Red blood cell transfusion thresholds in pediatric patients with sepsis

Abstract

Objectives: In children with severe sepsis or septic shock, the optimal red blood cell transfusion threshold is unknown. We analyzed the subgroup of patients with sepsis and transfusion requirements in a pediatric intensive care unit study to determine the impact of a restrictive vs. liberal transfusion strategy on clinical outcome. Design: Subgroup analysis of a prospective, multicenter, randomized, controlled trial. Setting: Multicenter pediatric critical care units. Patients: Stabilized critically ill children (mean systemic arterial pressure >2 SD below normal mean for age and cardiovascular support not increased for at least 2 hrs before enrollment) with a hemoglobin ≤9.5 g/dL within 7 days after pediatric critical care unit admission. Interventions: One hundred thirty-seven stabilized critically ill children with sepsis were randomized to receive red blood cell transfusion if their hemoglobin decreased to either <7.0 g/dL (restrictive group) or 9.5 g/dL (liberal group). Measurements and Main Results: In the restrictive group (69 patients), 30 patients did not receive any red blood cell transfusion, whereas only one patient in the liberal group (68 patients) never underwent transfusion (p