Stacey L Valentine1, Melania M Bembea2, Jennifer A Muszynski3,4, Jill M Cholette5, Allan Doctor6, Phillip C Spinella6, Marie E Steiner7, Marisa Tucci8, Nabil E Hassan9, Robert I Parker10, Jacques Lacroix8, Andrew Argent11, Jeffrey L Carson12, Kenneth E Remy6, Pierre Demaret13, Guillaume Emeriaud8, Martin C J Kneyber14, Nina Guzzetta15, Mark W Hall3,4, Duncan Macrae16, Oliver Karam17, Robert T Russell18, Paul A Stricker19, Adam M Vogel20, Robert C Tasker21, Alexis F Turgeon22, Steven M Schwartz23, Ariane Willems24, Cassandra D Josephson25, Naomi L C Luban26, Leslie E Lehmann27, Simon J Stanworth28, Nicole D Zantek29, Timothy E Bunchman17, Ira M Cheifetz30, James D Fortenberry25, Meghan Delaney31, Leo van de Watering32, Karen A Robinson33, Sara Malone6, Katherine M Steffen34, Scot T Bateman1. 1. Division of Pediatric Critical Care, Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA. 2. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD. 3. Division of Critical Care Medicine, Nationwide Children's Hospital, Columbus, OH. 4. The Research Institute at Nationwide Children's Hospital, Columbus, OH. 5. Department of Pediatrics, University of Rochester, Rochester, NY. 6. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO. 7. Department of Pediatrics, University of Minnesota, Minneapolis, MN. 8. Department of Pediatrics, University of Montreal, Montreal, QC, Canada. 9. Department of Pediatrics, University of Illinois College of Medicine, Peoria, IL. 10. Department of Pediatrics, Stony Brook University, Stony Brook, NY. 11. Department of Pediatrics, University of Cape Town, Cape Town, South Africa. 12. Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ. 13. Department of Pediatrics, CHC, Liege, Belgium. 14. Department of Pediatrics, University of Groningen, Groningen, The Netherlands. 15. Department of Anesthesiology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA. 16. Pediatric Critical Care, Royal Brompton Hospital, London, United Kingdom. 17. Department of Pediatrics, Professor and Director Pediatric Nephrology, Childrens Hospital of Richmond, Virginia Commonwealth University, Richmond, VA. 18. Department of Surgery, University of Alabama Birmingham, Birmingham, AL. 19. Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA. 20. Division of Pediatric Surgery and Pediatrics, Baylor College of Medicine, Houston, TX. 21. Departments of Neurology and Anesthesia (Pediatrics), Harvard Medical School, Boston, MA. 22. Department of Anesthesiology and Critical Care Medicine, Univesite Laval Research Center, Quebec City, QC, Canada. 23. Department of Critical Care Medicine and Paediatrics, University of Toronto, ON, Canada. 24. Pediatric Intensive Care Unit, University of Brussels, Brussels, Belgium. 25. Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA. 26. Department of Pediatrics and Pathology, George Washington University, Washington, DC. 27. Department of Pediatrics, Harvard Medical School, Boston, MA. 28. Department of Medicine, University of Oxford, Oxford, United Kingdom. 29. Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN. 30. Department of Pediatrics, Duke University, Durham, NC. 31. Division of Pathology and Laboratory Medicine, Children's National Health System, Washington, DC. 32. Sanquin-Leiden University Medical Center, Leiden, The Netherlands. 33. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. 34. Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA.
Abstract
OBJECTIVES: To date, there are no published guidelines to direct RBC transfusion decision-making specifically for critically ill children. We present the recommendations from the Pediatric Critical Care Transfusion and Anemia Expertise Initiative. DESIGN: Consensus conference series of multidisciplinary, international experts in RBC transfusion management of critically ill children. SETTING: Not applicable. INTERVENTION: None. SUBJECTS: Children with, or children at risk for, critical illness who receive or are at risk for receiving a RBC transfusion. METHODS: A panel of 38 content and four methodology experts met over the course of 2 years to develop evidence-based, and when evidence lacking, expert consensus-based recommendations regarding decision-making for RBC transfusion management and research priorities for transfusion in critically ill children. The experts focused on nine specific populations of critically ill children: general, respiratory failure, nonhemorrhagic shock, nonlife-threatening bleeding or hemorrhagic shock, acute brain injury, acquired/congenital heart disease, sickle cell/oncology/transplant, extracorporeal membrane oxygenation/ventricular assist/ renal replacement support, and alternative processing. Data to formulate evidence-based and expert consensus recommendations were selected based on searches of PubMed, EMBASE, and Cochrane Library 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. MEASUREMENTS AND RESULTS: The Transfusion and Anemia Expertise Initiative consensus conference developed and reached consensus on a total of 102 recommendations (57 clinical [20 evidence based, 37 expert consensus], 45 research recommendations). All final recommendations met agreement, defined a priori as greater than 80%. A decision tree to aid clinicians was created based on the clinical recommendations. CONCLUSIONS: The Transfusion and Anemia Expertise Initiative recommendations provide important clinical guidance and applicable tools to avoid unnecessary RBC transfusions. Research recommendations identify areas of focus for future investigation to improve outcomes and safety for RBC transfusion.
OBJECTIVES: To date, there are no published guidelines to direct RBC transfusion decision-making specifically for critically ill children. We present the recommendations from the Pediatric Critical Care Transfusion and Anemia Expertise Initiative. DESIGN: Consensus conference series of multidisciplinary, international experts in RBC transfusion management of critically ill children. SETTING: Not applicable. INTERVENTION: None. SUBJECTS:Children with, or children at risk for, critical illness who receive or are at risk for receiving a RBC transfusion. METHODS: A panel of 38 content and four methodology experts met over the course of 2 years to develop evidence-based, and when evidence lacking, expert consensus-based recommendations regarding decision-making for RBC transfusion management and research priorities for transfusion in critically ill children. The experts focused on nine specific populations of critically ill children: general, respiratory failure, nonhemorrhagic shock, nonlife-threatening bleeding or hemorrhagic shock, acute brain injury, acquired/congenital heart disease, sickle cell/oncology/transplant, extracorporeal membrane oxygenation/ventricular assist/ renal replacement support, and alternative processing. Data to formulate evidence-based and expert consensus recommendations were selected based on searches of PubMed, EMBASE, and Cochrane Library 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. MEASUREMENTS AND RESULTS: The Transfusion and Anemia Expertise Initiative consensus conference developed and reached consensus on a total of 102 recommendations (57 clinical [20 evidence based, 37 expert consensus], 45 research recommendations). All final recommendations met agreement, defined a priori as greater than 80%. A decision tree to aid clinicians was created based on the clinical recommendations. CONCLUSIONS: The Transfusion and Anemia Expertise Initiative recommendations provide important clinical guidance and applicable tools to avoid unnecessary RBC transfusions. Research recommendations identify areas of focus for future investigation to improve outcomes and safety for RBC transfusion.
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