Intraoperative transfusion practice in burned children in a university hospital over four years: a retrospective analysis

BMC Anesthesiology

Astor Katharina¹  Eva Wittenmeier²  Marc Kriege²  Eva-Verena Griemert²  Pirlich Nina²  Tatjana König³  Irene Schmidtmann⁴ 

[1] Department of Anesthesiology and Intensive Care, Catholic Clinical Centre, Mainz, Germany;Department of Anesthesiology, University Medical Centre of Johannes Gutenberg University, Langenbeckstraße 1, 55131, Mainz, Germany;Department of Pediatric Surgery, University Medical Centre of Johannes Gutenberg University, Mainz, Germany;Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of Johannes Gutenberg University, Mainz, Germany;

关键词: Blood transfusion;    Transfusion thresholds;    Pediatric burn injury;    Patient blood management;    Pediatric;    Red blood cells;   

DOI  :  10.1186/s12871-021-01336-3

来源: Springer

【 摘 要 】

BackgroundPatient blood management programs should be applied to the pediatric population, but little is known about the current transfusion practice of pediatric burn injury patients. This retrospective study was performed to evaluate the practice of red blood cell (RBC) transfusion in children with burn injury, their predictive factors, and adherence to the German transfusion guideline.MethodsWe reviewed the RBC transfusion practice of all children younger than 8 years with burn injury who were operated during a four-year period in a German university medical center. We analyzed the data associated with transfusion and guideline conformity of transfusion triggers for RBCs from the beginning to the end of hospital stay using logistic regression.ResultsDuring the four-year period, 138 children (median age 21 months, minimum-maximum 9–101 months) with burn injury needed surgery, 31 children were transfused with RBCs. During their hospital stay, the median hemoglobin concentrations (Hb) of transfused and non-transfused children were 8 g/dL (6.3–11.3 g/dL) and 10.7 (7–13.8 g/dL), respectively. Total body surface area burned (TBSA) (OR = 1.17 per % TBSA, 95% CI = [1.05; 1.30], p = 0.0056), length of surgery (OR = 1.016 per minute, 95% CI = [1.003; 1.028], p = 0.0150), and Hb (OR = 0.48 per 1 g/dl in Hb, 95% CI = [0.24; 0.95], p = 0.0343) were associated with transfusion while other factors (age, gender, ASA, and catecholamines) did not show notable association. Length of stay was mainly influenced by TSBA (+ 1.38 days per %, p <  0.0001), age (+ 0.21 days per month, p = 0.0206), and administering of catecholamines (+ 14.3 days, p = 0.0118), but not by RBC transfusion. The decision to transfuse was in 23% too restrictive and in 74% too liberal according to the German guidelines.ConclusionsAmount of TBSA, length of surgery, and Hb influenced the RBC transfusion rate in burned children. However, age and length of stay were not affected by transfusion of RBCs. In clinical practice of burned children, physicians follow a more liberal transfusion strategy than the proposed in guidelines.

【 授权许可】

CC BY