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Comprehensive Analysis of Liberal and Restrictive Transfusion Strategies in Pediatric Intensive Care Unit
Basak Akyildiz1, Nazan Ulgen Tekerek1, Ozge Pamukcu2
1Department of Pediatric Intensive Care, Faculty of Medicine, University of Erciyes, Kayseri, Turkey.
Insights
A restrictive transfusion strategy for critically ill children showed better hemodynamic and laboratory outcomes than a liberal approach. Perfusion index (PI) monitoring effectively assesses packed red blood cell (PRBC) transfusion efficacy.
Area of Science:
- Pediatric critical care medicine
- Transfusion medicine
Background:
- Critically ill children often require blood transfusions.
- Hemodynamic and laboratory parameters are crucial for assessing transfusion effectiveness.
Purpose of the Study:
- To compare restrictive versus liberal transfusion strategies in critically ill children.
- To evaluate the impact on hemodynamic and laboratory parameters.
Main Methods:
- 160 children were randomized into liberal (trigger < 10 g/dL) and restrictive (trigger ≤ 7 g/dL) packed red blood cell (PRBC) transfusion groups.
- Hemodynamic (cardiac output, PI) and laboratory (lactate) parameters were measured.
- Monitoring utilized the Radical-7 Pulse co-oximeter.
Main Results:
- Restrictive transfusion led to a smaller decrease in cardiac output (24% vs 9.9%) and a larger increase in perfusion index (45% vs 10%) compared to liberal.
- Lactate levels decreased more significantly with the restrictive strategy (31.68% vs 9.8%).
Conclusions:
- Restrictive transfusion strategies demonstrate superior hemodynamic and laboratory benefits in the early period for critically ill children.
- Perfusion index (PI) is a valuable tool for assessing PRBC transfusion efficacy in clinical practice.
Background:
We prospectively compared restrictive and liberal transfusion strategies for critically ill children regarding hemodynamic and laboratory parameters.
Methods:
A total of 180 children requiring packed red blood cells (PRBCs) were randomized into two groups: the liberal transfusion strategy group (transfusion trigger < 10 g/dL, Group 1) and the restrictive transfusion strategy group (transfusion trigger ≤ 7 g/dL, Group 2). Basal variables including venous/arterial hemoglobin, hematocrit and lactate levels; stroke volume; and cardiac output were recorded at the beginning and end of the transfusion. Oxygen saturation, noninvasive total hemoglobin, noninvasive total oxygen content, perfusion index (PI), heart rate and systolic and diastolic blood pressures were assessed via the Radical-7 Pulse co-oximeter (Masimo, Irvine, CA, USA) with the Root monitor, initially and at 4 h.
Results:
In all, 160 children were eligible for final analysis. The baseline hemoglobin level for the PRBC transfusion was 7.38 ± 0.98 g/dL for all patients. At the end of the PRBC transfusion, cardiac output decreased by 9.9% in Group 1 and by 24% in Group 2 (p < 0.001); PI increased by 10% in Group 1 and by 45% in Group 2 (p < 0.001). Lactate decreased by 9.8% in Group 1 and by 31.68% in Group 2 (p < 0.001).
Conclusion:
Restrictive blood transfusion strategy is better than liberal transfusion strategy with regard to the hemodynamic and laboratory values during the early period. PI also provides valuable information regarding the efficacy of PRBC transfusion in clinical practice.
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