title: Transfusion of leukocyte-depleted RBCs is independently associated with increased morbidity after pediatric cardiac surgery.
abstract: OBJECTIVE
  To test the hypothesis that transfusion of leukocyte-depleted RBC preparations within the first 48 hours of PICU stay was independently associated with prolonged duration of mechanical ventilation, irrespective of surgery type and disease severity.
  
  
  METHODS
  Retrospective, observational study.
  
  
  METHODS
  Single-center PICU in The Netherlands.
  
  
  METHODS
  Children less than 18 years consecutively admitted after pediatric cardiac surgery between February 2007 and February 2010.
  
  
  METHODS
  None.
  
  
  RESULTS
  Data from 335 patients were used for analysis of whom 86 (25.7%) were transfused during the first 48 hours of PICU stay. Duration of mechanical ventilation (115 ± 19 hours vs. 25 ± 4 hours, p < 0.001) was longer among transfused patients. Ventilator-associated pneumonia (10.5% vs. 1.6%, odds ratio 7.2; 95% confidence interval 1.92-32.47; p < 0.001) was more frequent among transfused patients. New acute kidney injury after 48 hours of PICU admission (23.9% vs. 15.4%, p = 0.18) and mortality were comparable (2.3% vs. 4%, p = 0.16). The number of discrete transfusion events was significantly correlated with the duration of mechanical ventilation (Spearman's rho 0.617, p < 0.001). Transfusion remained independently associated with prolonged duration of mechanical ventilation after adjusting for confounders using Cox proportional hazards regression analysis.
  
  
  CONCLUSIONS
  Transfusion of leukocyte-depleted RBCs within the first 48 hours of PICU stay after cardiac surgery is independently associated with prolonged duration of mechanical ventilation.
authors: Division of Paediatric Intensive Care, Department of Paediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands. m.c.j.kneyber@bkk.umcg.nl
authors: Martin C J
authors: MC
authors: Kneyber
authors: Femke
authors: F
authors: Grotenhuis
authors: Rolf F M
authors: RF
authors: Berger
authors: Tjark W
authors: TW
authors: Ebels
authors: Johannes G M
authors: JG
authors: Burgerhof
authors: Marcel J I J
authors: MJ
authors: Albers
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology; D000293:Adolescent; D006348:Cardiac Surgical Procedures / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000379:methods* / Q000706:statistics & numerical data; D017707:Erythrocyte Transfusion / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D047589:Leukocyte Reduction Procedures; D016015:Logistic Models; D008297:Male; D017063:Outcome Assessment, Health Care; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000209:etiology; D011182:Postoperative Care / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D057216:Propensity Score; D016016:Proportional Hazards Models; D012121:Respiration, Artificial / Q000009:adverse effects / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors