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Transfusion of Leukocyte-Depleted RBCs Is Independently Associated With Increased Morbidity After Pediatric Cardiac Surgery*

Kneyber, Martin C. J. MD, PhD1,2; Grotenhuis, Femke MD1; Berger, Rolf F. M. MD, PhD3,4; Ebels, Tjark W. MD, PhD4,5; Burgerhof, Johannes G. M. MSc6; Albers, Marcel J. I. J. MD, PhD1

Pediatric Critical Care Medicine: March 2013 - Volume 14 - Issue 3 - p 298–305
doi: 10.1097/PCC.0b013e3182745472
Cardiac Intensive Care

Objective: To test the hypothesis that transfusion of leukocyte-depleted RBC preparations within the first 48 hours of PICU stay was independently associated with prolonged duration of mechanical ventilation, irrespective of surgery type and disease severity.

Design: Retrospective, observational study.

Setting: Single-center PICU in The Netherlands.

Patients: Children less than 18 years consecutively admitted after pediatric cardiac surgery between February 2007 and February 2010.

Interventions: None.

Measurements and Main Results: Data from 335 patients were used for analysis of whom 86 (25.7%) were transfused during the first 48 hours of PICU stay. Duration of mechanical ventilation (115 ± 19 hours vs. 25 ± 4 hours, p < 0.001) was longer among transfused patients. Ventilator-associated pneumonia (10.5% vs. 1.6%, odds ratio 7.2; 95% confidence interval 1.92–32.47; p < 0.001) was more frequent among transfused patients. New acute kidney injury after 48 hours of PICU admission (23.9% vs. 15.4%, p = 0.18) and mortality were comparable (2.3% vs. 4%, p = 0.16). The number of discrete transfusion events was significantly correlated with the duration of mechanical ventilation (Spearman’s rho 0.617, p < 0.001). Transfusion remained independently associated with prolonged duration of mechanical ventilation after adjusting for confounders using Cox proportional hazards regression analysis.

Conclusions: Transfusion of leukocyte-depleted RBCs within the first 48 hours of PICU stay after cardiac surgery is independently associated with prolonged duration of mechanical ventilation.

1Division of Paediatric Intensive Care, Department of Paediatrics, Beatrix Children’s Hospital, University Medical Center Groningen, Groningen, the Netherlands.

2Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, Groningen, the Netherlands.

3Division of Paediatric Cardiology, Department of Paediatrics, Beatrix Children’s Hospital, University Medical Center Groningen, Groningen, the Netherlands.

4Center for Congenital Heart Disease, Beatrix Children’s Hospital, University Medical Center Groningen, Groningen, the Netherlands.

5Department of Thoracic Surgery, University Medical Center Groningen, Groningen, the Netherlands.

6Department of Epidemiology, University Medical Center Groningen, Groningen, the Netherlands.

*See also p. 330.

Dr. Kneyber designed and supervised the study and drafted the manuscript. Dr. Kneyber and Mr. Grotenhuis collected and analyzed the data. Mr. Burgerhof assisted in the statistical analysis. Drs Berger, Ebels, and Albers and Mr. Burgerhof contributed to the intellectual content of the manuscript.

The authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: m.c.j.kneyber@bkk.umcg.nl

©2013The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies