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International survey on plasma transfusion practices in critically ill children
Oliver Karam1, Marisa Tucci, Jacques Lacroix
1Pediatric Critical Care Unit, Geneva University Hospital, Geneva, Switzerland.
Insights
Pediatric critical care physicians often transfuse plasma to nonbleeding children, with significant variations in practice. Thresholds for plasma transfusion differ based on clinical scenarios like pneumonia and traumatic brain injury.
Area of Science:
- Pediatric Critical Care Medicine
- Transfusion Medicine
- Hematology
Background:
- Red blood cell transfusion practices exhibit heterogeneity.
- Plasma transfusion is common in intensive care, but data in pediatric critical care is lacking.
Purpose of the Study:
- To investigate plasma transfusion practices in pediatric critical care units.
- To identify variations in decision-making for plasma transfusions across different clinical scenarios.
Main Methods:
- A scenario-based survey was distributed to 718 pediatric critical care physicians.
- Respondents reported plasma transfusion decisions for pneumonia, septic shock, traumatic brain injury (TBI), and post-cardiac surgery.
Main Results:
- A 26% response rate (187 physicians) was achieved.
- 66-84% of physicians transfused plasma to nonbleeding patients based on abnormal international normalized ratio (INR).
- Median INR thresholds varied from 2.0 to 2.5, and factors like bleeding and hypotension influenced decisions.
Conclusions:
- Over two-thirds of surveyed physicians prescribe plasma transfusions to nonbleeding critically ill children.
- Significant variability exists in pediatric plasma transfusion practices and thresholds.
Background:
Studies have shown heterogeneity in red blood cell transfusion practices. Although plasma transfusion is common in intensive care, there are no data on plasma transfusion practices in pediatric critical care units.
Study Design And Methods:
A scenario-based survey was sent to 718 pediatric critical care physicians working in Europe, North America, Australia, and New Zealand. Respondents were asked to report their decisions regarding plasma transfusion practice with respect to four scenarios: pneumonia, septic shock, traumatic brain injury (TBI), and postoperative care after a Tetralogy of Fallot correction.
Results:
The response rate was 187 of 718 (26%); half of the responders worked in North America. The proportion of physicians who transfused plasma to nonbleeding patients, solely based on abnormal international normalized ratio (INR), varied from 66% for pneumonia to 84% for TBI (p < 0.001). In such nonbleeding patients, the median INR threshold that would trigger plasma transfusion was 2.5 for pneumonia and septic shock patients and 2.0 for TBI and the cardiac postoperative patients (p < 0.001). Minor bleeding, minor surgery, insertion of a femoral line, hypotension, abnormal activated partial thromboplastin time, thrombocytopenia, and anemia levels were important determinants of plasma transfusion, whereas none of the respondents' demographic characteristics were important.
Conclusion:
More than two-thirds of responding pediatric critical care physicians prescribe plasma transfusions for nonbleeding critically ill children. Additionally, there is a significant variation in transfusion practice patterns with respect to plasma transfusion thresholds.
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