, Volume 33, Issue 8, pp 1414-1422,
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Red blood cell transfusion in critically ill children is independently associated with increased mortality

Abstract

Objective

To test the hypothesis that RBC transfusion in critically ill children is independently associated with increased mortality and morbidity.

Design

Retrospective, descriptive epidemiologic cohort study.

Setting

Single-center experience of a nine-bed pediatric intensive care unit (PICU) facility.

Patients

Critically ill children without ongoing active blood loss aged 0 months to 18 years, excluding prematurely born infants or patients after cardiothoracic surgery, and patients with chronic anemia.

Interventions

None.

Measurements and Results

Data of 295 consecutive patients was studied. Of these patients, 13.4% had a Hb concentration less than 9.6 g/dl. Sixty-seven (22.7%) of all patients were transfused, 39 only once. Transfused patients had a higher mortality (16.4 vs. 2.6%, p < 0.001). Mortality seemed related to the number of transfusion (p = 0.002) rather than the pre-transfusion Hb concentration (p = 0.10). Transfused patients required prolonged ventilatory support (11.1 ± 1.8 vs. 3.2 ± 0.3 days, p < 0.001), infusion of vaso-active agents (8.2 ± 1.8 vs. 2.8 ± 0.6 days, p < 0.001) and PICU stay (13.0 ± 1.8 vs. 3.2 ± 0.2 days, p < 0.001). After multivariate analysis adjusting for age, PIM probability of death, mean TISS-28 score during the first 48 h, post-operative admission, diagnosis of sepsis or trauma or malignancy, pre-transfusion Hb concentration, and RBC transfusion remained independently associated with mortality and morbidity.

Conclusions

RBC transfusion in critically ill children is independently associated with increased mortality and prolonged duration of mechanical ventilation, prolonged infusion of vaso-active agents and prolonged PICU stay.