Department of Anesthesiology, University Medical Centre of Johannes Gutenberg University, Langenbeckstraße 1, 55131, Mainz, Germany.
Department of Anesthesiology and Intensive Care, Catholic Clinical Centre, Mainz, Germany.
BMC Anesthesiol. 2021 Apr 15;21(1):118. doi: 10.1186/s12871-021-01336-3.
Patient blood management programs should be applied to the pediatric population, but little is known about the current transfusion practice of pediatric burn injury patients. This retrospective study was performed to evaluate the practice of red blood cell (RBC) transfusion in children with burn injury, their predictive factors, and adherence to the German transfusion guideline.
We reviewed the RBC transfusion practice of all children younger than 8 years with burn injury who were operated during a four-year period in a German university medical center. We analyzed the data associated with transfusion and guideline conformity of transfusion triggers for RBCs from the beginning to the end of hospital stay using logistic regression.
During the four-year period, 138 children (median age 21 months, minimum-maximum 9-101 months) with burn injury needed surgery, 31 children were transfused with RBCs. During their hospital stay, the median hemoglobin concentrations (Hb) of transfused and non-transfused children were 8 g/dL (6.3-11.3 g/dL) and 10.7 (7-13.8 g/dL), respectively. Total body surface area burned (TBSA) (OR = 1.17 per % TBSA, 95% CI = [1.05; 1.30], p = 0.0056), length of surgery (OR = 1.016 per minute, 95% CI = [1.003; 1.028], p = 0.0150), and Hb (OR = 0.48 per 1 g/dl in Hb, 95% CI = [0.24; 0.95], p = 0.0343) were associated with transfusion while other factors (age, gender, ASA, and catecholamines) did not show notable association. Length of stay was mainly influenced by TSBA (+ 1.38 days per %, p < 0.0001), age (+ 0.21 days per month, p = 0.0206), and administering of catecholamines (+ 14.3 days, p = 0.0118), but not by RBC transfusion. The decision to transfuse was in 23% too restrictive and in 74% too liberal according to the German guidelines.
Amount of TBSA, length of surgery, and Hb influenced the RBC transfusion rate in burned children. However, age and length of stay were not affected by transfusion of RBCs. In clinical practice of burned children, physicians follow a more liberal transfusion strategy than the proposed in guidelines.
患者血液管理方案应适用于儿科人群，但目前对于儿科烧伤患者的输血实践知之甚少。本回顾性研究旨在评估儿童烧伤患者红细胞（RBC）输注的情况、预测因素以及对德国输血指南的遵循情况。
我们回顾了在德国大学医学中心接受手术的四年间所有年龄小于 8 岁的烧伤患儿的 RBC 输注情况。我们使用逻辑回归分析了与输血相关的数据以及住院期间从开始到结束时 RBC 输注触发因素与指南的一致性。
在四年期间，有 138 名烧伤患儿（中位年龄 21 个月，最小-最大年龄 9-101 个月）需要手术，其中 31 名患儿接受了 RBC 输注。在住院期间，输注 RBC 患儿和未输注 RBC 患儿的血红蛋白浓度（Hb）中位数分别为 8g/dL（6.3-11.3g/dL）和 10.7g/dL（7-13.8g/dL）。总体表烧伤面积（TBSA）（OR=每 1%TBSA 增加 1.17，95%CI=1.05-1.30，p=0.0056）、手术时长（OR=每增加 1 分钟增加 1.016，95%CI=1.003-1.028，p=0.0150）和 Hb（OR=每降低 1g/dL Hb 降低 0.48，95%CI=0.24-0.95，p=0.0343）与输血相关，而其他因素（年龄、性别、ASA 和儿茶酚胺）则无明显相关性。住院时间主要受 TBSA 影响（每增加 1%TBSA 增加 1.38 天，p<0.0001）、年龄（每增加 1 个月增加 0.21 天，p=0.0206）和儿茶酚胺的使用（增加 14.3 天，p=0.0118），但不受 RBC 输血的影响。根据德国指南，输血决策在 23%的情况下过于保守，在 74%的情况下过于宽松。
TBSA 面积、手术时长和 Hb 影响烧伤患儿的 RBC 输注率。然而，年龄和住院时间不受 RBC 输注的影响。在烧伤患儿的临床实践中，医生遵循的输血策略比指南中建议的更为宽松。
