protocols changed resulting in a decrease of morbidity and mortality over the past 2 decades. Here, transfusion and fluid resuscitation practices were analysed in severe injured children in Germany. Methods Severely injured children (maximum Abbreviated Injury Scale (AIS) ≥ 3) admitted to a certified trauma-centre (TraumaZentrum DGU®) between 2002 and 2017 and registered at the TraumaRegister DGU® were included and assessed regarding blood transfusion rates and fluid therapy. Results 5,118 children (aged 1–15 years) with a mean ISS 22 were analysed. Blood transfusion rates administered until ICU admission decreased from 18% (2002–2005) to 7% (2014–2017). Children who are transfused are increasingly seriously injured. ISS has increased for transfused children aged 1–15 years (2002–2005: mean 27.7–34.4 in 2014–2017). ISS in non-transfused children has decreased in children aged 1–15 years (2002–2005: mean 19.6 to mean 17.6 in 2014–2017). Mean prehospital fluid administration decreased from 980 to 549 ml without affecting hemodynamic instability. Conclusion Blood transfusion rates and amount of fluid resuscitation decreased in severe injured children over a 16-year period in Germany. Restrictive blood transfusion and fluid management has become common practice in severe injured children. A prehospital restrictive fluid management strategy in severely injured children is not associated with a worsened hemodynamic state, abnormal coagulation or base excess but leads to higher hemoglobin levels.

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Section: Discussionmentioning

confidence: 99%

Changes in transfusion and fluid therapy practices in severely injured children: an analysis of 5118 children from the TraumaRegister DGU®

Piekarski

Kaufmann

Engelhardt

et al. 2020

Eur J Trauma Emerg Surg

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“…Although the PBM was primarily introduced in the area of adult care, its individual measures may also have had an impact on pediatrics. The treatment of iron deficiency anemia with iron preparations or the use of erythropoietin; reduction of the number and volume of blood samples; and adherence to physiological conditions of hemostasis (pH, calcium concentration and temperature) can be used, as well as the use of bedside coagulation diagnostics and targeted therapy in children [2,[13][14][15][16][17][18][19][20][21][22][23][24].…”

Section: Discussionmentioning

confidence: 99%

Changes in Transfusion Practice in Children and Adolescents over Time

Piekarski

Steinbicker

Zacharowski

et al. 2020

Transfus Med Hemother

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Introduction: In recent years, resource-saving handling of allogeneic blood products and a reduction of transfusion rates in adults has been observed. However, comparable published national data for transfusion practices in pediatric patients are currently not available. In this study, the transfusion rates for children and adolescents were analyzed based on data from the Federal Statistical Office of Germany during the past 2 decades. Methods: Data were queried via the database of the Federal Statistical Office (Destasis). The period covered was from 2005 to 2018, and those in the sample group were children and adolescents aged 0-17 years receiving inpatient care. Operation and procedure codes (OPS) for transfusions, procedures, or interventions with increased transfusion risk were queried and evaluated in detail. Results: In Germany, 0.9% of the children and adolescents treated in hospital received a transfusion in 2018. A reduction in transfusion rates from 1.02% (2005) to 0.9% (2018) was observed for the total collective of children and adolescents receiving inpatient care. Increases in transfusion rates were recorded for 1-to 4-(1.41-1.45%) and 5-to 10-year-olds (1.24-1.33%). Children under 1 year of age were most frequently transfused (in 2018, 40.2% of the children were cared for in hospital). Transfusion-associated procedures such as chemotherapy or machine ventilation and respiratory support for new-borns and infants are on the rise. Conclusion: Transfusion rates are declining in children and adolescents, but the reasons for increases in transfusion rates in other groups are unclear. Prospective studies to evaluate transfusion rates and triggers in children are urgently needed.

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“…The literature review did not find any specific papers that examined PBM programmes or their implementation in neonates or infants. Two review articles were identified that addressed key aspects of paediatric PBM programmes (Goel et al, ; Wittenmeier et al, ) and four articles were identified that discussed specific PBM approaches in the setting of surgery for paediatric scoliosis or craniosynostosis (Haas et al, ; Lejus et al, ; Perez‐Ferrer et al, ; Stehrer et al, ). The results of two recent systematic reviews examining paediatric and neonatal transfusion practice and PBM were examined to provide the background for this paper (NBA, ; New et al, ) with reference to any new literature published subsequent to these guidelines.…”

Section: What Does the Term Patient Blood Management Mean In The Contmentioning

confidence: 99%

Patient blood management, what does this actually mean for neonates and infants?

Crighton

New

Liley

et al. 2018

Transfusion Medicine

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Patient blood management (PBM) refers to an evidence-based package of care that aims to improve patient outcomes by optimal use of transfusion therapy, including managing anaemia, preventing blood loss and improving anaemia tolerance in surgical and other patients who may need transfusion. In adults, PBM programmes are well established, yet the definition and implementation of PBM in neonates and children lags behind. Neonates and infants are frequently transfused, yet they are often under-represented in transfusion trials. Adult PBM programmes may not be directly applicable to these populations. We review the literature in neonatal (and applicable paediatric) transfusion medicine and propose specific neonatal PBM definitions and elements.

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Implementation of a patient blood management programme in pediatric scoliosis surgery

Cited by 5 publications

References 28 publications

Changes in transfusion and fluid therapy practices in severely injured children: an analysis of 5118 children from the TraumaRegister DGU®

Changes in transfusion and fluid therapy practices in severely injured children: an analysis of 5118 children from the TraumaRegister DGU®

Changes in Transfusion Practice in Children and Adolescents over Time

Patient blood management, what does this actually mean for neonates and infants?

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