Risks and Predictors of Blood Transfusion in Pediatric Patients Undergoing Open Heart Operations

Székely, Andrea; Cserép, Zsuzsanna; Sápi, Erzsébet; Breuer, Tamás; Nagy, Csaba A.; Vargha, P.; Hartyánszky, István; Szatmári, András; Treszl, András

doi:10.1016/j.athoracsur.2008.09.079

Cited by 141 publications

(106 citation statements)

References 34 publications

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“…However, to date, no prospective study examining either transfusion practices or the efficacy of this aggressive transfusion strategy in children with cyanotic congenital heart disease has been performed. Szekely and colleagues (118) retrospectively reviewed 657 consecutive children undergoing open heart surgery for congenital heart disease and found that blood transfusions were independently associated with an increased risk of infection (odds ratio, 1.01; 95% confidence interval, 1.002-1.02, p ϭ .01). In addition, Willems et al (119) conducted a retrospective subgroup analysis of 125 postoperative cardiac surgery patients enrolled in the Transfusion Requirements in Pediatric Intensive Care Units study.…”

Section: Rbc Transfusion and Outcomes In Cyanotic Congenital Heart DImentioning

confidence: 97%

Red blood cell transfusion in critically ill children: A narrative review*

Istaphanous

Wheeler

Lisco

et al. 2011

Pediatric Critical Care Medicine

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The available evidence does not support the extensive use of RBC transfusions in general or critically ill patients. Transfusions are still associated with risks, and although their benefits are established in limited situations, the associated negative outcomes in many more patients must be closely addressed. Given the frequency of anemia and its proven negative outcomes, transfusion decisions in the critically ill children should be based on individual patient's characteristics rather than generalized triggers, with consideration of potential risks and benefits, and available blood conservation strategies that can reduce transfusion needs.

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Section: Rbc Transfusion and Outcomes In Cyanotic Congenital Heart DImentioning

confidence: 97%

Red blood cell transfusion in critically ill children: A narrative review*

Istaphanous

Wheeler

Lisco

et al. 2011

Pediatric Critical Care Medicine

View full text Add to dashboard Cite

show abstract

“…In a retrospective study on transfusions in pediatric cardiac ICU [24], admission Hb ranged from 141 to 150 g/L, nadir Hb level was 121 g/L in patients who were not transfused, 119 g/L in a low transfusion group, and 115 g/L in a high transfusion group, suggesting that transfusions may have been given for reasons other than anemia. Age below one year, low weight, high severity of illness as measured by the acute physiology and chronic health evaluation (APACHE) or pediatric risk of mortality (PRISM) score, cardiopulmonary bypass, cyanotic heart condition and lower admission Hb level are also reported to be independently associated with increased administration of RBC transfusions [24,33]. …”

Section: Reviewmentioning

confidence: 99%

“…Three studies reported prolonged length of mechanical ventilation in children who received RBC transfusion after cardiac surgery [48,49,54], three reported prolonged length of PICU and/or hospital stay [24,49,54] and three reported an increased incidence of infections [33,50,54]. In 657 consecutive children undergoing open heart surgery, Székely et al .…”

Section: Risks and Benefits Of Rbc Transfusionsmentioning

confidence: 99%

Anemia and red blood cell transfusion in critically ill cardiac patients

Pont‐Thibodeau

Harrington

Lacroix

2014

Ann. Intensive Care

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Anemia and red blood cell (RBC) transfusion occur frequently in hospitalized patients with cardiac disease. In this narrative review, we report the epidemiology of anemia and RBC transfusion in hospitalized adults and children (excluding premature neonates) with cardiac disease, and on the outcome of anemic and transfused cardiac patients. Both anemia and RBC transfusion are common in cardiac patients, and both are associated with mortality. RBC transfusion is the only way to rapidly treat severe anemia, but is not completely safe. In addition to hemoglobin (Hb) concentration, the determinant(s) that should drive a practitioner to prescribe a RBC transfusion to cardiac patients are currently unclear. In stable acyanotic cardiac patients, Hb level above 70 g/L in children and above 70 to 80 g/L in adults appears safe. In cyanotic children, Hb level above 90 g/L appears safe. The appropriate threshold Hb level for unstable cardiac patients and for children younger than 28 days is unknown. The optimal transfusion strategy in cardiac patients is not well characterized. The threshold at which the risk of anemia outweighs the risk of transfusion is not known. More studies are needed to determine when RBC transfusion is indicated in hospitalized patients with cardiac disease.

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“…Though transfusion-related infectious complications of RBC transfusions have decreased in recent years [2], significant non-infectious serious hazards of transfusion remain, including storage lesions and transfusion-related immunomodulation [2][3][4]. RBC transfusion in pediatric cardiac surgery patients has been associated with longer ventilation time, prolonged hospital stay and increased infections [5][6][7]. Furthermore, RBC transfusion is associated with increased morbidity and mortality in adults with cardiac disease [8][9][10].…”

Section: Introductionmentioning

confidence: 98%

Red Blood Cell Transfusion in the Postoperative Care of Pediatric Cardiac Surgery: Survey on Stated Practice

et al. 2016

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The optimal red blood cell transfusion threshold for postoperative pediatric cardiac surgery patients is unknown. This study describes the stated red blood cell transfusion practice of physicians who treat postoperative pediatric cardiac surgery patients in intensive care units. A scenario-based survey was sent to physicians involved in postoperative intensive care of pediatric cardiac surgery patients in all Canadian centers that perform such surgery. Respondents reported their red blood cell transfusion practice in four postoperative scenarios: acyanotic or cyanotic cardiac lesion, in a neonate or an infant. In part A of each scenario, the patient was critically ill, but stabilized; in part B, the patient became unstable. Response rate was 58 % (71 of 123), with 45 respondents indicating direct involvement in postoperative intensive care. There was a wide variability in stated transfusion threshold, ranging from <7.0-14.0 g/dL for stabilized cases. There was no significant difference between neonates and infants in stated transfusion threshold. The mean hemoglobin level below which respondents would transfuse a stabilized patient was 9 g/dL for acyanotic and 11.2 g/dL for cyanotic patients, a statistically significant difference (2.2 ± 0.9 g/dL, p < 0.001). All clinical determinants of instability significantly increased transfusion threshold. Hemodynamic instability increased transfusion threshold by 2.3 ± 1.3 g/dL in acyanotic patients and by 1.3 ± 1.1 g/dL in cyanotic patients. Cyanotic lesion and clinical instability, but not patient age, increased stated red blood cell transfusion threshold. Significant variation in reported red blood cell transfusion practice exists among physicians treating pediatric patients in intensive care following cardiac surgery.

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Risks and Predictors of Blood Transfusion in Pediatric Patients Undergoing Open Heart Operations

Cited by 141 publications

References 34 publications

Red blood cell transfusion in critically ill children: A narrative review*

Red blood cell transfusion in critically ill children: A narrative review*

Anemia and red blood cell transfusion in critically ill cardiac patients

Red Blood Cell Transfusion in the Postoperative Care of Pediatric Cardiac Surgery: Survey on Stated Practice

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