Lacroix Jacques, Tucci Marisa, Du Pont-Thibodeau Geneviève
Division of Pediatric Critical Care, Department of Pediatrics, Sainte-Justine Hospital, Université de Montréal, Montréal, Canada.
Curr Opin Pediatr. 2015 Jun;27(3):286-91. doi: 10.1097/MOP.0000000000000221.
To discuss the tradeoff between permissive anemia and administering red blood cell transfusion to children in pediatric ICUs.
Postsurgical mortality in adults increases abruptly if their nadir hemoglobin level falls below 5 g/dl. Patients with sepsis, even those in septic shock, and patients with upper gastrointestinal bleeding do not require red blood cell (RBC) transfusion if their hemoglobin level is above 7 g/dl.
Anemia is common in critically ill children and is well tolerated most of the time. RBC transfusion is required in cases of hemorrhagic shock and in children with a hemoglobin level below 5 g/dl. Children with sepsis, including septic shock, those with a severe upper gastrointestinal bleeding and all stable critically ill children, including noncyanotic cardiac children older than 28 days, do not require an RBC transfusion if their hemoglobin level is above 7 g/dl. Transfusion threshold in children with univentricular physiology and in critically ill children with a hemoglobin level between 5 and 7 g/dl remains to be determined.
探讨小儿重症监护病房（PICU）中对儿童采取允许性贫血策略与输注红细胞之间的权衡。
如果成人术后最低血红蛋白水平降至5g/dl以下，其术后死亡率会急剧上升。脓毒症患者，即使是感染性休克患者，以及上消化道出血患者，若血红蛋白水平高于7g/dl，则不需要输注红细胞（RBC）。
贫血在危重症儿童中很常见，且大多数情况下耐受性良好。失血性休克患儿以及血红蛋白水平低于5g/dl的儿童需要输注红细胞。脓毒症患儿，包括感染性休克患儿，严重上消化道出血患儿以及所有病情稳定的危重症儿童，包括出生28天以上的非紫绀型心脏病患儿，若血红蛋白水平高于7g/dl，则不需要输注红细胞。单心室生理患儿以及血红蛋白水平在5至7g/dl之间的危重症儿童的输血阈值仍有待确定。
