title: Blood transfusion policy among European pediatric intensive care physicians.
abstract: The objective of this study was to define current blood transfusion practices among European pediatric intensive care physicians treating critically ill children. A questionnaire of case scenarios was administered to members of the European Society of Pediatric and Neonatal Intensive Care (ESPNIC). Of the 258 members of the ESPNIC, 134 (51.9%) pediatric intensive care physicians completed the questionnaire. The suggested blood transfusion thresholds for case scenario 1 (post-orthopedic surgery child) ranged from <7.0 g/dl to 11 g/dl. A total of 57.3% suggested 7 g/dl, 33.6% suggested 8 g/dl, and 6.9% suggested 9 g/dl as a hemoglobin threshold for transfusion (mean, 7.54 +/- 0.75). For case scenarios 2 to 4, the suggested hemoglobin thresholds were 7 g/dl to 12 g/dl. For case scenario 2 (a child with acute respiratory distress syndrome), 22.4% suggested 8 g/dl, 15.7% suggested 9 g/dl, and 41% suggested 10 g/dl as a hemoglobin threshold for transfusion (mean, 9.40 +/- 1.27 g/dl). For case scenario 3 (a post-cardiac surgery infant), 20.1% suggested 7 g/dl, 24.6% suggested 8 g/dl, 21.6% suggested 9 g/dl, and 23.9% suggested 10 g/dl as a hemoglobin threshold for transfusion (mean, 8.72 +/- 1.24 g/dl). For case scenario 4 (a child with septic shock), 23.1% suggested 8 g/dl, 16.4% suggested 9 g/dl, and 41% suggested 10 g/dl as a hemoglobin threshold for transfusion (mean, 9.45 +/- 1.24 g/dl). The threshold for transfusion was not statistically different (P >.05) between the physicians according to their subspecialty, years of experience, or country of origin. The suggested volume of transfused blood was 10 to 15 ml/kg in 427 responses (82.6%) and 20 ml/kg in 89 responses (17.2%). Most physicians, 78/128 (60.9%), did not consider the age of the transfused blood an important factor in their decision to transfuse. Of the 106 (79.1%) physicians who detailed their considerations for elevating the threshold for transfusion, 82 (77.3%) gave a general nonspecific indication, 47 (44.3%) stated hemodynamic instability and shock, and 40 (37.7%) an ongoing bleeding. The hemoglobin threshold for blood transfusion and transfusion volume varies among European pediatric intensive care physicians, for the same patient.
authors.affiliation: Intensive Care Unit, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel. enahum@cw.bc.ca
authors.forename: Elhanan
authors.initials: E
authors.lastname: Nahum
authors.forename: Josef
authors.initials: J
authors.lastname: Ben-Ari
authors.forename: Tommy
authors.initials: T
authors.lastname: Schonfeld
mesh_terms: D000704:Analysis of Variance; D001803:Blood Transfusion / Q000592:standards* / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000379:methods / Q000592:standards; D005060:Europe; D019538:Health Care Surveys; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000592:standards; D015278:Intensive Care Units, Pediatric / Q000592:standards*; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*