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Patient blood management in critically ill children undergoing cardiac surgery: A cohort study
Debbie A Long1, Eugene Slaughter2, Gabor Mihala3
1School of Nursing and Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD, Australia; Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, QLD, Australia; Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia.
Insights
This audit of pediatric cardiac surgery patient blood management found practices align with national guidelines. Further research is needed to enhance blood conservation strategies in pediatric critical care.
Area of Science:
- Pediatric Critical Care Medicine
- Cardiac Surgery
- Patient Blood Management
Background:
- Patient blood management (PBM) is crucial in pediatric cardiac surgery.
- Optimizing PBM can reduce transfusion needs and improve outcomes.
- Current PBM practices in pediatric intensive care units (PICUs) require auditing.
Purpose of the Study:
- To audit current patient blood management practices in children undergoing cardiac surgery.
- To assess PBM during admission to the pediatric intensive care unit (PICU).
Main Methods:
- Prospective observational cohort study.
- Single-centre audit in a tertiary children's hospital's cardiac operating room (OR) and PICU.
- Included children undergoing corrective cardiac surgery requiring PICU admission.
Main Results:
- Audited 56 patients and 1779 blood sampling episodes over 7 months.
- Median blood sampling episodes per patient per day was 6.6; arterial blood gas analysis was most common (86%).
- Blood sampling and loss correlated with longer PICU stays; Cell Saver® and other infusions were administered.
Conclusions:
- Observed PBM practices largely conform to National Blood Authority guidelines.
- Further implementation projects are needed to accelerate blood conservation strategies.
- Research is essential to optimize PBM in pediatric critical care environments.
Objective:
The objective of this study was to audit current patient blood management practice in children throughout cardiac surgery and paediatric intensive care unit (PICU) admission.
Design:
This was a prospective observational cohort study.
Setting:
This was a single-centre study in the cardiac operating room (OR) and PICU in a major tertiary children's hospital in Australia.
Patients:
Children undergoing corrective cardiac surgery and requiring admission to PICU for postoperative recovery were included in the study.
Measurements And Main Results:
Fifty-six patients and 1779 blood sampling episodes were audited over a 7-month period. The median age was 9 months (interquartile range [IQR] = 1-102), with the majority (n = 30 [54%]) younger than 12 months. The median number of blood sampling episodes per patient per day was 6.6 (IQR = 5.8-8.0) in total, with a median of 5.0 (IQR = 4.0-7.5) episodes in the OR and 5.0 (IQR = 3.4-6.2) episodes per day throughout PICU admission. The most common reason for blood tests across both OR and PICU settings was arterial blood gas analysis (total median = 86%, IQR = 79-96). The overall median blood sampling volume per kg of bodyweight, patient, and day was 0.63 mL (IQR = 0.20-1.14) in total. Median blood loss for each patient was 3.5 mL/kg per patient per day (IQR = 1.7-5.6) with negligible amounts in the OR and a median of 3.6 mL/kg (IQR = 1.7-5.7) in the PICU. The median Cell Saver® transfusion volume was 9.9 mL/kg per patient per day (IQR = 4.0-19.1) in the OR. The overall median volume of other infusion products (albumin 4%, albumin 20%, packed red blood cells) received by each patient was 20.1 mL/kg (IQR = 10.7-36.4) per day. Sampling events and blood loss were positively associated with PICU stay.
Conclusions:
Patient blood management practices observed in this study largely conform to National Blood Authority guidelines. Further implementation projects and research are needed to accelerate implementation of known effective blood conservation strategies within paediatric critical care environments.
