TY - JOUR
T1 - How 217 Pediatric Intensivists Manage Anemia at PICU Discharge
T2 - Online Responses to an International Survey*
AU - Demaret, Pierre
AU - Karam, Oliver
AU - Labreuche, Julien
AU - Chiusolo, Fabrizio
AU - Mayordomo Colunga, Juan
AU - Erickson, Simon
AU - Nellis, Marianne E.
AU - Perez, Marie Hélène
AU - Ray, Samiran
AU - Tucci, Marisa
AU - Willems, Ariane
AU - Duhamel, Alain
AU - Lebrun, Frédéric
AU - Loeckx, Isabelle
AU - Mulder, André
AU - Leteurtre, Stéphane
N1 - Funding Information:
Dr. Labreuche disclosed work for hire, and he received support for article research from Centre Hospitalier Universitaire of Lille. Dr. Ray disclosed that this work was undertaken at Great Ormond Street Hospital/University College London Institute of Child Health, which received a proportion of funding from the Department of Health’s National Institute for Health Research Biomedical Research Centre’s funding scheme. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: pierre.demaret@chc.be
Publisher Copyright:
© 2020 Lippincott Williams and Wilkins. All rights reserved.
PY - 2020/6/1
Y1 - 2020/6/1
N2 - Objective: To describe the management of anemia at PICU discharge by pediatric intensivists. Design: Self-Administered, online, scenario-based survey. Setting: PICUs in Australia/New Zealand, Europe, and North America. Subjects: Pediatric intensivists. Interventions: None. Measurements and Main Results: Respondents were asked to report their decisions regarding RBC transfusions, iron, and erythropoietin prescription to children ready to be discharged from PICU, who had been admitted for hemorrhagic shock, cardiac surgery, craniofacial surgery, and polytrauma. Clinical and biological variables were altered separately in order to assess their effect on the management of anemia. Two-hundred seventeen responses were analyzed. They reported that the mean (± sem) transfusion threshold was a hemoglobin level of 6.9 ± 0.09 g/dL after hemorrhagic shock, 7.6 ± 0.10 g/dL after cardiac surgery, 7.0 ± 0.10 g/dL after craniofacial surgery, and 7.0 ± 0.10 g/dL after polytrauma (p < 0.001). The most important increase in transfusion threshold was observed in the presence of a cyanotic heart disease (mean increase ranging from 1.80 to 2.30 g/dL when compared with baseline scenario) or left ventricular dysfunction (mean increase, 1.41-2.15 g/dL). One third of respondents stated that they would not prescribe iron at PICU discharge, regardless of the hemoglobin level or the baseline scenario. Most respondents (69.4-75.0%, depending on the scenario) did not prescribe erythropoietin. Conclusions: Pediatric intensivists state that they use restrictive transfusion strategies at PICU discharge similar to those they use during the acute phase of critical illness. Supplemental iron is less frequently prescribed than RBCs, and prescription of erythropoietin is uncommon. Optimal management of post-PICU anemia is currently unknown. Further studies are required to highlight the consequences of this anemia and to determine appropriate management.
AB - Objective: To describe the management of anemia at PICU discharge by pediatric intensivists. Design: Self-Administered, online, scenario-based survey. Setting: PICUs in Australia/New Zealand, Europe, and North America. Subjects: Pediatric intensivists. Interventions: None. Measurements and Main Results: Respondents were asked to report their decisions regarding RBC transfusions, iron, and erythropoietin prescription to children ready to be discharged from PICU, who had been admitted for hemorrhagic shock, cardiac surgery, craniofacial surgery, and polytrauma. Clinical and biological variables were altered separately in order to assess their effect on the management of anemia. Two-hundred seventeen responses were analyzed. They reported that the mean (± sem) transfusion threshold was a hemoglobin level of 6.9 ± 0.09 g/dL after hemorrhagic shock, 7.6 ± 0.10 g/dL after cardiac surgery, 7.0 ± 0.10 g/dL after craniofacial surgery, and 7.0 ± 0.10 g/dL after polytrauma (p < 0.001). The most important increase in transfusion threshold was observed in the presence of a cyanotic heart disease (mean increase ranging from 1.80 to 2.30 g/dL when compared with baseline scenario) or left ventricular dysfunction (mean increase, 1.41-2.15 g/dL). One third of respondents stated that they would not prescribe iron at PICU discharge, regardless of the hemoglobin level or the baseline scenario. Most respondents (69.4-75.0%, depending on the scenario) did not prescribe erythropoietin. Conclusions: Pediatric intensivists state that they use restrictive transfusion strategies at PICU discharge similar to those they use during the acute phase of critical illness. Supplemental iron is less frequently prescribed than RBCs, and prescription of erythropoietin is uncommon. Optimal management of post-PICU anemia is currently unknown. Further studies are required to highlight the consequences of this anemia and to determine appropriate management.
KW - anemia
KW - critically ill child
KW - erythrocyte
KW - erythropoietin
KW - iron
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U2 - 10.1097/PCC.0000000000002307
DO - 10.1097/PCC.0000000000002307
M3 - Article
C2 - 32217901
AN - SCOPUS:85085713212
VL - 21
SP - e342-e353
JO - Pediatric Critical Care Medicine
JF - Pediatric Critical Care Medicine
SN - 1529-7535
IS - 6
ER -