title: Respiratory Dysfunction Associated With RBC Transfusion in Critically Ill Children: A Prospective Cohort Study.
abstract: OBJECTIVE
  Respiratory complications associated with RBC transfusions may be underestimated in PICUs because current definitions exclude patients with preexisting respiratory dysfunction. This study aims to determine the prevalence and characterize the risk factors and outcomes of new or progressive respiratory dysfunction observed after RBC transfusion in critically ill children.
  
  
  METHODS
  Prospective cohort study of all children admitted over a 1-year period.
  
  
  METHODS
  A multidisciplinary PICU in a tertiary pediatric university hospital.
  
  
  METHODS
  Patients who received a RBC transfusion while in PICU.
  
  
  METHODS
  None.
  
  
  RESULTS
  Two independent adjudicators established the diagnosis of respiratory dysfunction. A respiratory dysfunction associated with transfusion was considered new if it appeared after the first RBC transfusion in PICU. A progressive respiratory dysfunction associated with transfusion was diagnosed if the respiratory dysfunction was present before the transfusion and the PaO2/FIO2 or the SpO2/FIO2 ratio dropped by at least 20% thereafter. Among 842 children admitted into the PICU, 136 received at least one RBC transfusion and were analyzed. Fifty-eight cases of respiratory dysfunction associated with transfusion (43% of transfused patients) were detected, including nine new respiratory dysfunction associated with transfusion (7%) and 49 progressive respiratory dysfunction associated with transfusion (36%). Higher severity of illness, multiple organ dysfunction syndrome prior to transfusion, and volume (mL/kg) of RBC transfusion were independently associated with respiratory dysfunction associated with transfusion. A dose-response relationship was observed between transfusion volume (mL/kg) and the prevalence of respiratory dysfunction associated with transfusion. Patients with respiratory dysfunction associated with transfusion had more progressive multiple organ dysfunction and less ventilation-free and PICU-free days at day 28.
  
  
  CONCLUSIONS
  Development of respiratory dysfunction associated with transfusion is frequent in PICU and occurs mainly in patients with prior respiratory dysfunction, who would not be identified using current definitions for transfusion-associated complications. A cause-effect relationship cannot be confirmed. However, the high prevalence and the serious adverse outcomes associated with respiratory dysfunction associated with transfusion suggest that this complication should be further studied.
authors: 1Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine and Université de Montréal, Montreal, Canada. 2Division of Hematology/Oncology, Department of Pediatrics, CHU Sainte-Justine and Université de Montréal, Montreal, Canada. 3Department of Preventive and Social Medicine, Université de Montréal and CHU Sainte-Justine, Montreal, Canada. 4Unité de recherche clinique appliquée, Research Center, CHU Sainte-Justine, Université de Montréal, Montreal, Canada.
authors: Niina
authors: N
authors: Kleiber
authors: Émilie
authors: É
authors: Lefebvre
authors: France
authors: F
authors: Gauvin
authors: Marisa
authors: M
authors: Tucci
authors: Nancy
authors: N
authors: Robitaille
authors: Helen
authors: H
authors: Trottier
authors: Philippe
authors: P
authors: Jouvet
authors: Thierry
authors: T
authors: Ducruet
authors: Nicole
authors: N
authors: Poitras
authors: Jacques
authors: J
authors: Lacroix
authors: Guillaume
authors: G
authors: Emeriaud
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009102:Multiple Organ Failure / Q000453:epidemiology*; D015995:Prevalence; D011446:Prospective Studies; D012129:Respiratory Function Tests; D012131:Respiratory Insufficiency / Q000453:epidemiology* / Q000209:etiology*; D012307:Risk Factors