Intraoperative transfusion practice in burned children in a university hospital over four years: a retrospective analysis

Abstract

Background Patient blood management programs should be applied to the pediatric population, but little is known about the current transfusion practice of pediatric burn injury patients. This retrospective study was performed to evaluate the practice of red blood cell (RBC) transfusion in children with burn injury, their predictive factors, and adherence to the German transfusion guideline. Methods We reviewed the RBC transfusion practice of all children younger than 8 years with burn injury who were operated during a four-year period in a German university medical center. We analyzed the data associated with transfusion and guideline conformity of transfusion triggers for RBCs from the beginning to the end of hospital stay using logistic regression. Results During the four-year period, 138 children (median age 21 months, minimum-maximum 9–101 months) with burn injury needed surgery, 31 children were transfused with RBCs. During their hospital stay, the median hemoglobin concentrations (Hb) of transfused and non-transfused children were 8 g/dL (6.3–11.3 g/dL) and 10.7 (7–13.8 g/dL), respectively. Total body surface area burned (TBSA) (OR = 1.17 per % TBSA, 95% CI = [1.05; 1.30], p = 0.0056), length of surgery (OR = 1.016 per minute, 95% CI = [1.003; 1.028], p = 0.0150), and Hb (OR = 0.48 per 1 g/dl in Hb, 95% CI = [0.24; 0.95], p = 0.0343) were associated with transfusion while other factors (age, gender, ASA, and catecholamines) did not show notable association. Length of stay was mainly influenced by TSBA (+ 1.38 days per %, p < 0.0001), age (+ 0.21 days per month, p = 0.0206), and administering of catecholamines (+ 14.3 days, p = 0.0118), but not by RBC transfusion. The decision to transfuse was in 23% too restrictive and in 74% too liberal according to the German guidelines. Conclusions Amount of TBSA, length of surgery, and Hb influenced the RBC transfusion rate in burned children. However, age and length of stay were not affected by transfusion of RBCs. In clinical practice of burned children, physicians follow a more liberal transfusion strategy than the proposed in guidelines.

Manejo anestésico y perioperatorio de trauma térmico en pediatría

“…Algunos estudios han demostrado que quemaduras de más del 20% TBSA en pacientes pediátricos puede ser un predictor de transfusión [39]. Existen múltiples diferencias con los adultos a la hora del abordaje para la transfusión que varía con la edad, como en los más jóvenes tiene mayor área de superficie corporal por masa que el adulto, la frecuencia cardíaca, la función cardíaca, el volumen sanguíneo que varía según los grupos de edad.…”

“…No hay que olvidar que la transfusión de glóbulos rojos debe ser realizada teniendo en cuenta el estado general y metabólico del paciente y consideraciones en las que el paciente sigue perdiendo sangre más que por los valores del hemograma [23]. Adicionalmente, la transfusión masiva incrementa el riesgo de mortalidad temprana, ya que puede resultar en hipotermia, acidosis y coagulopatía, la triada de la muerte [39].…”