TY - JOUR
T1 - Recommendations on RBC transfusion in critically ill children with nonlife-threatening bleeding or hemorrhagic shock from the pediatric critical care transfusion and Anemia expertise initiative
AU - Karam, Oliver
AU - Russell, Robert T.
AU - Stricker, Paul
AU - Vogel, Adam M.
AU - Bateman, Scot T.
AU - Valentine, Stacey L.
AU - Spinella, Philip C.
N1 - Funding Information:
Drs. Bateman's and Valentine's institution received funding from an R13 conference grant from the National Institute of Child Health and Human Development (NICHD) and National Heart, Lung, and Blood Institute (NHLBI) and from the Society for the Advancement of Blood Management (SABM, and he received support for article research from the National Institutes of Health (NIH). Their institution received funding from Eunice Kennedy Shriver NICHD and NHLBI under award number 1 R13 HD088086-01, SABM SABM-Haemonetics Research Starter Grant, and the Washington University Children's Discovery Institute (CDI-E1-2015-499). They received other support from CHU-Sainte-Justine Foundation and the University of Massachusetts Medical School, and they received support for article research from the NIH, SABM SABM-Haemonetics Research Starter Grant, CHU-Sainte-Justine Foundation, Washington University Children's Discovery Institute, and the University of Massachusetts Medical School. Dr. Spinella received funding from New Health Sciences. The other authors have disclosed that they do not have any potential conflicts of interest.
Funding Information:
1Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children’s Hospital of Richmond at VCU, Richmond, VA. 2Division of Pediatric Surgery, Department of Surgery, Children’s of Alabama, University of Alabama at Birmingham, Birmingham, AL. 3Department of Anesthesiology and Critical Care, The Children’s Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. 4Division of Pediatric Surgery, Departments of Surgery and Pediatrics, Baylor College of Medicine Texas Children’s Hospital, Houston, TX. 5Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA. 6Division of Critical Care, Department of Pediatrics, Washington University in St Louis, St. Louis, MO. Pediatric Critical Care Transfusion and Anemia Expertise Initiative (TAXI) members are listed in Appendix 1. 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). The Transfusion and Anemia Expertise Initiative was supported, in part, by the National Institutes of Health Eunice Kennedy Shriver National Institute of Child Health and Human Development and National Heart, Lung, and Blood Institute under award number 1 R13 HD088086-01, the Society for the Advancement of Blood Management (SABM)-Haemonetics Research Starter Grant, the CHU-Sainte-Justine Foundation, the Washington University Children’s Discovery Institute (CDI-E1-2015–499), and the University of Massachusetts Medical School. Drs. Bateman’s and Valentine's institution received funding from an R13 conference grant from the National Institute of Child Health and Human Development (NICHD) and National Heart, Lung, and Blood Institute (NHLBI) and from the Society for the Advancement of Blood Management (SABM, and he received support for article research from the National Institutes of Health (NIH). Their institution received funding from Eunice Kennedy Shriver NICHD and NHLBI under award number 1 R13 HD088086-01, SABM SABM-Haemonetics Research Starter Grant, and the Washington University Children’s Discovery Institute (CDI-E1-2015– 499). They received other support from CHU-Sainte-Justine Foundation and the University of Massachusetts Medical School, and they received support for article research from the NIH, SABM SABM-Haemonetics Copyright © 2018 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies DOI: 10.1097/PCC.0000000000001605 Research Starter Grant, CHU-Sainte-Justine Foundation, Washington University Children’s Discovery Institute, and the University of Massachusetts Medical School. Dr. Spinella received funding from New Health Sciences. The other authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: oliver.karam@vcuhealth.org
Publisher Copyright:
Copyright © 2018 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.
PY - 2018
Y1 - 2018
N2 - Objectives: To present the recommendations and supporting literature for RBC transfusions in critically ill children with bleeding developed by the Pediatric Critical Care Transfusion and Anemia Expertise Initiative. Design: Consensus conference series of international, multidisciplinary experts in RBC transfusion management of critically ill children. Methods: The panel of 38 experts developed evidence-based and, when evidence was lacking, expert-based clinical recommendations as well as research priorities for RBC transfusions in critically ill children. The bleeding subgroup included five experts. Electronic searches were conducted using PubMed, EMBASE, and Cochrane Library databases jrom 1980 to May 2017. Agreement was obtained using the Research and Development/UCLA Appropriateness Method. Results were summarized using the Grading of Recommendations Assessment, Development, and Evaluation method. Results: Transfusion and Anemia Expertise Initiative Consensus Conference experts developed a total of six recommendations focused on transfusion in the critically ill child with acute bleeding. In critically ill children with nonlife-threatening bleeding, we recommend giving a RBC transfusion for a hemoglobin concentration less than 5 g/dL, and be considered for a hemoglobin concentration between 5 and 7 g/dL. In critically ill children with hemorrhagic shock, we suggest that RBCs, plasma and platelets transfusion ratio between 2:1:1 to 1:1:1 until the bleeding is no longer life-threatening. We recommend future studies to develop physiologic and laboratory measures to indicate the need for RBC transfusions, and to determine if goal directed hemostatic resuscitation improves survival. Finally, we recommend future studies to determine if low titer group O whole blood is more efficacious and safe compared with reconstituted whole blood in children with hemorrhagic shock. Conclusions: The Transfusion and Anemia Expertise Initiative Consensus Conference developed pediatric specific recommendations regarding RBC transfusion management in the critically ill child with acute bleeding, as well as recommendations to help guide future research priorities.
AB - Objectives: To present the recommendations and supporting literature for RBC transfusions in critically ill children with bleeding developed by the Pediatric Critical Care Transfusion and Anemia Expertise Initiative. Design: Consensus conference series of international, multidisciplinary experts in RBC transfusion management of critically ill children. Methods: The panel of 38 experts developed evidence-based and, when evidence was lacking, expert-based clinical recommendations as well as research priorities for RBC transfusions in critically ill children. The bleeding subgroup included five experts. Electronic searches were conducted using PubMed, EMBASE, and Cochrane Library databases jrom 1980 to May 2017. Agreement was obtained using the Research and Development/UCLA Appropriateness Method. Results were summarized using the Grading of Recommendations Assessment, Development, and Evaluation method. Results: Transfusion and Anemia Expertise Initiative Consensus Conference experts developed a total of six recommendations focused on transfusion in the critically ill child with acute bleeding. In critically ill children with nonlife-threatening bleeding, we recommend giving a RBC transfusion for a hemoglobin concentration less than 5 g/dL, and be considered for a hemoglobin concentration between 5 and 7 g/dL. In critically ill children with hemorrhagic shock, we suggest that RBCs, plasma and platelets transfusion ratio between 2:1:1 to 1:1:1 until the bleeding is no longer life-threatening. We recommend future studies to develop physiologic and laboratory measures to indicate the need for RBC transfusions, and to determine if goal directed hemostatic resuscitation improves survival. Finally, we recommend future studies to determine if low titer group O whole blood is more efficacious and safe compared with reconstituted whole blood in children with hemorrhagic shock. Conclusions: The Transfusion and Anemia Expertise Initiative Consensus Conference developed pediatric specific recommendations regarding RBC transfusion management in the critically ill child with acute bleeding, as well as recommendations to help guide future research priorities.
KW - Bleeding
KW - Consensus conference
KW - Critically ill child
KW - Red blood cell
KW - Transfusion
UR - http://www.scopus.com/inward/record.url?scp=85054895553&partnerID=8YFLogxK
U2 - 10.1097/PCC.0000000000001605
DO - 10.1097/PCC.0000000000001605
M3 - Article
C2 - 30161067
AN - SCOPUS:85054895553
VL - 19
SP - S127-S132
JO - Pediatric Critical Care Medicine
JF - Pediatric Critical Care Medicine
SN - 1529-7535
IS - 9
ER -