title: Survey on stated transfusion practices in PICUs*.
abstract: OBJECTIVE
  To analyze the RBC transfusion practice patterns among pediatric intensivists in light of the new evidence advocating for a restrictive transfusion strategy.
  
  
  METHODS
  Self-administered questionnaire.
  
  
  METHODS
  PICUs.
  
  
  METHODS
  Intensivists and fellows in pediatric critical care medicine.
  
  
  METHODS
  None.
  
  
  RESULTS
  Scenario-based survey carried out among North American and European intensivists, working in tertiary-care PICUs. Respondents were asked to report their decisions with regard to RBC transfusion in stable critically ill children with bronchiolitis, septic shock, trauma, or tetralogy of Fallot repair scenarios. Answers were compared with those of a similar scenario-based survey administered to pediatric intensivists in 1997. Ninety-seven respondents were retained for the study, the majority from the United States, Canada, and France. In 2010, respondents reported that the mean (± SD) transfusion threshold was a hemoglobin level of 7.7 ± 1.0 g/dL for bronchiolitis, 8.1 ± 1.2 g/dL for trauma, 9.1 ± 1.2 g/dL for a tetralogy of Fallot repair, and 9.2 ± 1.0 g/dL for septic shock. For all clinical scenarios, there was a trend toward a more restrictive transfusion approach (a threshold ≤ 7 g/dL) in 2010 compared with 1997: a restrictive strategy was adopted by 55.7% of respondents in 2010 versus 37.0% in 1997 (p = 0.01) with the scenario of bronchiolitis, 8.3% versus 3.4% (p = 0.16) with septic shock, 38.1% versus 9.0% (p < 0.001) with trauma, and 16.0% versus 7.9% (p = 0.10) with tetralogy of Fallot repair.
  
  
  CONCLUSIONS
  Stated transfusion practice patterns of pediatric intensivists appear to be evolving toward a more restrictive approach two and a half years after the publication of the Transfusion Requirement in PICU trial. Incomplete implementation of new knowledge with regard to the safety of a restrictive transfusion approach in stable PICU patients is perplexing and requires further studies.
authors.affiliation: 1Division of Pediatric Critical Care, Department of Pediatrics, Sainte-Justine Hospital, Université de Montréal, Montréal, QC, Canada. 2Department of Pediatrics, Research Center, Sainte-Justine Hospital, Université de Montréal, Montréal, QC, Canada.
authors.forename: Geneviève
authors.initials: G
authors.lastname: Du Pont-Thibodeau
authors.forename: Marisa
authors.initials: M
authors.lastname: Tucci
authors.forename: Thierry
authors.initials: T
authors.lastname: Ducruet
authors.forename: Jacques
authors.initials: J
authors.lastname: Lacroix
mesh_terms: D001988:Bronchiolitis / Q000097:blood / Q000628:therapy; D002170:Canada; D003430:Cross-Sectional Studies; D017707:Erythrocyte Transfusion / Q000592:standards* / Q000706:statistics & numerical data / Q000639:trends; D005602:France; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D010818:Practice Patterns, Physicians'; D012772:Shock, Septic / Q000097:blood / Q000628:therapy; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers; D013771:Tetralogy of Fallot / Q000097:blood / Q000601:surgery / Q000628:therapy; D014481:United States; D014947:Wounds and Injuries / Q000097:blood / Q000628:therapy
chemical_list: D006454:Hemoglobins