Red blood cell transfusion thresholds in pediatric patients with sepsis

Objectives: In children with severe sepsis or septic shock, the optimal red blood cell transfusion threshold is unknown. We analyzed the subgroup of patients with sepsis and transfusion requirements in a pediatric intensive care unit study to determine the impact of a restrictive vs. liberal transfusion strategy on clinical outcome. Design: Subgroup analysis of a prospective, multicenter, randomized, controlled trial. Setting: Multicenter pediatric critical care units. Patients: Stabilized critically ill children (mean systemic arterial pressure > 2 SD below normal mean for age and cardiovascular support not increased for at least 2 hrs before enrollment) with a hemoglobin <= 9.5 g/dL within 7 days after pediatric critical care unit admission. Interventions: One hundred thirty-seven stabilized critically ill children with sepsis were randomized to receive red blood cell transfusion if their hemoglobin decreased to either <7.0 g/dL (restrictive group) or 9.5 g/dL (iberal group). Measurements and Main Results: In the restrictive group (69 patients), 30 patients did not receive any red blood cell transfusion, whereas only one patient in the liberal group (68 patients) never underwent transfusion (p < .01). No clinically significant differences were found for the occurrence of new or progressive multiple organ dysfunction syndrome (18.8% vs. 19.1%; p = .97), for pediatric critical care unit length of stay (p = .74), or for pediatric critical care unit mortality (p = .44) in the restrictive vs. liberal group. Conclusions: In this subgroup analysis of children with stable sepsis, we found no evidence that a restrictive red cell transfusion strategy, as compared to a liberal one, increased the rate of new or progressive multiple organ dysfunction syndromes. Furthermore, a restrictive transfusion threshold significantly reduced exposure to blood products. Our data suggest that a hemoglobin level of 7.0 g/dL may be safe stabilized for children with sepsis, but further studies are required to support this recommendation. (Pediatr Crit Care Med 2011; 12:512-518)