Transfusion strategies for patients in pediatric intensive care units.
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. (Controlled-trials.com number, ISRCTN37246456 [controlled-trials.com].).
Lacroix
Jacques
J
Université de Montréal, Montreal, Canada. jacques_lacroix@ssss.gouv.qc.ca
Hébert
Paul C
PC
Hutchison
James S
JS
Hume
Heather A
HA
Tucci
Marisa
M
Ducruet
Thierry
T
Gauvin
France
F
Collet
Jean-Paul
JP
Toledano
Baruch J
BJ
Robillard
Pierre
P
Joffe
Ari
A
Biarent
Dominique
D
Meert
Kathleen
K
Peters
Mark J
MJ
D000740:Anemia / Q000097:blood / Q000175:diagnosis / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D017707:Erythrocyte Transfusion; D005260:Female; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D047589:Leukocyte Reduction Procedures; D008297:Male; D009102:Multiple Organ Failure / Q000453:epidemiology; D012720:Severity of Illness Index
D006454:Hemoglobins