Pediatric Critical Care Transfusion and Anemia Expertise Initiative

 描述(由申请人提供)：近一半的危重儿童与儿科重症监护病房(PICU)的住院期和48小时将接受输注红细胞(PRBC)。尽管有证据表明，在PICU中输入较低的pRBC血红蛋白门槛是安全的，但多项研究表明，实际应用中的门槛要高得多，使儿童面临与pRBC相关的显著发病率和死亡率。因此，对于护理危重儿童的临床医生来说，越来越需要循证的血液管理策略，旨在保持生理上相关的血红蛋白浓度，优化止血，并尽量减少失血，以努力改善患者的预后。在这一领域针对儿童的研究仍然很少，因此迫切需要一份研究指南。儿科重症监护输血和贫血专业知识倡议(TAIL)与儿科重症监护血液研究网络(BroudNet)、儿科急性肺损伤和败血症调查员(PALISI)、美国血库协会(AABB)和重症监护医学会(SCCM)合作，提议由国际和多学科专家领导的一系列会议，为临床指导和未来研究工作制定儿科重症监护血液管理共识。该小组将在两年内通过有组织和结构化的过程创建一系列全面的共识声明，概述危重儿童pRBC输注领域的现有数据和未来的研究重点。出租车已经获得了40多名国际专家对该项目的同意/支持，以及SCCM和AABB的支持，他们积极参与并处于支持共识产品的地位。这一倡议的新特点包括及早与正式的实施科学、医学人类学和人类因素工程专家接触，以便我们可以最好地指导共识声明的理解，以便改善接受pRBC输血的风险儿童或需要pRBC输血的儿童的结局和安全性。共识声明将包括在各种临床/研究环境中进行适应性传播和实施的具体战略。还必须考虑到环境和整体医学文化中可能限制广泛应用和传播声明建议的挑战。

 DESCRIPTION (provided by applicant): Nearly half of critically ill children with a pediatric intensive care unit (PICU) length of stay >48hrs will receive a transfusion of packed red blood cells (pRBC). Despite evidence that a lower hemoglobin threshold for pRBC transfusion in the PICU is safe, multiple studies have shown that the threshold in practice is much higher, exposing children to the significant morbidity and mortality associated with pRBC. Therefore there is increased need for evidence- based blood management strategies for clinicians caring for critically ill children aimed to maintain a physiologically relevant hemoglobin concentration, optimize hemostasis and minimize blood loss in an effort to improve patient outcomes. There remains a paucity of research in this area for children so a research guide is desperately needed. The Pediatric Critical Care Transfusion and Anemia Expertise Initiative (TAXI), in collaboration with the Pediatric Critical Care Blood Research Network (BloodNet), the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI), the American Association of Blood Banks (AABB) and the Society for Critical Care Medicine (SCCM), proposes a conference series led by international and multidisciplinary experts to develop pediatric critical care blood management consensus for clinical guidance and future research efforts. This group will create a comprehensive series of consensus statements via an organized and structured process over 2 years to outline existing data and future research foci in the area of pRBC transfusions in critically ill children. TAXI has obtained letters of agreement/support from over 40 international experts for this project, as well as from the SCCM and the AABB, who are actively engaged and positioned to endorse the consensus products. Novel features of this initiative include early engagement with formal implementation science, medical anthropology and human factor engineering experts, so that we may best guide consensus statement uptake in order to improve outcomes and safety for children at risk for, or who require, pRBC transfusion. The consensus statements will include specific strategies for adaptive dissemination and implementation into various clinical/research environments. It will also be imperative that the statements be developed with an approach that accounts for the challenges in the environment and overall medical culture that may limit wide application and dissemination of the statement's recommendations.