Secondary Logo

Institutional members access full text with Ovid®

Respiratory Dysfunction Associated With RBC Transfusion in Critically Ill Children

A Prospective Cohort Study*

Kleiber, Niina, MD, MSc1; Lefebvre, Émilie, MD1; Gauvin, France, MD, MSc1; Tucci, Marisa, MD, BSc1; Robitaille, Nancy, MD2; Trottier, Helen, PhD3; Jouvet, Philippe, MD, PhD1; Ducruet, Thierry, MSc4; Poitras, Nicole, MSc4; Lacroix, Jacques, MD1; Emeriaud, Guillaume, MD, PhD1

Pediatric Critical Care Medicine: May 2015 - Volume 16 - Issue 4 - p 325–334
doi: 10.1097/PCC.0000000000000365
Feature Articles
Buy
SDC
SCCM Podcast

Objective: Respiratory complications associated with RBC transfusions may be underestimated in PICUs because current definitions exclude patients with preexisting respiratory dysfunction. This study aims to determine the prevalence and characterize the risk factors and outcomes of new or progressive respiratory dysfunction observed after RBC transfusion in critically ill children.

Design: Prospective cohort study of all children admitted over a 1-year period.

Setting: A multidisciplinary PICU in a tertiary pediatric university hospital.

Patients: Patients who received a RBC transfusion while in PICU.

Interventions: None.

Measurements and Main Results: Two independent adjudicators established the diagnosis of respiratory dysfunction. A respiratory dysfunction associated with transfusion was considered new if it appeared after the first RBC transfusion in PICU. A progressive respiratory dysfunction associated with transfusion was diagnosed if the respiratory dysfunction was present before the transfusion and the PaO2/FIO2 or the SpO2/FIO2 ratio dropped by at least 20% thereafter. Among 842 children admitted into the PICU, 136 received at least one RBC transfusion and were analyzed. Fifty-eight cases of respiratory dysfunction associated with transfusion (43% of transfused patients) were detected, including nine new respiratory dysfunction associated with transfusion (7%) and 49 progressive respiratory dysfunction associated with transfusion (36%). Higher severity of illness, multiple organ dysfunction syndrome prior to transfusion, and volume (mL/kg) of RBC transfusion were independently associated with respiratory dysfunction associated with transfusion. A dose-response relationship was observed between transfusion volume (mL/kg) and the prevalence of respiratory dysfunction associated with transfusion. Patients with respiratory dysfunction associated with transfusion had more progressive multiple organ dysfunction and less ventilation-free and PICU-free days at day 28.

Conclusions: Development of respiratory dysfunction associated with transfusion is frequent in PICU and occurs mainly in patients with prior respiratory dysfunction, who would not be identified using current definitions for transfusion-associated complications. A cause-effect relationship cannot be confirmed. However, the high prevalence and the serious adverse outcomes associated with respiratory dysfunction associated with transfusion suggest that this complication should be further studied.

1Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine and Université de Montréal, Montreal, Canada.

2Division of Hematology/Oncology, Department of Pediatrics, CHU Sainte-Justine and Université de Montréal, Montreal, Canada.

3Department of Preventive and Social Medicine, Université de Montréal and CHU Sainte-Justine, Montreal, Canada.

4Unité de recherche clinique appliquée, Research Center, CHU Sainte-Justine, Université de Montréal, Montreal, Canada.

*See also p. 380.

Drs. Kleiber and Lefebvre contributed equally.

This work was performed at CHU Sainte-Justine, Université de Montréal.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/pccmjournal).

Supported, in part, by the Fonds de la Recherche en Santé du Québec (grant no. 24460).

Presented, in part, as an abstract at the 40th Annual Congress of the Société de Réanimation de Langue Française, Paris, January 18–20, 2012.

Dr. Trottier is receiving a salary award from the Canadian Institutes of Health Research. Dr. Jouvet is receiving a salary award (chercheur-boursier) from the Fonds de la Recherche en Santé du Québec (FRQ-S). Dr. Emeriaud holds a Clinical Research Scholarship from the FRQ-S. Dr. Emeriaud’s institution received grant support from FRQ-S (study was financed by a grant from FRQ-S and Dr. Emeriaud's research program is supported by Clinical Research Scholarship from FRQ-S). Dr. Robitaille consulted for Apopharma and lectured for Novartis and Griffols. Her institution received grant support from Lilly. Dr. Trottier served as board member for Merck Frosst and GSK Belgium; consulted for Merck Frosst, GSK Belgium, and Gilead science; lectured for Merck Frosst and GSK Belgium; received support for the development of educational presentations from Merck Frosst; and received support for travel from Merck Frosst and GSK Belgium. Dr. Jouvet received support for travel from Air Liquide (travel to a meeting on medical device development) and received support from Philips Medical and Maquet Medical (lent a medical device). Dr. Lacroix received royalties (Textbook on pediatric critical care medicine) and received support for article research from FRQ-S. His institution received grant support from FRQ-S (study was financed by this grant).

For information regarding this article, E-mail: guillaume.emeriaud@umontreal.ca

©2015The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies