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Transfusion in children with acute respiratory distress syndrome
Tine François1, Guillaume Emeriaud1, Oliver Karam2
1Department of Pediatrics, Division of Pediatric Critical Care Medicine, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Québec, Canada.
Insights
Transfusion practices in pediatric acute respiratory distress syndrome (PARDS) lack evidence. A restrictive red blood cell (RBC) strategy is suggested for stable patients, but more research is needed for severe PARDS and hemostatic product transfusions.
Area of Science:
- Pediatric Critical Care Medicine
- Hematology
- Respiratory Medicine
Background:
- Transfusion is common in pediatric acute respiratory distress syndrome (PARDS) but lacks supporting evidence for decision-making.
- Current guidelines and literature offer limited guidance on transfusion strategies for PARDS patients.
Purpose of the Study:
- To review the current knowledge on transfusion in pediatric patients with PARDS.
- To outline potential benefits and harms of transfusion in this population.
Main Methods:
- Literature review of existing studies and guidelines.
- Analysis of evidence regarding red blood cell (RBC), plasma, and platelet transfusions in PARDS.
Main Results:
- A restrictive RBC transfusion strategy (hemoglobin > 7 g/dL) is recommended for stable patients without severe PARDS.
- Evidence is insufficient to guide RBC transfusion decisions in severe PARDS based on factors beyond hemoglobin.
- Indications for prophylactic hemostatic product transfusion (plasma, platelets) in PARDS are not established.
Conclusions:
- Restrictive RBC transfusion may be appropriate for stable PARDS patients, but further research is crucial for severe cases.
- Additional studies are needed to identify optimal triggers for RBC transfusion in severe PARDS, considering oxygen delivery.
- Clear guidelines for prophylactic hemostatic product transfusion in PARDS are currently lacking.
Abstract:
Transfusion is a frequent treatment in pediatric patients with acute respiratory distress syndrome (PARDS) although evidence to support transfusion decision-making is lacking. The purpose of this review is to review the current state of knowledge on the issue of transfusion in children with PARDS and to detail the possible beneficial effects and potential deleterious impacts of transfusion in this patient population. Based on the current literature and recent guidelines, a restrictive red blood cell (RBC) transfusion strategy (avoidance of transfusion when the haemoglobin level is above 7 g/dL) is indicated in stable patients without severe PARDS, as these were excluded from the large trials. In children with severe PARDS, further research is needed to determine if factors other than the haemoglobin level might guide RBC transfusion decision-making by better characterizing the presence of low oxygen delivery (DO2). Additionally, appropriate indications for prophylactic transfusion of hemostatic products (plasma or platelets) in children with PARDS are lacking.
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