Nearly half of critically ill children with a pediatric intensive care unit (PICU) length of stay >48hrs will receive a transfusion of packed red blood cells (pRBC). Despite evidence that a lower hemoglobin threshold for pRBC transfusion in the PICU is safe, multiple studies have shown that the threshold in practice is much higher, exposing children to the significant morbidity and mortality associated with pRBC. Therefore there is increased need for evidence- based blood management strategies for clinicians caring for critically ill children aimed to maintain a physiologically relevant hemoglobin concentration, optimize hemostasis and minimize blood loss in an effort to improve patient outcomes. There remains a paucity of research in this area for children so a research guide is desperately needed. The Pediatric Critical Care Transfusion and Anemia Expertise Initiative (TAXI), in collaboration with the Pediatric Critical Care Blood Research Network (BloodNet), the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI), the American Association of Blood Banks (AABB) and the Society for Critical Care Medicine (SCCM), proposes a conference series led by international and multidisciplinary experts to develop pediatric critical care blood management consensus for clinical guidance and future research efforts. This group will create a comprehensive series of consensus statements via an organized and structured process over 2 years to outline existing data and future research foci in the area of pRBC transfusions in critically ill children. TAXI has obtained letters of agreement/support from over 40 international experts for this project, as well as from the SCCM and the AABB, who are actively engaged and positioned to endorse the consensus products. Novel features of this initiative include early engagement with formal implementation science, medical anthropology and human factor engineering experts, so that we may best guide consensus statement uptake in order to improve outcomes and safety for children at risk for, or who require, pRBC transfusion. The consensus statements will include specific strategies for adaptive dissemination and implementation into various clinical/research environments. It will also be imperative that the statements be developed with an approach that accounts for the challenges in the environment and overall medical culture that may limit wide application and dissemination of the statement's recommendations.

Public Health Relevance

A mounting body of evidence suggests that altering red blood cell transfusion practice may improve outcome in critically ill children. Coordinating this evidenc and identifying areas that need further research is vitally important to aid clinicians and researcher in the care of these children. The Pediatric Critical Care Transfusion and Anemia Expertise Initiative (TAXI), in collaboration with the Pediatric Critical Care Blood Research Network (BloodNet), the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI), the American Association of Blood Banks (AABB) and the Society for Critical Care Medicine (SCCM), proposes a conference series led by international and multidisciplinary experts to develop pediatric critical care blood management consensus for clinical guidance and future research efforts.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Conference (R13)
Project #
1R13HD088086-01
Application #
9126170
Study Section
Pediatrics Subcommittee (CHHD-A)
Program Officer
Tamburro, Robert F
Project Start
2016-09-01
Project End
2017-08-31
Budget Start
2016-09-01
Budget End
2017-08-31
Support Year
1
Fiscal Year
2016
Total Cost
$9,000
Indirect Cost
Name
University of Massachusetts Medical School Worcester
Department
Pediatrics
Type
Schools of Medicine
DUNS #
603847393
City
Worcester
State
MA
Country
United States
Zip Code
01655
Karam, Oliver; Russell, Robert T; Stricker, Paul et al. (2018) Recommendations on RBC Transfusion in Critically Ill Children With Nonlife-Threatening Bleeding or Hemorrhagic Shock From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative. Pediatr Crit Care Med 19:S127-S132
Steiner, Marie E; Zantek, Nicole D; Stanworth, Simon J et al. (2018) Recommendations on RBC Transfusion Support in Children With Hematologic and Oncologic Diagnoses From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative. Pediatr Crit Care Med 19:S149-S156
Cholette, Jill M; Willems, Ariane; Valentine, Stacey L et al. (2018) Recommendations on RBC Transfusion in Infants and Children With Acquired and Congenital Heart Disease From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative. Pediatr Crit Care Med 19:S137-S148
Steffen, Katherine M; Bateman, Scot T; Valentine, Stacey L et al. (2018) Implementation of the Recommendations for RBC Transfusions for Critically Ill Children From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative. Pediatr Crit Care Med 19:S170-S176
Bembea, Melania M; Valentine, Stacey L; Bateman, Scot T et al. (2018) The Pediatric Critical Care Transfusion and Anemia Expertise Initiative Consensus Conference Methodology. Pediatr Crit Care Med 19:S93-S97
Demaret, Pierre; Emeriaud, Guillaume; Hassan, Nabil E et al. (2018) Recommendations on RBC Transfusions in Critically Ill Children With Acute Respiratory Failure From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative. Pediatr Crit Care Med 19:S114-S120
Muszynski, Jennifer A; Guzzetta, Nina A; Hall, Mark W et al. (2018) Recommendations on RBC Transfusions for Critically Ill Children With Nonhemorrhagic Shock From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative. Pediatr Crit Care Med 19:S121-S126
Doctor, Allan; Cholette, Jill M; Remy, Kenneth E et al. (2018) Recommendations on RBC Transfusion in General Critically Ill Children Based on Hemoglobin and/or Physiologic Thresholds From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative. Pediatr Crit Care Med 19:S98-S113
Tasker, Robert C; Turgeon, Alexis F; Spinella, Philip C et al. (2018) Recommendations on RBC Transfusion in Critically Ill Children With Acute Brain Injury From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative. Pediatr Crit Care Med 19:S133-S136
Zantek, Nicole D; Parker, Robert I; van de Watering, Leo M et al. (2018) Recommendations on Selection and Processing of RBC Components for Pediatric Patients From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative. Pediatr Crit Care Med 19:S163-S169

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