Pediatric Critical Care Transfusion and Anemia Expertise Initiative

 描述（由申请人提供）：在儿科重症监护室（PICU）住院时间> 48小时的危重患儿中，近一半将接受浓缩红细胞（pRBC）输注。尽管有证据表明，在PICU中输注pRBC的血红蛋白阈值较低是安全的，但多项研究表明，实际阈值要高得多，使儿童暴露于与pRBC相关的显著发病率和死亡率。因此，越来越需要为护理危重患儿的临床医生制定循证血液管理策略，旨在维持生理相关的血红蛋白浓度，优化止血并最大限度地减少失血，以改善患者结局。在这一领域对儿童的研究仍然很少，因此迫切需要一个研究指南。儿科重症监护输血和贫血专业知识倡议（TAXI），与儿科重症监护血液研究网络合作（BloodNet）、儿科急性肺损伤和脓毒症研究者（PALISI）、美国血库协会（AABB）和重症监护医学学会（SCCM），提出了一个由国际和多学科专家领导的系列会议，以制定儿科重症监护血液管理共识，为临床指导和未来的研究工作。该小组将在2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，以概述危重儿童pRBC输注领域的现有数据和未来研究重点。TAXI已经获得了40多位国际专家对该项目的协议/支持，以及SCCM和AABB的支持，他们积极参与并支持共识产品。该计划的新特点包括与正式实施科学，医学人类学和人因工程专家的早期接触，以便我们可以最好地指导共识声明的吸收，以改善有风险或需要pRBC输血的儿童的结局和安全性。共识声明将包括适应性传播和实施到各种临床/研究环境的具体策略。还必须在制定声明时考虑到环境和整个医学文化中的挑战，这些挑战可能会限制声明建议的广泛应用和传播。

 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.