Recommendations on RBC Transfusion in Infants and Children With Acquired and Congenital Heart Disease From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative.
Recommendations on RBC Transfusion in Infants and Children With Acquired and Congenital Heart Disease From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative.
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儿科重症监护输血和贫血专业知识倡议对患有后天性心脏病和先天性心脏病的婴儿和儿童红细胞输血的建议。
DOI：
10.1097/pcc.0000000000001603
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发表时间：
2018-09
期刊：
影响因子：
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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：
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作者：
Cholette JM;Willems A;Valentine SL;Bateman ST;Schwartz SM;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
介绍儿科重症护理输血和贫血专业倡议 (TAXI) 制定的关于患有获得性心脏病和先天性心脏病的危重儿童红细胞 (RBC) 输注的建议和支持文献。由 38 位国际多学科专家组成的危重儿童红细胞输血管理共识会议系列专家制定了基于证据的以及在证据缺乏时基于专家的危重儿童红细胞输血临床建议和研究重点。心脏病小组包括三名专家。 Electronic searches were conducted using PubMed, EMBASE, and Cochrane Library (CENTRAL) databases from 1980 to May 2017. Agreement was obtained using the Research And Development/University of California, Los Angeles (RAND UCLA) appropriateness method.使用建议评估、制定和评估分级 (GRADE) 方法对结果进行总结。制定了21项建议并达成一致。对于患有心肌功能障碍和/或肺动脉高压的儿童，没有证据表明输血血红蛋白 > 10g/dL 是有益的。对于患有未纠正的心脏病的儿童，我们建议根据他们的心肺储备将 Hb 维持在 > 7-9.0 g/dL。对于接受双心室修复的稳定儿童，如果 Hb > 7.0 g/dL，我们建议不要输血。对于正在接受分阶段姑息治疗且血流动力学稳定的婴儿，如果 Hb > 9.0 g/dL，我们建议避免仅根据 Hb 进行输血。我们建议术中和术后采取血液保存措施。没有足够的数据支持较短的红细胞储存时间。患有心脏病的儿童输注红细胞的风险和益处需要进一步研究。我们为患有心脏病的危重儿童提出红细胞输血管理建议。临床建议强调相关的 Hb 阈值，研究建议强调需要进一步了解生理和 Hb 阈值以及缺乏儿科文献的亚人群中红细胞输注的替代方案。
To present the recommendations and supporting literature for red blood cell (RBC) transfusions in critically ill children with acquired and congenital heart disease developed by the Pediatric Critical Care Transfusion and Anemia Expertise Initiative (TAXI). Consensus conference series of 38 international, multidisciplinary experts in RBC transfusion management of critically ill children Experts developed evidence-based and when evidence was lacking, expert-based clinical recommendations and research priorities for RBC transfusions in critically ill children. The cardiac disease subgroup included three experts. Electronic searches were conducted using PubMed, EMBASE, and Cochrane Library (CENTRAL) databases from 1980 to May 2017. Agreement was obtained using the Research And Development/University of California, Los Angeles (RAND UCLA) appropriateness method. Results were summarized using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method. 21 recommendations were developed, and reached agreement. For children with myocardial dysfunction and/or pulmonary hypertension there is no evidence that transfusion > Hb of 10g/dL is beneficial. For children with uncorrected heart disease, we recommended maintaining Hb > 7–9.0 g/dL depending upon their cardiopulmonary reserve. For stable children undergoing biventricular repairs, we recommend not transfusing if the Hb is > 7.0 g/dL. For infants undergoing staged palliative procedures with stable hemodynamics, we recommend avoiding transfusions solely based upon Hb, if Hb is > 9.0 g/dL. We recommend intra- and postoperative blood conservation measures. There is insufficient data supporting shorter storage duration RBCs. The risks and benefits of RBC transfusions in children with cardiac disease requires further study. We present RBC transfusion management recommendations for the critically ill child with cardiac disease. Clinical recommendations emphasize relevant Hb thresholds and research recommendations emphasize need for further understanding of physiological and Hb thresholds and alternatives to RBC transfusion in sub-populations lacking pediatric literature.