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Transfusion-associated circulatory overload in a pediatric intensive care unit: different incidences with different

Lise De Cloedt1, Guillaume Emeriaud1, Émilie Lefebvre1

  • 1Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada.

Transfusion
|February 2, 2018
PubMed

Insights

The incidence of transfusion-associated circulatory overload (TACO) in pediatric intensive care units (PICUs) varies widely based on diagnostic criteria. Further research is needed to establish an optimal, operational definition for TACO in this vulnerable patient population.

Area of Science:

  • Pediatric critical care medicine
  • Transfusion medicine
  • Patient safety

Background:

  • The incidence of transfusion-associated circulatory overload (TACO) in pediatric intensive care unit (PICU) patients is not well established.
  • TACO poses a significant risk in critically ill children receiving blood transfusions.

Purpose of the Study:

  • To investigate the incidence of TACO in PICU patients.
  • To evaluate different diagnostic criteria for TACO in this population.
  • To highlight the need for an improved, operational definition of TACO.

Main Methods:

  • A prospective study included 136 PICU patients receiving their first red blood cell transfusion.
  • TACO diagnosis utilized International Society of Blood Transfusion criteria with two approaches: "normal pediatric values" and patient-specific "% threshold" (10% or 20%).
  • Monitoring for TACO occurred for up to 24 hours post-transfusion.

Main Results:

  • TACO incidence ranged dramatically from 1.5% to 76% depending on the definition used.
  • The "normal pediatric values" definition yielded higher incidence rates (up to 104 cases at 24 hours) compared to "10%" (27 cases) and "20%" (17 cases) thresholds.
  • Chest radiographs were frequently missing, particularly at 6 and 12 hours post-transfusion.

Conclusions:

  • Current diagnostic criteria for TACO in PICU patients lack operational clarity, leading to variable incidence rates.
  • Threshold-based definitions may offer a more optimal approach, but further studies are required to determine the best threshold.
  • Refining TACO diagnostic criteria is crucial for accurate assessment and management in pediatric critical care.
Abstract

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