Long Debbie A, Slaughter Eugene, Mihala Gabor, Macfarlane Fiona, Ullman Amanda J, Keogh Samantha, Stocker Christian
School of Nursing and Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD, Australia; Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, QLD, Australia; Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia.
School of Nursing and Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD, Australia; Alliance for Vascular Access Teaching and Research, School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia.
Aust Crit Care. 2023 Mar;36(2):201-207. doi: 10.1016/j.aucc.2021.12.008. Epub 2022 Feb 25.
The objective of this study was to audit current patient blood management practice in children throughout cardiac surgery and paediatric intensive care unit (PICU) admission.
This was a prospective observational cohort study.
This was a single-centre study in the cardiac operating room (OR) and PICU in a major tertiary children's hospital in Australia.
Children undergoing corrective cardiac surgery and requiring admission to PICU for postoperative recovery were included in the study.
Fifty-six patients and 1779 blood sampling episodes were audited over a 7-month period. The median age was 9 months (interquartile range [IQR] = 1-102), with the majority (n = 30 [54%]) younger than 12 months. The median number of blood sampling episodes per patient per day was 6.6 (IQR = 5.8-8.0) in total, with a median of 5.0 (IQR = 4.0-7.5) episodes in the OR and 5.0 (IQR = 3.4-6.2) episodes per day throughout PICU admission. The most common reason for blood tests across both OR and PICU settings was arterial blood gas analysis (total median = 86%, IQR = 79-96). The overall median blood sampling volume per kg of bodyweight, patient, and day was 0.63 mL (IQR = 0.20-1.14) in total. Median blood loss for each patient was 3.5 mL/kg per patient per day (IQR = 1.7-5.6) with negligible amounts in the OR and a median of 3.6 mL/kg (IQR = 1.7-5.7) in the PICU. The median Cell Saver® transfusion volume was 9.9 mL/kg per patient per day (IQR = 4.0-19.1) in the OR. The overall median volume of other infusion products (albumin 4%, albumin 20%, packed red blood cells) received by each patient was 20.1 mL/kg (IQR = 10.7-36.4) per day. Sampling events and blood loss were positively associated with PICU stay.
Patient blood management practices observed in this study largely conform to National Blood Authority guidelines. Further implementation projects and research are needed to accelerate implementation of known effective blood conservation strategies within paediatric critical care environments.
本研究的目的是审查儿童在整个心脏手术及入住儿科重症监护病房（PICU）期间当前的患者血液管理实践情况。
这是一项前瞻性观察队列研究。
这是在澳大利亚一家大型三级儿童医院的心脏手术室（OR）和PICU进行的单中心研究。
接受心脏矫正手术且术后需要入住PICU恢复的儿童被纳入本研究。
在7个月的时间里，对56名患者和1779次采血事件进行了审查。中位年龄为9个月（四分位间距[IQR]=1-102），大多数（n=30[54%]）年龄小于12个月。每位患者每天采血事件的中位数总计为6.6次（IQR=5.8-8.0），其中在手术室的中位数为5.0次（IQR=4.0-7.5），在整个PICU住院期间每天的中位数为5.0次（IQR=3.4-6.2）。手术室和PICU环境中血液检测最常见的原因是动脉血气分析（总计中位数=86%，IQR=79-96）。每位患者、每千克体重、每天的总体采血中位数体积总计为0.63mL（IQR=0.20-1.14）。每位患者每天的中位失血量为3.5mL/kg（IQR=1.7-5.6），在手术室中失血量可忽略不计，在PICU中的中位数为3.6mL/kg（IQR=1.7-5.7）。在手术室中，每位患者每天Cell Saver®输血量的中位数为9.9mL/kg（IQR=4.0-19.1）。每位患者每天接受的其他输注产品（4%白蛋白、20%白蛋白、浓缩红细胞）的总体中位数体积为20.1mL/kg（IQR=10.7-36.4）。采血事件和失血量与PICU住院时间呈正相关。
本研究中观察到的患者血液管理实践在很大程度上符合国家血液管理局的指南。需要进一步开展实施项目和研究，以加速在儿科重症监护环境中实施已知有效的血液保护策略。
