Pediatric Critical Care Unit, Sainte-Justine Hospital and Université de Montréal, Montreal, Canada.
Pediatr Crit Care Med. 2011 Sep;12(5):512-8. doi: 10.1097/PCC.0b013e3181fe344b.
In children with severe sepsis or septic shock, the optimal red blood cell transfusion threshold is unknown. We analyzed the subgroup of patients with sepsis and transfusion requirements in a pediatric intensive care unit study to determine the impact of a restrictive vs. liberal transfusion strategy on clinical outcome.
Subgroup analysis of a prospective, multicenter, randomized, controlled trial.
Multicenter pediatric critical care units.
Stabilized critically ill children (mean systemic arterial pressure >2 sd below normal mean for age and cardiovascular support not increased for at least 2 hrs before enrollment) with a hemoglobin ≤ 9.5 g/dL within 7 days after pediatric critical care unit admission.
One hundred thirty-seven stabilized critically ill children with sepsis were randomized to receive red blood cell transfusion if their hemoglobin decreased to either <7.0 g/dL (restrictive group) or 9.5 g/dL (liberal group).
In the restrictive group (69 patients), 30 patients did not receive any red blood cell transfusion, whereas only one patient in the liberal group (68 patients) never underwent transfusion (p < .01). No clinically significant differences were found for the occurrence of new or progressive multiple organ dysfunction syndrome (18.8% vs. 19.1%; p = .97), for pediatric critical care unit length of stay (p = .74), or for pediatric critical care unit mortality (p = .44) in the restrictive vs. liberal group.
In this subgroup analysis of children with stable sepsis, we found no evidence that a restrictive red cell transfusion strategy, as compared to a liberal one, increased the rate of new or progressive multiple organ dysfunction syndromes. Furthermore, a restrictive transfusion threshold significantly reduced exposure to blood products. Our data suggest that a hemoglobin level of 7.0 g/dL may be safe stabilized for children with sepsis, but further studies are required to support this recommendation.
在患有严重脓毒症或感染性休克的儿童中，最佳的红细胞输注阈值尚不清楚。我们分析了儿科重症监护病房研究中患有脓毒症且有输血需求的患者亚组，以确定限制与宽松输血策略对临床结局的影响。
前瞻性、多中心、随机、对照试验的亚组分析。
多中心儿科重症监护病房。
入住儿科重症监护病房 7 天内稳定的危重症儿童（平均体动脉压低于年龄正常均值 2 个标准差以上，且在入组前至少 2 小时未增加心血管支持），血红蛋白 ≤ 9.5g/dL。
将 137 例稳定的脓毒症危重症儿童随机分为两组，若血红蛋白降至 <7.0g/dL（限制组）或 9.5g/dL（宽松组），则输注红细胞。
在限制组（69 例）中，有 30 例患者未接受任何红细胞输注，而在宽松组（68 例）中仅有 1 例患者从未接受过输血（p <.01）。在新发生或进展性多器官功能障碍综合征的发生率（18.8% vs. 19.1%；p =.97）、儿科重症监护病房住院时间（p =.74）或儿科重症监护病房死亡率（p =.44）方面，限制组与宽松组之间均无显著差异。
在本项稳定脓毒症患儿的亚组分析中，我们未发现与宽松输血策略相比，限制红细胞输血策略会增加新发生或进展性多器官功能障碍综合征的发生率。此外，限制输血阈值可显著减少血液制品的暴露。我们的数据表明，血红蛋白水平为 7.0g/dL 可能对脓毒症患儿是安全的，但还需要进一步的研究来支持这一建议。
