Objectives: In children with severe sepsis or septic shock, the optimal red blood cell transfusion threshold is unknown. We analyzed the subgroup of patients with sepsis and transfusion requirements in a pediatric intensive care unit study to determine the impact of a restrictive vs. liberal transfusion strategy on clinical outcome.
Design: Subgroup analysis of a prospective, multicenter, randomized, controlled trial.
Setting: Multicenter pediatric critical care units.
Patients: Stabilized critically ill children (mean systemic arterial pressure >2 sd below normal mean for age and cardiovascular support not increased for at least 2 hrs before enrollment) with a hemoglobin ≤9.5 g/dL within 7 days after pediatric critical care unit admission.
Interventions: One hundred thirty-seven stabilized critically ill children with sepsis were randomized to receive red blood cell transfusion if their hemoglobin decreased to either <7.0 g/dL (restrictive group) or 9.5 g/dL (liberal group).
Measurements and Main Results: In the restrictive group (69 patients), 30 patients did not receive any red blood cell transfusion, whereas only one patient in the liberal group (68 patients) never underwent transfusion (p < .01). No clinically significant differences were found for the occurrence of new or progressive multiple organ dysfunction syndrome (18.8% vs. 19.1%; p = .97), for pediatric critical care unit length of stay (p = .74), or for pediatric critical care unit mortality (p = .44) in the restrictive vs. liberal group.
Conclusions: In this subgroup analysis of children with stable sepsis, we found no evidence that a restrictive red cell transfusion strategy, as compared to a liberal one, increased the rate of new or progressive multiple organ dysfunction syndromes. Furthermore, a restrictive transfusion threshold significantly reduced exposure to blood products. Our data suggest that a hemoglobin level of 7.0 g/dL may be safe stabilized for children with sepsis, but further studies are required to support this recommendation.
From the Pediatric Critical Care Unit (OK, MT, TD, JL, FG), Sainte-Justine Hospital and Université de Montréal, Montreal, Canada; and Division of Hematology/Oncology (HH), Sainte-Justine Hospital and Université de Montréal, Montreal, Canada.
Supported, in part, by the Canadian Institutes of Health Research (grants 84300 and 130770) and the Fonds de la Recherche en Santé du Québec (grant 13904).
Dr. Lacroix has disclosed that he has consulted for Novo Nordisk. The remaining authors have not disclosed any potential conflicts of interest.
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