Robert C Tasker1,2, Alexis F Turgeon3, Philip C Spinella4. 1. Department of Neurology, Harvard Medical School, Boston Children's Hospital, Boston, MA. 2. Division of Critical Care Medicine, Department of Anesthesia (Pediatrics), Harvard Medical School, Boston Children's Hospital, Boston, MA. 3. Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, and CHU de Québec - Université Laval Research Center (Population Health and Optimal Health Practices Research Unit), Université Laval, Québec City, QC, Canada. 4. Division of Critical Care, Department of Pediatrics, Washington University in St Louis, St Louis, MO.
Abstract
OBJECTIVES: To present the recommendations and supporting literature for RBC transfusions in critically ill children with acute brain injury developed by the Pediatric Critical Care Transfusion and Anemia Expertise Initiative. DESIGN: Consensus conference series of international, multidisciplinary experts in RBC transfusion management of critically ill children. METHODS: The panel of 38 experts developed evidence-based, and when evidence was lacking, expert-based clinical recommendations as well as research priorities for RBC transfusions in critically ill children. The acute brain injury subgroup included three experts. Electronic searches were conducted using PubMed, EMBASE, and Cochrane Library databases from 1980 to May 2017. Agreement was obtained using the Research and Development/UCLA Appropriateness Method. Results were summarized using the Grading of Recommendations Assessment, Development, and Evaluation method. RESULTS: Transfusion and Anemia Expertise Initiative Consensus Conference experts developed and agreed upon two clinical and two research recommendations focused on RBC transfusion in the critically ill child with acute brain injury. Recommendations include consideration of RBC transfusion for a hemoglobin concentration between 7 and 10 g/dL in patients with acute brain injury and do not support the use of brain tissue PO2 monitoring to guide RBC transfusion decisions. Research is needed to better understand transfusion thresholds and brain tissue monitoring for pediatric patients with acute brain injury. CONCLUSIONS: The Transfusion and Anemia Expertise Initiative Consensus Conference developed pediatric-specific clinical and research recommendations regarding RBC transfusion in the critically ill child with acute brain injury. Although agreement among experts was very strong, the available pediatric evidence was extremely limited with major gaps in the literature.
OBJECTIVES: To present the recommendations and supporting literature for RBC transfusions in critically illchildren with acute brain injury developed by the Pediatric Critical Care Transfusion and Anemia Expertise Initiative. DESIGN: Consensus conference series of international, multidisciplinary experts in RBC transfusion management of critically illchildren. METHODS: The panel of 38 experts developed evidence-based, and when evidence was lacking, expert-based clinical recommendations as well as research priorities for RBC transfusions in critically illchildren. The acute brain injury subgroup included three experts. Electronic searches were conducted using PubMed, EMBASE, and Cochrane Library databases from 1980 to May 2017. Agreement was obtained using the Research and Development/UCLA Appropriateness Method. Results were summarized using the Grading of Recommendations Assessment, Development, and Evaluation method. RESULTS: Transfusion and Anemia Expertise Initiative Consensus Conference experts developed and agreed upon two clinical and two research recommendations focused on RBC transfusion in the critically illchild with acute brain injury. Recommendations include consideration of RBC transfusion for a hemoglobin concentration between 7 and 10 g/dL in patients with acute brain injury and do not support the use of brain tissue PO2 monitoring to guide RBC transfusion decisions. Research is needed to better understand transfusion thresholds and brain tissue monitoring for pediatric patients with acute brain injury. CONCLUSIONS: The Transfusion and Anemia Expertise Initiative Consensus Conference developed pediatric-specific clinical and research recommendations regarding RBC transfusion in the critically illchild with acute brain injury. Although agreement among experts was very strong, the available pediatric evidence was extremely limited with major gaps in the literature.
Authors: Amélie Boutin; Michaël Chassé; Michèle Shemilt; François Lauzier; Lynne Moore; Ryan Zarychanski; Donald Griesdale; Philippe Desjardins; Jacques Lacroix; Dean Fergusson; Alexis F Turgeon Journal: Transfus Med Rev Date: 2015-08-28
Authors: Timothy P Welch; Michael J Wallendorf; Evan D Kharasch; Jeffrey R Leonard; Allan Doctor; Jose A Pineda Journal: Crit Care Med Date: 2016-04 Impact factor: 7.598
Authors: Anthony A Figaji; Eugene Zwane; A Graham Fieggen; Andrew C Argent; Peter D Le Roux; Jonathan C Peter Journal: Neurocrit Care Date: 2010-06 Impact factor: 3.210
Authors: Anthony A Figaji; Eugene Zwane; Crispin Thompson; A Graham Fieggen; Andrew C Argent; Peter D Le Roux; Jonathan C Peter Journal: Childs Nerv Syst Date: 2009-02-13 Impact factor: 1.475
Authors: Pradeep K Narotam; Sathyaprasad C Burjonrappa; Stephen C Raynor; Malini Rao; Charles Taylon Journal: J Pediatr Surg Date: 2006-03 Impact factor: 2.545
Authors: Jacques Lacroix; Paul C Hébert; James S Hutchison; Heather A Hume; Marisa Tucci; Thierry Ducruet; France Gauvin; Jean-Paul Collet; Baruch J Toledano; Pierre Robillard; Ari Joffe; Dominique Biarent; Kathleen Meert; Mark J Peters Journal: N Engl J Med Date: 2007-04-19 Impact factor: 91.245
Authors: Anthony A Figaji; Eugene Zwane; M Kogels; A Graham Fieggen; Andrew C Argent; Peter D Le Roux; Jonathan C Peter Journal: Pediatr Crit Care Med Date: 2010-05 Impact factor: 3.624
Authors: Philippe Desjardins; Alexis F Turgeon; Marie-Hélène Tremblay; François Lauzier; Ryan Zarychanski; Amélie Boutin; Lynne Moore; Lauralyn A McIntyre; Shane W English; Andrea Rigamonti; Jacques Lacroix; Dean A Fergusson Journal: Crit Care Date: 2012-12-12 Impact factor: 9.097
Authors: Allan Doctor; Jill M Cholette; Kenneth E Remy; Andrew Argent; Jeffrey L Carson; Stacey L Valentine; Scot T Bateman; Jacques Lacroix Journal: Pediatr Crit Care Med Date: 2018-09 Impact factor: 3.624
Authors: Stacey L Valentine; Melania M Bembea; Jennifer A Muszynski; Jill M Cholette; Allan Doctor; Phillip C Spinella; Marie E Steiner; Marisa Tucci; Nabil E Hassan; Robert I Parker; Jacques Lacroix; Andrew Argent; Jeffrey L Carson; Kenneth E Remy; Pierre Demaret; Guillaume Emeriaud; Martin C J Kneyber; Nina Guzzetta; Mark W Hall; Duncan Macrae; Oliver Karam; Robert T Russell; Paul A Stricker; Adam M Vogel; Robert C Tasker; Alexis F Turgeon; Steven M Schwartz; Ariane Willems; Cassandra D Josephson; Naomi L C Luban; Leslie E Lehmann; Simon J Stanworth; Nicole D Zantek; Timothy E Bunchman; Ira M Cheifetz; James D Fortenberry; Meghan Delaney; Leo van de Watering; Karen A Robinson; Sara Malone; Katherine M Steffen; Scot T Bateman Journal: Pediatr Crit Care Med Date: 2018-09 Impact factor: 3.624