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Respiratory Impairment after Early Red Cell Transfusion in Pediatric Patients with ALI/ARDS

Surender Rajasekaran1, Dominic Sanfilippo, Allen Shoemaker

  • 1Division of Pediatric Critical Care Medicine, Helen DeVos Children's Hospital, 100 Michigan Street NE, Grand Rapids, MI 49503, USA.

Critical Care Research and Practice
|September 8, 2012
PubMed

Insights

Early packed red blood cell (PRBC) transfusions in children with acute lung injury/acute respiratory distress syndrome (ALI/ARDS) may worsen outcomes. Transfused patients required longer mechanical ventilation and showed poorer oxygenation compared to controls.

Area of Science:

  • Pediatric Critical Care Medicine
  • Hematology
  • Respiratory Medicine

Background:

  • Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) management in children often involves packed red blood cell (PRBC) transfusions to ensure adequate oxygen delivery.
  • The impact of early PRBC transfusion on outcomes in pediatric ALI/ARDS patients remains an area of investigation.

Purpose of the Study:

  • To investigate the hypothesis that early PRBC transfusion in children with ALI/ARDS, initiated within 48 hours of mechanical ventilation, is associated with worse clinical outcomes.

Main Methods:

  • A retrospective cohort study comparing 34 transfused pediatric patients with 45 non-transfused controls admitted to a pediatric intensive care unit (PICU) between 2008 and 2009.
  • Data collected included pre-transfusion hemoglobin levels, oxygenation index (OI), PaO2/FiO2 (P/F) ratio, duration of mechanical ventilation, and rates of multiple organ dysfunction syndrome (MODS).

Main Results:

  • Transfused patients had a lower mean pre-transfusion hemoglobin (8.2 g/dL vs. 10.1 g/dL in controls).
  • The P/F ratio decreased in transfused patients but increased in controls (P < 0.001).
  • Transfused patients experienced increased OI (11.7 to 18.7) and significantly longer ventilator days (15.6 vs. 9.5 days, P < 0.001).
  • A trend towards higher MODS rates was observed in transfused patients (29.4% vs. 17.7%).

Conclusions:

  • Early PRBC transfusion in pediatric ALI/ARDS patients may be associated with increased ventilatory requirements and potentially worse oxygenation.
  • These findings suggest a need for careful consideration of transfusion triggers in this vulnerable population.

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