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Published on: November 8, 2024
Plasma and Platelet Transfusion Strategies in Critically Ill Children Following Noncardiac Surgery and Critically Ill
Marisa Tucci1, Gemma Crighton2, Susan M Goobie3
1Department of Pediatrics, Sainte-Justine University Hospital, University of Montreal, Montreal, QC, Canada.
Insights
Limited evidence exists for plasma and platelet transfusions in critically ill children. The Transfusion and Anemia EXpertise Initiative developed 18 pediatric-specific consensus statements to guide management in these vulnerable populations.
Area of Science:
- Pediatric critical care medicine
- Hematology
- Transfusion medicine
Background:
- Plasma and platelet transfusions are critical interventions for critically ill children.
- Evidence guiding transfusion practices in pediatric surgical and procedural patients is limited.
- The Transfusion and Anemia EXpertise Initiative (TAXI) - Control/Avoidance of Bleeding (CAB) aimed to address this gap.
Purpose of the Study:
- To present consensus statements and supporting literature for plasma and platelet transfusions.
- Focus on critically ill children undergoing noncardiac surgery or invasive procedures outside the operating room.
- Provide evidence-based and expert-based guidance for transfusion management.
Main Methods:
- Systematic review of literature (MEDLINE, EMBASE, Cochrane Library) up to December 2020.
- Consensus conference involving international, multidisciplinary experts.
- Utilized Research and Development/University of California, Los Angeles Appropriateness Method for consensus.
- Grading of Recommendations Assessment, Development, and Evaluation (GRADE) for summarizing results.
Main Results:
- Developed eight expert consensus statements for critically ill children post-noncardiac surgery.
- Developed ten expert consensus statements for critically ill children undergoing invasive procedures outside the OR.
- Total of 18 pediatric-specific consensus statements were generated.
- Highlighted the scarcity of robust evidence in this field.
Conclusions:
- Significant need for standardized transfusion practices in critically ill pediatric populations.
- The developed consensus statements provide crucial guidance for managing plasma and platelet transfusions.
- These statements aim to improve outcomes for critically ill children undergoing surgery or procedures.
Objectives:
To present consensus statements and supporting literature for plasma and platelet transfusions in critically ill children following noncardiac surgery and critically ill children undergoing invasive procedures outside the operating room from the Transfusion and Anemia EXpertise Initiative - Control/Avoidance of Bleeding.
Design:
Systematic review and consensus conference of international, multidisciplinary experts in platelet and plasma transfusion management of critically ill children.
Setting:
Not applicable.
Patients:
Critically ill children undergoing invasive procedures outside of the operating room or noncardiac surgery.
Interventions:
None.
Measurements And Main Results:
A panel of 10 experts developed evidence-based and, when evidence was insufficient, expert-based statements for plasma and platelet transfusions in critically ill children following noncardiac surgery or undergoing invasive procedures outside of the operating room. These statements were reviewed and ratified by the 29 Transfusion and Anemia EXpertise Initiative-Control/Avoidance of Bleeding experts. A systematic review was conducted using MEDLINE, EMBASE, and Cochrane Library databases, from inception to December 2020. Consensus was obtained using the Research and Development/University of California, Los Angeles Appropriateness Method. Results were summarized using the Grading of Recommendations Assessment, Development, and Evaluation method. We developed eight expert consensus statements focused on the critically ill child following noncardiac surgery and 10 expert consensus statements on the critically ill child undergoing invasive procedures outside the operating room.
Conclusions:
Evidence regarding plasma and platelet transfusion in critically ill children in this area is very limited. The Transfusion and Anemia EXpertise Initiative-Control/Avoidance of Bleeding Consensus Conference developed 18 pediatric specific consensus statements regarding plasma and platelet transfusion management in these critically ill pediatric populations.
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