Nahum Elhanan, Ben-Ari Josef, Schonfeld Tommy
Intensive Care Unit, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel.
J Intensive Care Med. 2004 Jan-Feb;19(1):38-43. doi: 10.1177/0885066603257966.
The objective of this study was to define current blood transfusion practices among European pediatric intensive care physicians treating critically ill children. A questionnaire of case scenarios was administered to members of the European Society of Pediatric and Neonatal Intensive Care (ESPNIC). Of the 258 members of the ESPNIC, 134 (51.9%) pediatric intensive care physicians completed the questionnaire. The suggested blood transfusion thresholds for case scenario 1 (post-orthopedic surgery child) ranged from <7.0 g/dl to 11 g/dl. A total of 57.3% suggested 7 g/dl, 33.6% suggested 8 g/dl, and 6.9% suggested 9 g/dl as a hemoglobin threshold for transfusion (mean, 7.54 +/- 0.75). For case scenarios 2 to 4, the suggested hemoglobin thresholds were 7 g/dl to 12 g/dl. For case scenario 2 (a child with acute respiratory distress syndrome), 22.4% suggested 8 g/dl, 15.7% suggested 9 g/dl, and 41% suggested 10 g/dl as a hemoglobin threshold for transfusion (mean, 9.40 +/- 1.27 g/dl). For case scenario 3 (a post-cardiac surgery infant), 20.1% suggested 7 g/dl, 24.6% suggested 8 g/dl, 21.6% suggested 9 g/dl, and 23.9% suggested 10 g/dl as a hemoglobin threshold for transfusion (mean, 8.72 +/- 1.24 g/dl). For case scenario 4 (a child with septic shock), 23.1% suggested 8 g/dl, 16.4% suggested 9 g/dl, and 41% suggested 10 g/dl as a hemoglobin threshold for transfusion (mean, 9.45 +/- 1.24 g/dl). The threshold for transfusion was not statistically different (P >.05) between the physicians according to their subspecialty, years of experience, or country of origin. The suggested volume of transfused blood was 10 to 15 ml/kg in 427 responses (82.6%) and 20 ml/kg in 89 responses (17.2%). Most physicians, 78/128 (60.9%), did not consider the age of the transfused blood an important factor in their decision to transfuse. Of the 106 (79.1%) physicians who detailed their considerations for elevating the threshold for transfusion, 82 (77.3%) gave a general nonspecific indication, 47 (44.3%) stated hemodynamic instability and shock, and 40 (37.7%) an ongoing bleeding. The hemoglobin threshold for blood transfusion and transfusion volume varies among European pediatric intensive care physicians, for the same patient.
本研究的目的是确定欧洲治疗危重症儿童的儿科重症监护医生当前的输血实践。向欧洲儿科和新生儿重症监护学会（ESPNIC）的成员发放了一份病例情景问卷。在ESPNIC的258名成员中，134名（51.9%）儿科重症监护医生完成了问卷。病例情景1（骨科手术后儿童）建议的输血阈值范围为<7.0 g/dl至11 g/dl。共有57.3%的人建议以7 g/dl、33.6%的人建议以8 g/dl、6.9%的人建议以9 g/dl作为输血的血红蛋白阈值（平均值为7.54±0.75）。对于病例情景2至4，建议的血红蛋白阈值为7 g/dl至12 g/dl。对于病例情景2（一名患有急性呼吸窘迫综合征的儿童），22.4%的人建议以8 g/dl、15.7%的人建议以9 g/dl、41%的人建议以10 g/dl作为输血的血红蛋白阈值（平均值为9.40±1.27 g/dl）。对于病例情景3（一名心脏手术后婴儿），20.1%的人建议以7 g/dl、24.6%的人建议以8 g/dl、21.6%的人建议以9 g/dl、23.9%的人建议以10 g/dl作为输血的血红蛋白阈值（平均值为8.72±1.24 g/dl）。对于病例情景4（一名患有感染性休克的儿童），23.1%的人建议以8 g/dl、16.4%的人建议以9 g/dl、41%的人建议以10 g/dl作为输血的血红蛋白阈值（平均值为9.45±1.24 g/dl）。根据医生的亚专业、工作年限或原籍国，输血阈值在统计学上没有差异（P>.05）。在427份回复（82.6%）中，建议的输血量为10至15 ml/kg，在89份回复（17.2%）中为20 ml/kg。大多数医生，78/128（60.9%），在决定输血时不认为所输血液的年龄是一个重要因素。在详细阐述提高输血阈值考虑因素的106名（79.1%）医生中，82名（77.3%）给出了一般的非特异性指征，47名（44.3%）指出存在血流动力学不稳定和休克，40名（37.7%）指出存在持续出血。对于同一患者，欧洲儿科重症监护医生的输血血红蛋白阈值和输血量各不相同。
