Related Experiment Video
Updated: May 8, 2026
Continuous Manual Exchange Transfusion for Patients with Sickle Cell Disease: An Efficient Method to Avoid Iron Overload
Published on: March 14, 2017
Changes in transfusion practice over time in the PICU
Michael D Dallman1, Xinggang Liu, Anthony D Harris
11Division of Pediatric Critical Care Medicine, University of Mississippi School of Medicine, Jackson, MS. 2Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD. 3Department of Pathology, University of Maryland School of Medicine, Baltimore, MD. 4Division of Pulmonary and Critical Care Medicine, Emory University School of Medicine, Atlanta, GA. 5Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD.
Insights
Pediatric red blood cell (RBC) transfusions in the ICU decreased significantly from 1998 to 2009. Transfusion practices did not change after a key 2007 trial, indicating limited impact on clinical practice.
Area of Science:
- Pediatric critical care medicine
- Transfusion medicine
- Clinical practice research
Background:
- Restrictive transfusion strategies have demonstrated efficacy in critically ill children.
- The influence of major clinical trials on pediatric transfusion practices remains unclear.
- Long-term trends in intensive care unit (ICU) transfusion practices for children are not well-documented.
Purpose of the Study:
- To assess temporal trends in pediatric transfusion practices within an ICU.
- To evaluate the impact of a major pediatric clinical trial publication on transfusion rates.
- To identify factors associated with red blood cell (RBC) transfusion in critically ill children.
Main Methods:
- A single-center, retrospective observational study was conducted.
- Data were collected from critically ill, nonbleeding children (3 days to 14 years) admitted to a pediatric ICU between 1998 and 2009.
- Exclusion criteria included congenital heart disease, hemolytic anemia, and hemoglobinopathies.
Main Results:
- Over 5,000 children were analyzed, with 335 receiving RBC transfusions.
- The overall proportion of transfused patients declined from 10.5% in 1998 to 6.8% in 2009 (p = 0.007).
- Factors associated with increased transfusion likelihood included neonatal age, respiratory failure, shock, multiple organ dysfunction syndrome, and acidosis.
Conclusions:
- A significant decrease in the proportion of pediatric ICU patients receiving transfusions was observed between 1998 and 2009.
- Publication of a major pediatric clinical trial in 2007 did not result in a discernible change in transfusion practices.
- Higher illness severity and younger age were linked to a greater likelihood of transfusion.
Objectives:
Recent randomized clinical trials have shown the efficacy of a restrictive transfusion strategy in critically ill children. The impact of these trials on pediatric transfusion practice is unknown. Additionally, long-term trends in pediatric transfusion practice in the ICU have not been described. We assessed transfusion practice over time, including the effect of clinical trial publication.
Design:
Single-center, retrospective observational study.
Setting:
A 10-bed PICU in an urban academic medical center.
Patients:
Critically ill, nonbleeding children between the ages of 3 days and 14 years old, admitted to the University of Maryland Medical Center PICU between January 1, 1998, and December 31, 2009, excluding those with congenital heart disease, hemolytic anemia, and hemoglobinopathies.
Interventions:
None.
Measurements And Main Results:
During the time period studied, 5,327 patients met inclusion criteria. Of these, 335 received at least one RBC transfusion while in the PICU. The overall proportion transfused declined from 10.5% in 1998 to 6.8% in 2009 (p = 0.007). Adjusted for acuity, the likelihood of transfusion decreased by calendar year of admission. In transfused patients, the pretransfusion hemoglobin level declined, from 10.5 g/dL to 9.3 g/dL, though these changes failed to meet statistical significance (p = 0.09). Neonatal age, respiratory failure, shock, multiple organ dysfunction syndrome, and acidosis were associated with an increased likelihood of transfusion in both univariate and multivariable models.
Conclusions:
The overall proportion of patients transfused between 1998 and 2009 decreased significantly. The magnitude of the decrease varied over time, and no additional change in transfusion practice occurred after the publication of a major pediatric clinical trial in 2007. Greater illness acuity and younger patient age were associated with an increased likelihood of transfusion.
Related Concept Videos
01:27Parentral Nutrition: Centeral and Peripheral Parental Nutrition
PN can be administered through two primary routes:
1. Central Parenteral Nutrition (CPN):
CPN involves delivering a high concentration of nutrients through a large vein. This is typically achieved using a Peripherally Inserted Central Catheter (PICC) or,...
02:45Blood Transfusion and Agglutination
History
The history of blood transfusion dates back to the 17th century, when early attempts were made in animals. In 1818 James Blundell, a British doctor, performed the first successful human blood transfusion. Later in 1900, Karl...
01:29Endocarditis IV: Nursing Management
01:30Continuous Renal Replacement Therapy