Anemia, blood loss, and blood transfusions in North American children in the intensive care unit
Anemia, blood loss, and blood transfusions in North American children in the intensive care unit
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DOI：
10.1164/rccm.200711-1637oc
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发表时间：
2008-07-01
影响因子：
24.7
通讯作者：
Randolph, Adrienne G.
中科院分区：
文献类型：
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作者：
Bateman, Scot T.;Lacroix, Jacques;Randolph, Adrienne G.
目的：了解儿科重症监护病房(PICU)的贫血发展、失血和红细胞输注情况。方法：在30个PICU中进行前瞻性、多中心、6个月的观察性研究。收集了在PICU连续48小时或更长时间的儿童(18岁)的数据。测量和主要结果：贫血的发生、失血和红细胞输注。共有977名儿童入学。大多数儿童(74%)在PICU中患有贫血(33%在入院时，41%发展为贫血)。每天抽血占出血量的73%，中位数为5.0ml/天。49%的儿童接受了输血；74%的首次输血是在第1-2天。在调整了年龄和疾病严重程度后，与未输血的儿童相比，接受输血的儿童显著延长了机械通气天数(2.1d，P<；0.001)和在PICU停留的时间(1.8d，P=0.03)，并增加了死亡率(优势比[OR]，11.6；95%可信区间[CI]，1.43-90.9；P=0.02)，医院感染(OR，1.9；95%CI，1.2-3.0；P=0.004)，以及心肺功能障碍(OR，2.1；95%可信区间，1.5-3.0%；P<；0.001)。入院后48小时以上输血与每公斤体重失血量(OR，1.11；95%CI，1.03~1.2；P=0.01)相关。最常见的输血指征是低血红蛋白(42%)。输血前血红蛋白平均值为9.7+/-2.7g/dl，差异很大。结论：危重患儿有发生贫血和输血的危险。在PICU中输血与较差的结果相关。当务之急是尽量减少抽血造成的失血，并设定明确的输血阈值。
Rationale Minimizing exposure of children to blood products is desirable.Objectives: We aimed to understand anemia development, blood loss, and red blood cell (RBC) transfusions in the pediatric intensive care unit (PICU).Methods: Prospective, multicenter, 6-month observational study in 30 PICUs. Data were collected on consecutive children (< 18 yr old) in the PICU for 48 hours or more.Measurements and Main Results: Anemia development, blood loss, and RBC transfusions were measured. A total of 977 children were enrolled. Most (74%) children were anemic in the PICU (33% on admission, 41% developed anemia). Blood draws accounted for 73% of daily blood loss; median loss was 5.0 ml/day. Forty-nine percent of children received transfusions; 74% of first transfusions were on Days 1-2. After adjusting for age and illness severity, compared with nontransfused children, children who underwent transfusion had significantly longer days of mechanical ventilation (2.1 d, P < 0.001) and PICU stay (1.8 d, P = 0.03), and had increased mortality (odds ratio [OR], 11.6; 95% confidence interval [CI], 1.43-90.9; P = 0.02), nosocomial infections (OR, 1.9; 95% CI, 1.2-3.0; P = 0.004), and cardiorespiratory dysfunction (OR, 2.1; 95% CI, 1.5-3.0; P < 0.001). High blood loss per kilogram body weight from blood draws (OR, 1.11;95%CI, 1.03-1.2; P = 0.01) was associated with RBC transfusion more than 48 hours after admission. The most common indication for transfusion was low hemoglobin (42%). Pretransfusion hemoglobin values varied greatly (mean, 9.7 +/- 2.7 g/dl).Conclusions: Critically ill children are at significant risk for developing anemia and receiving blood transfusions. Transfusion in the PICU was associated with worse outcomes. It is imperative to minimize blood loss from blood draws and to set clear transfusion thresholds.