Pediatr Crit Care Me
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Pediatr Crit Care Me · Mar 2011
ReviewRed blood cell transfusion in critically ill children: a narrative review.
To review the pathophysiology of anemia, as well as transfusion-related complications and indications for red blood cell (RBC) transfusion, in critically ill children. Although allogeneic blood has become increasingly safer from infectious agents, mounting evidence indicates that RBC transfusions are associated with complications and unfavorable outcomes. As a result, there has been growing interest and efforts to limit RBC transfusion, and indications are being revisited and revamped. Although a so-called restrictive RBC transfusion strategy has been shown to improve morbidity and mortality in critically ill adults, there have been relatively few studies on RBC transfusion performed in critically ill children. ⋯ The available evidence does not support the extensive use of RBC transfusions in general or critically ill patients. Transfusions are still associated with risks, and although their benefits are established in limited situations, the associated negative outcomes in many more patients must be closely addressed. Given the frequency of anemia and its proven negative outcomes, transfusion decisions in the critically ill children should be based on individual patient's characteristics rather than generalized triggers, with consideration of potential risks and benefits, and available blood conservation strategies that can reduce transfusion needs.
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Pediatr Crit Care Me · Mar 2011
Multicenter StudyPerformance of the Pediatric Index of Mortality 2 for pediatric cardiac surgery patients.
To evaluate the performance of the Pediatric Index of Mortality 2 (PIM-2) for pediatric cardiac surgery patients admitted to the pediatric intensive care unit (PICU). ⋯ The PIM-2 demonstrated poor performance with fair discrimination, poor calibration, and predictive ability for pediatric cardiac surgery population and thus cannot be recommended in its current form as an adequate adjustment tool for quality measurement in this patient group.