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Survey on stated transfusion practices in PICUs*.

Geneviève Du Pont-Thibodeau1, Marisa Tucci, Thierry Ducruet

  • 11Division of Pediatric Critical Care, Department of Pediatrics, Sainte-Justine Hospital, Université de Montréal, Montréal, QC, Canada. 2Department of Pediatrics, Research Center, Sainte-Justine Hospital, Université de Montréal, Montréal, QC, Canada.

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Pediatric intensivists are shifting towards restrictive red blood cell (RBC) transfusion strategies. However, the adoption of evidence-based practices for stable pediatric intensive care unit (PICU) patients remains incomplete.

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Area of Science:

  • Pediatric Critical Care Medicine
  • Hematology
  • Clinical Practice Guidelines

Background:

  • Evidence suggests a restrictive red blood cell (RBC) transfusion strategy is safe for critically ill children.
  • Previous studies indicate variability in RBC transfusion practices among pediatric intensivists.

Purpose of the Study:

  • To assess current RBC transfusion practice patterns in pediatric intensivists.
  • To evaluate the adoption of restrictive transfusion strategies following new evidence.

Main Methods:

  • A scenario-based survey was administered to pediatric intensivists and fellows in North America and Europe.
  • Respondents reported transfusion decisions for stable critically ill children in various clinical scenarios.
  • Practices in 2010 were compared to a similar survey from 1997.

Main Results:

  • A trend towards more restrictive RBC transfusion thresholds was observed in 2010 compared to 1997 across all clinical scenarios.
  • Restrictive strategies (hemoglobin ≤ 7 g/dL) were adopted by a higher percentage of respondents in 2010, notably for bronchiolitis and trauma.
  • Significant increases in restrictive approach adoption were seen for bronchiolitis (55.7% vs 37.0%) and trauma (38.1% vs 9.0%).

Conclusions:

  • Pediatric intensivists' stated practices are evolving towards more restrictive RBC transfusion.
  • The implementation of restrictive transfusion strategies, supported by the Transfusion Requirement in PICU trial, is not yet complete.
  • Further research is needed to understand the barriers to full adoption of restrictive transfusion practices in stable PICU patients.