Wittenmeier Eva, Komorek Yannick, Engelhard Kristin
Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg University Mainz, Germany.
Curr Opin Anaesthesiol. 2023 Jun 1;36(3):301-310. doi: 10.1097/ACO.0000000000001253. Epub 2023 Feb 15.
The use of restrictive transfusion triggers to avoid unnecessary transfusions is one important pillar of Patient Blood Management (PBM). For the safe application of this principle in pediatric patients, anesthesiologists need evidence-based guidelines for hemoglobin (Hb) transfusions thresholds in this specially vulnerable age-group.
This review outlines recent prospective and observational studies examining transfusion thresholds in pediatrics. Recommendations to use transfusion triggers in the perioperative or intensive care setting are summarized.
Two high-quality studies confirmed that the use of restrictive transfusion triggers in preterm infants in the intensive care unit (ICU) is reasonable and feasible. Unfortunately, no recent prospective study could be found investigating intraoperative transfusion triggers. Some observational studies showed wide variability in Hb levels before transfusion, a tendency toward restrictive transfusion practices in preterm infants, and liberal transfusion practices in older infants. Although there are comprehensive and useful guidelines for clinical practice in pediatric transfusion, most of them do not cover the intraoperative period in particular because of a lack of high-quality studies. This lack of prospective randomized trials focusing on intraoperative transfusion management remains a major problem for the application of pediatric PBM.
使用限制性输血阈值以避免不必要的输血是患者血液管理（PBM）的一个重要支柱。为了在儿科患者中安全应用这一原则，麻醉医生需要针对这个特别脆弱年龄组的血红蛋白（Hb）输血阈值的循证指南。
本综述概述了近期关于儿科输血阈值的前瞻性和观察性研究。总结了在围手术期或重症监护环境中使用输血阈值的建议。
两项高质量研究证实，在重症监护病房（ICU）的早产儿中使用限制性输血阈值是合理且可行的。遗憾的是，未找到近期研究术中输血阈值的前瞻性研究。一些观察性研究显示输血前Hb水平差异很大，早产儿有采取限制性输血做法的趋势，而大龄婴儿则有宽松输血做法的趋势。尽管有针对儿科输血临床实践的全面且实用的指南，但由于缺乏高质量研究，其中大多数并未特别涵盖术中阶段。缺乏专注于术中输血管理的前瞻性随机试验仍然是儿科PBM应用中的一个主要问题。
