Transfusion strategies for patients in pediatric intensive care units

被引:769
作者
Lacroix, Jacques
Hebert, Paul C.
Hutchison, James S.
Hume, Heather A.
Tucci, Marisa
Ducruet, Thierry
Gauvin, France
Collet, Jean-Paul
Toledano, Baruch J.
Robillard, Pierre
Joffe, Ari
Biarent, Dominique
Meert, Kathleen
Peters, Mark J.
机构
[1] Univ Montreal, Hop St Justine, Montreal, PQ H3T 1C5, Canada
[2] McGill Univ, Montreal, PQ, Canada
[3] Univ Ottawa, Ottawa, ON, Canada
[4] Univ Toronto, Toronto, ON, Canada
[5] Univ British Columbia, Vancouver, BC V5Z 1M9, Canada
[6] Univ Alberta, Edmonton, AB, Canada
[7] Univ Libre Bruxelles, Brussels, Belgium
[8] Wayne State Univ, Detroit, MI USA
[9] Inst Child Hlth, London, England
关键词
D O I
10.1056/NEJMoa066240
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND: The optimal hemoglobin threshold for erythrocyte transfusions in critically ill children is unknown. We hypothesized that a restrictive transfusion strategy of using packed red cells that were leukocyte-reduced before storage would be as safe as a liberal transfusion strategy, as judged by the outcome of multiple-organ dysfunction. METHODS: In this noninferiority trial, we enrolled 637 stable, critically ill children who had hemoglobin concentrations below 9.5 g per deciliter within 7 days after admission to an intensive care unit. We randomly assigned 320 patients to a hemoglobin threshold of 7 g per deciliter for red-cell transfusion (restrictive-strategy group) and 317 patients to a threshold of 9.5 g per deciliter (liberal-strategy group). RESULTS: Hemoglobin concentrations were maintained at a mean (+/- SD) level that was 2.1 +/- 0.2 g per deciliter lower in the restrictive-strategy group than in the liberal-strategy group (lowest average levels, 8.7 +/- 0.4 and 10.8 +/- 0.5 g per deciliter, respectively; P < 0.001). Patients in the restrictive-strategy group received 44% fewer transfusions; 174 patients (54%) in that group did not receive any transfusions, as compared with 7 patients (2%) in the liberal-strategy group (P < 0.001). New or progressive multiple-organ dysfunction syndrome (the primary outcome) developed in 38 patients in the restrictive-strategy group, as compared with 39 in the liberal-strategy group (12% in both groups) (absolute risk reduction with the restrictive strategy, 0.4%; 95% confidence interval, -4.6 to 5.4). There were 14 deaths in each group within 28 days after randomization. No significant differences were found in other outcomes, including adverse events. CONCLUSIONS: In stable, critically ill children a hemoglobin threshold of 7 g per deciliter for red-cell transfusion can decrease transfusion requirements without increasing adverse outcomes.
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收藏
页码:1609 / 1619
页数:11
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