Recommendations on the Indications for RBC Transfusion for the Critically Ill Child Receiving Support From Extracorporeal Membrane Oxygenation, Ventricular Assist, and Renal Replacement Therapy Devices From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative.
Recommendations on the Indications for RBC Transfusion for the Critically Ill Child Receiving Support From Extracorporeal Membrane Oxygenation, Ventricular Assist, and Renal Replacement Therapy Devices From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative.
复制标题
DOI：
10.1097/pcc.0000000000001600
复制
发表时间：
2018-09
期刊：
影响因子：
--
通讯作者：
Pediatric Critical Care Blood Research Network (BloodNet), and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network
中科院分区：
文献类型：
--
作者：
Bembea MM;Cheifetz IM;Fortenberry JD;Bunchman TE;Valentine SL;Bateman ST;Steiner ME;Pediatric Critical Care Transfusion and Anemia Expertise Initiative (TAXI);Pediatric Critical Care Blood Research Network (BloodNet), and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network
介绍在体外膜肺氧合（ECMO）、心室辅助装置（VAD）或肾脏替代治疗（RRT）支持下，危重患儿红细胞（RBC）输注的建议和支持文献。由38名专家组成的专家小组制定了基于证据的临床建议以及在缺乏证据的情况下，基于专家的临床建议以及危重儿童红细胞输注的研究优先事项。ECMO/VAD/RRT亚组包括6名专家。我们对1980年至2017年5月的PubMed、Embase和科克伦图书馆（CENTRAL）数据库进行了电子检索，使用医学主题词和文本词定义RBC输血、ECMO、VAD和RRT的概念。我们使用标准化的数据提取表格来构建证据表，并使用建议评估、开发和评估（GRADE）系统对证据进行分级。所有专家组成员对提出的建议和支持性文献进行了审查和评分。使用研究与开发部/加州大学洛杉矶分校（兰德/UCLA）适当性方法获得协议。对于需要ECMO、VAD或RRT支持的住院患者，专家同意（>80%）五项良好实践声明，旨在提高儿科ECMO、VAD和RRT研究和质量改进项目中RBC输注数据的准确性和统一报告;除了血红蛋白浓度外，还提出了四项关于生理指标和氧气输送生物标志物的临床建议，以指导RBC输注，承认没有足够的证据推荐特定的红细胞输血策略;和八项研究建议。显然需要进一步研究体外装置上儿童红细胞输注的适应症、风险、益处和替代方案。使用结构化的文献综述和分级过程，TAXI专家组得出结论，目前没有足够的证据推荐需要ECMO、VAD或RRT支持的儿童的特定RBC输血参数。
To present recommendations and supporting literature for red blood cell (RBC) transfusions in critically ill children supported with extracorporeal membrane oxygenation (ECMO), ventricular assist devices (VAD) or renal replacement therapy (RRT). Consensus conference series of international, multidisciplinary experts in RBC transfusion management of critically ill children The panel of 38 experts developed evidence-based and when evidence was lacking, expert-based clinical recommendations as well as research priorities for RBC transfusions in critically ill children. The ECMO/VAD/RRT subgroup included six experts. We conducted electronic searches of the PubMed, Embase, and Cochrane Library (CENTRAL) databases from 1980 to May 2017, using medical subject heading terms and text words to define concepts of RBC transfusion, ECMO, VAD, and RRT. We used a standardized data extraction form to construct evidence tables and graded the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Recommendations developed and supporting literature were reviewed and scored by all panel members. Agreement was obtained using the Research And Development/University of California, Los Angeles (RAND/UCLA) appropriateness method. For inpatients requiring ECMO, VAD, or RRT support, there was expert agreement (>80%) on five good practice statements aimed to improve accuracy and uniform reporting of RBC transfusion data in pediatric ECMO, VAD, and RRT studies and quality improvement projects; four clinical recommendations of physiologic metrics and biomarkers of oxygen delivery, in addition to hemoglobin concentration, to guide RBC transfusion, acknowledging insufficient evidence to recommend specific RBC transfusion strategies; and eight research recommendations. Further research surrounding indications, risks, benefits, and alternatives to RBC transfusion in children on extracorporeal devices is clearly needed. Using a structured literature review and grading process, the TAXI panel concluded that there is currently insufficient evidence to recommend specific RBC transfusion parameters in children requiring ECMO, VAD, or RRT support.