Restrictive Protocol for Blood Transfusions
Matthew G. Gartland
Brian M. Cummings
Transfusion Strategies for Patients in Pediatric Intensive Care Units
Lacroix J, Hébert PC, Hutchison JS, et al. N Engl J Med. 2007;356(16):1609–1619
Background
As many as 50% of critically ill children in the pediatric intensive care unit (PICU) may receive a blood transfusion for anemia.1 However, blood transfusions are an expensive and limited resource with potential adverse effects, and the optimal hemoglobin (Hb) threshold requiring transfusion is unknown. Adult ICU studies showed equivalency at lower Hb transfusion thresholds, with a landmark study demonstrating increased mortality with a liberal transfusion strategy, prompting this pediatric study.
Objectives
To determine if a restrictive transfusion strategy is as safe as a liberal strategy in critically ill children in regard to development of multiorgan dysfunction syndrome (MODS).
Methods
Randomized controlled noninferiority trial in 19 PICUs in 4 countries from 2001 to 2005.
Patients
637 children ages 3 days to 14 years who had Hb <9.5 g/dL within 7 days after PICU admission. Select exclusion criteria: expected PICU stay <24 hours, hemodynamic instability, hemolytic anemia, prematurity, hypoxemia.
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