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Sepsis-related anemia in a pediatric intensive care unit: transfusion-associated outcomes
Mohamed Elshinawy1,2, Maha Kamal1, Hanan Nazir1,2
1Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Insights
Liberal red blood cell (RBC) transfusion in pediatric sepsis patients may worsen outcomes. A restrictive strategy showed better results, suggesting a need to minimize anemia factors in the pediatric intensive care unit (PICU).
Area of Science:
- Pediatric critical care medicine
- Hematology
- Clinical research
Background:
- Pediatric patients in intensive care units with sepsis face a high risk of anemia.
- Anemia in pediatric sepsis can negatively impact patient prognosis.
- This study investigates the effect of red blood cell (RBC) transfusion on outcomes in pediatric intensive care unit (PICU) sepsis patients.
Purpose of the Study:
- To evaluate the impact of different red blood cell (RBC) transfusion strategies on patient outcomes in a pediatric intensive care unit (PICU) setting.
- To compare the effectiveness of liberal versus restrictive RBC transfusion protocols for children with sepsis.
Main Methods:
- A prospective randomized clinical trial involving 67 children (2-144 months) admitted to the PICU with new-onset sepsis.
- Patients were randomized into two groups: a liberal transfusion group (Hb 7-10 g/dL received transfusion to 12 g/dL) and a restrictive group (Hb 7-10 g/dL did not receive transfusion).
- Exclusion criteria included hemoglobin levels below 7 g/dL or above 10 g/dL.
Main Results:
- The liberal transfusion group (33 patients) showed significantly higher mortality (42.4% vs. 17.6%) compared to the restrictive group (34 patients).
- Patients receiving liberal transfusions experienced longer hospital stays, higher rates of ventilation (93.94%), multiorgan dysfunction (87.88%), acute respiratory distress syndrome, and acute lung injury.
- A restrictive transfusion strategy was associated with improved outcomes in pediatric sepsis patients.
Conclusions:
- Liberal RBC transfusion strategies may be linked to adverse outcomes in pediatric sepsis patients.
- Restrictive transfusion protocols appear more beneficial, though confounding factors and protocol deviations warrant consideration.
- Minimizing anemia-inducing factors in PICU patients is recommended to reduce transfusion requirements.
Background:
Pediatric patients with sepsis in intensive care units are at high risk of developing anemia, which might have adverse effects on their prognosis. This study aimed to evaluate the impact of red blood cell (RBC) transfusion on the outcomes of patients admitted to a pediatric intensive care unit (PICU) with sepsis.
Methods:
We conducted a prospective randomized clinical trial, enrolling 67 children, aged 2 to 144 months who were admitted to a PICU with a new episode of sepsis from November 2017 to April 2018. Patients were allocated randomly to two groups: Group 1, liberal transfusion strategy group, including 33 patients who had initial hemoglobin (Hb) between 7 or greater and less than 10 g/dL and received an RBC top-up transfusion to 12 g/dL; and Group 2, restrictive strategy group, including 34 patients who had the same Hb range and did not receive RBCs. Patients with Hb less than 7 or greater than 10 g/dL were excluded.
Results:
Of 33 patients who received liberal transfusions, 31 (93.94%) required ventilation, and 29 (87.88%) had multiorgan dysfunction. They had a significantly lengthier hospital stay and a higher incidence of acute respiratory distress syndrome and acute lung injury. Moreover, mortality was significantly higher in the liberal transfusion group (42.4% vs. 17.6%).
Conclusions:
Compared to the restrictive transfusion strategy, liberal transfusion might be associated with a worse outcome. However, the possible role of other known and unknown confounding factors and minor protocol violations should be taken into consideration. We recommend minimizing factors worsening anemia in PICU patients to reduce the need for transfusion.
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