NoBlood

Sharon Grant · #1 (**permalink**) 05-12-2007, 08:44 PM

Transfusion Strategies for Patients in Pediatric Intensive Care Units

By: The New England Journal of Medicine

Jacques Lacroix, M.D., Paul C. Hébert, M.D., James S. Hutchison, M.D., Heather A. Hume, M.D., Marisa Tucci, M.D., Thierry Ducruet, M.Sc., France Gauvin, M.D., Jean-Paul Collet, M.D., Ph.D., Baruch J. Toledano, M.D., Pierre Robillard, M.D., Ari Joffe, M.D., Dominique Biarent, M.D., Kathleen Meert, M.D., Mark J. Peters, M.D., for the TRIPICU Investigators, the Canadian Critical Care Trials Group, and the Pediatric Acute Lung Injury and Sepsis Investigators Network

ABSTRACT Background The optimal hemoglobin threshold for erythrocytetransfusions in critically ill children is unknown. We hypothesizedthat a restrictive transfusion strategy of using packed redcells that were leukocyte-reduced before storage would be assafe as a liberal transfusion strategy, as judged by the outcomeof multiple-organ dysfunction.
Methods In this noninferiority trial, we enrolled 637 stable,critically ill children who had hemoglobin concentrations below9.5 g per deciliter within 7 days after admission to an intensivecare unit. We randomly assigned 320 patients to a hemoglobinthreshold of 7 g per deciliter for red-cell transfusion (restrictive-strategygroup) and 317 patients to a threshold of 9.5 g per deciliter(liberal-strategy group).

Results Hemoglobin concentrations were maintained at a mean(±SD) level that was 2.1±0.2 g per deciliter lowerin the restrictive-strategy group than in the liberal-strategygroup (lowest average levels, 8.7±0.4 and 10.8±0.5g per deciliter, respectively; P<0.001). Patients in therestrictive-strategy group received 44% fewer transfusions;174 patients (54%) in that group did not receive any transfusions,as compared with 7 patients (2%) in the liberal-strategy group(P<0.001). New or progressive multiple-organ dysfunctionsyndrome (the primary outcome) developed in 38 patients in therestrictive-strategy group, as compared with 39 in the liberal-strategygroup (12% in both groups) (absolute risk reduction with therestrictive strategy, 0.4%; 95% confidence interval, –4.6to 5.4). There were 14 deaths in each group within 28 days afterrandomization. No significant differences were found in otheroutcomes, including adverse events.

Conclusions In stable, critically ill children a hemoglobinthreshold of 7 g per deciliter for red-cell transfusion candecrease transfusion requirements without increasing adverseoutcomes. (Controlled-trials.com number, ISRCTN37246456 [controlled-trials.com] .)

Source Information
From Université de Montréal (J.L., H.A.H., M.T., T.D., F.G., B.J.T.) and McGill University (P.R.) — both in Montreal; University of Ottawa, Ottawa (P.C.H.); University of Toronto, Toronto (J.S.H.); University of British Columbia, Vancouver (J.-P.C.); and University of Alberta, Edmonton (A.J.) — all in Canada; Université Libre de Bruxelles, Brussels (D.B.); Wayne State University, Detroit (K.M.); and the Institute of Child Health, London (M.J.P.).

Address reprint requests to Dr. Lacroix at the Sainte-Justine Hospital, Rm. 3431, 3175 Côte Sainte-Catherine, Montreal, QC H3T 1C5, Canada, or at jacques_lacroix@ssss.gouv.qc.ca.