Division of Critical Care Medicine, Department of Pediatrics, Weill Cornell Medical College, New York, NY.
Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada.
Crit Care Med. 2022 Feb 1;50(2):173-182. doi: 10.1097/CCM.0000000000005393.
Primary objective is to determine if transfusion of short storage RBCs compared with standard issue RBCs reduced risk of delirium/coma in critically ill children. Secondary objective is to assess if RBC transfusion was independently associated with delirium/coma.
This study was performed in two stages. First, we compared patients receiving either short storage or standard RBCs in a multi-institutional prospective randomized controlled trial. Then, we compared all transfused patients in the randomized controlled trial with a single-center cohort of nontransfused patients matched for confounders of delirium/coma.
Twenty academic PICUs who participated in the Age of Transfused Blood in Critically Ill Children trial.
Children 3 days to 16 years old who were transfused RBCs within the first 7 days of admission.
Subjects were randomized to either short storage RBC study arm (defined as RBCs stored for up to seven days) or standard issue RBC study arm. In addition, subjects were screened for delirium prior to transfusion and every 12 hours after transfusion for up to 3 days.
Primary outcome measure was development of delirium/coma within 3 days of initial transfusion. Additional outcome measures were dose-response relationship between volume of RBCs transfused and delirium/coma, and comparison of delirium/coma rates between transfused patients and individually matched nontransfused patients. We included 146 subjects in the stage I analysis; 69 were randomized to short storage RBCs and 77 to standard issue. There was no significant difference in delirium/coma development between study arms (79.5% vs 70.1%; p = 0.184). In the stage II analysis, adjusted odds for delirium in the transfused cohort was more than eight-fold higher than in the nontransfused matched cohort, even after controlling for hemoglobin (adjusted odds ratio, 8.9; CI, 2.8-28.4; p < 0.001).
RBC transfusions (and not anemia) are independently associated with increased odds of subsequent delirium/coma. However, storage age of RBCs does not affect delirium risk.
主要目的是确定与标准发放的红细胞相比，输注短期储存的红细胞是否降低了危重症儿童发生谵妄/昏迷的风险。次要目的是评估红细胞输注是否与谵妄/昏迷独立相关。
本研究分两个阶段进行。首先，我们比较了多机构前瞻性随机对照试验中接受短期储存或标准红细胞的患者。然后，我们将随机对照试验中的所有输血患者与单中心未输血患者队列进行比较，这些患者在谵妄/昏迷的混杂因素方面进行了匹配。
参与危重症儿童输注血液年龄研究的 20 个学术 PICUs。
入院后 3 天至 16 岁接受 RBC 输血的患者。
受试者随机分配至短期储存 RBC 研究臂（定义为储存时间长达 7 天的 RBC）或标准发放 RBC 研究臂。此外，在输血前和输血后每 12 小时对受试者进行谵妄筛查，持续 3 天。
主要结局指标是初始输血后 3 天内发生谵妄/昏迷。其他结局指标包括输注 RBC 量与谵妄/昏迷之间的剂量反应关系，以及输血患者与单独匹配的未输血患者之间的谵妄/昏迷发生率比较。我们对 146 名患者进行了 I 期分析；69 名患者随机分配至短期储存 RBC 组，77 名患者分配至标准发放 RBC 组。研究组之间谵妄/昏迷的发生率无显著差异（79.5%与 70.1%；p=0.184）。在 II 期分析中，即使在校正血红蛋白后，输血队列发生谵妄的调整比值比未输血匹配队列高 8 倍以上（调整比值比，8.9；CI，2.8-28.4；p<0.001）。
红细胞输注（而非贫血）与随后发生谵妄/昏迷的几率增加独立相关。然而，红细胞的储存年龄并不影响谵妄的风险。
