Survey on Stated Transfusion Practices in PICUs

Objectives: To analyze the RBC transfusion practice patterns among pediatric intensivists in light of the new evidence advocating for a restrictive transfusion strategy. Design: Self-administered questionnaire. Setting: PICUs. Subjects: Intensivists and fellows in pediatric critical care medicine. Interventions: None. Measurements and Main 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 = 7g/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.